What is amalgam?

You have probably seen an amalgam filling, or may even have one yourself. This common filling material is a combination of silver, copper, tin, and mercury. Studies that have been performed over several years have found that no other material besides mercury can hold these metal substances sufficiently to form a filling.

Some have questioned the safety of amalgam or “silver fillings”. All research to date, reported by the American Dental Association, shows that amalgam fillings are safe.

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How safe is amalgam?

The American Dental Association continues to approve of the use of dental amalgam in patients aged 6 and older, stating:

“Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.”

When would my dentist recommend an amalgam filling?

Here are a couple situations in which amalgam fillings are recommended:

  • When a patient has a cavity on the root area below the gumline and complete moisture control is not possible.

Resins must have complete moisture control to be successful, so amalgam filling would be a recommendation of choice

  • When a cavity is under a crown, where the crown meets the tooth.

Replacing the restoration will be the ideal recommendation. When a patient does not have the finances to replace a crown, sometimes an amalgam “patch” can get a patient by until they can afford to have the crown replaced.

Cost of Amalgam Filling vs. Tooth Colored Filling

Silver fillings are faster to fill and less expensive than tooth colored fillings. Also some insurances downgrade to the cost of a silver filling. Amalgam fillings are often chosen by a patient who may not have insurance and cannot afford an alternative treatment or if their dental benefit plan has a small reimbursement rate for fillings or just plain does not cover composite tooth colored fillings. (Dental benefits are a predetermined allowance between the employer and the insurance company and will vary plan by plan based on what the employer chooses as a benefit for their employees).

Common alternatives to amalgams

Although amalgam is less expensive, preparations are more extensive to maximize strength of the restoration. Today we do have other materials that can be “long term temporaries” that are tooth colored and less expensive but not as long lasting as amalgams.

As techniques and products have improved, we often use more conservative restorations like resin to fill an anterior and/or posterior tooth.

Sometimes we use a softer tooth colored material called glass ionomer to fill a root cavity. These glass ionomer restorations not only look better in the mouth but also are more resistant to decay in a mouth that is at high risk for cavities. Glass ionomers are not the restoration of choice where occlusal forces are greater. Fujii Equia ™ can be used as a long term temporary for larger restorations in posterior teeth.

Amalgam filling Procedure

The tooth will be numbed with local anesthetic. Once numb the tooth is prepared and the filling placed and carved smooth with the adjacent tooth. If the filling is between the teeth then a band is placed to help place and shape the filling in the shape of a tooth. The amalgam filling takes up to 24 hours to set so one should refrain from chewing on the filling until the next day.

After getting an amalgam filling, your tooth may feel slightly sensitive for a few days. If you feel a sharp pain when you bite down, this could be caused by contact between your new amalgam filling and the metal of an existing restoration in the opposing tooth. Not to worry, the sensation should gradually diminish over the next few weeks. If you experience lingering sensitivity or pain when you bite down, contact us. We will reassess the height of your new filling and made adjustments if necessary.

Disadvantages of Amalgam Fillings

They are dark in color and do not match the color of the tooth. A composite filling can be matched much closer to the color of the tooth and be almost invisible in the mouth. Silver fillings tend to be cold and heat sensitive when initially placed, especially if a large filling, due to the conductivity of the metal. Another side effect is the components of the silver filling often leach into the adjacent tooth structure causing a staining or darkening of the tooth around the filling. One final drawback is that due to the expansion and contraction of the silver fillings, one often see’s crack lines in the teeth over time. This may weaken the adjacent tooth and over time cause a fracture of the tooth when chewing.

Should pregnant women be concerned about amalgam fillings?

Due to the fact that components of various chemicals can pass through the placenta to a developing fetus, the general recommendation is that pregnant women should postpone dental work unless absolutely necessary. That being said, no adverse effects have been found in newborns or infants whose mothers were treated with dental amalgam. According to EPA guidelines, the amount of mercury found in breastmilk is appropriately low enough to remain safe for nursing infants. It is important to note that limited clinical data is available for this situation. If you have questions or concerns, speak to your dentist for more information. Our concern is the health and well-being of our patients, and we will help you make the choice that is best for you by providing you with the full extent of details on various treatment options.

If amalgams are cheaper, why are they used less today?

The preparation for an amalgam is much more aggressive than for a resin filling thus removing more tooth structure. As patients live longer and longer, it is important to evaluate the best restoration for the tooth and one that preserves as much tooth structure as possible. Also amalgam fillings have more expansion and contraction than other restorations. We often find that a tooth can develop fractures years after the amalgam is placed. The excessive tooth preparation and fractures can increase the risk of needing a root canal or crown on the tooth later.

Schedule A Consultation

When a silver filling needs replacement due to fracture or caries, our Stockton dentists at Deer Park Dental will review with you all the options available to restore your tooth as well as the risks, benefits and cost of each procedure. Your smile, good oral health and function is important to us. Call 209-478-3036 for a consultation with our dentists at Deer Park Dental.