Dental Amalgam Fillings: What Does Current Evidence Say?

Dental amalgam has been used to restore teeth for generations. Because it contains mercury, many people understandably have questions about its safety. Current advice is more nuanced than many older articles suggest.

What is dental amalgam?

Dental amalgam, sometimes called a silver filling, is a mixture of metals. Approximately half of the material by weight is elemental mercury, combined with metals including silver, copper and tin.

Does dental amalgam release mercury vapour?

Amalgam fillings can release small amounts of mercury vapour. Exposure varies with factors such as the number and age of fillings and activities including chewing and tooth grinding. Placement or removal can temporarily increase exposure.

What does current evidence say?

Older claims have sometimes linked amalgam fillings with a wide range of chronic illnesses. Current regulatory advice does not establish that intact amalgam fillings routinely cause conditions such as multiple sclerosis or Alzheimer’s disease in the general population.

At the same time, regulators recognise that some people warrant additional consideration when a new filling is required. Your dentist can discuss alternative restorative materials and your individual circumstances.

Should intact amalgam fillings be removed?

Routine removal of an intact, functioning filling solely because it contains mercury is generally not recommended. Removal can take away healthy tooth structure and temporarily increase exposure to mercury vapour. A filling that is cracked, failing or affected by decay is a different situation and should be assessed by a dentist.

Who should discuss alternatives with their dentist?

The FDA identifies several groups who should discuss non-amalgam alternatives where possible and appropriate. These include women who are pregnant or planning pregnancy, nursing mothers, young children, people with certain neurological or kidney conditions, and people with sensitivity to components of amalgam.

What are the alternatives?

Tooth-coloured composite materials are commonly used today. Other restorative options may also be available. The best choice depends on the tooth, cavity size and position, durability requirements, moisture control, cost and individual preferences.

Why is amalgam use declining?

Environmental concerns about mercury are an important reason for the international move to reduce dental amalgam use. Environmental policy and individual patient safety are related topics, but they are not exactly the same question.

If you are concerned about an existing filling

Ask your dentist to examine the filling and discuss your concerns. Decisions about replacement are best based on the condition of the tooth, your dental needs and relevant health circumstances rather than alarming claims online.

Frequently asked questions

Are silver fillings made with mercury?

Yes. Dental amalgam contains elemental mercury mixed with other metals.

Do all old amalgam fillings need replacing?

No. An intact filling does not generally need to be removed simply because it is amalgam.

Can I ask for a different filling material?

Yes. Discuss the available restorative materials with your dentist, including their advantages and limitations for the particular tooth.

About Mick Jordan

Mick Jordan is a naturopath and Sports and Remedial Massage Therapist based in Brighton, Melbourne, with more than 30 years’ experience in natural therapies. He has a particular interest in nutrition, digestive health, sports performance and recovery, and takes an individual approach to helping clients improve their health and wellbeing.

This article is for general educational information and is not a substitute for individual medical or dental advice. Speak with an appropriately qualified health professional about your circumstances.