This is general patient information, not a diagnosis. Whether a particular filling needs attention is decided by a dentist who has examined the tooth.
Quick Answer
Composite fillings are tooth-coloured resin bonded to the tooth. Amalgam fillings are silver-coloured and made of a mixture of metals including mercury. Both have been used successfully for decades. Composite matches the tooth and usually needs less drilling of healthy structure; amalgam is durable and less sensitive to moisture during placement. Regulators have moved away from amalgam, largely for environmental reasons: the EU stopped its use in children under 15 and pregnant or breastfeeding women in 2018 and phased out general use from 2025, except where strictly necessary. The US FDA recommends that certain higher-risk groups avoid new amalgam where appropriate, but does not recommend removing intact amalgam fillings, because removal itself releases mercury vapour and removes healthy tooth.
Key Takeaways
- New fillings today are usually composite or another tooth-coloured material.
- Existing amalgam fillings that are intact and problem-free do not routinely need replacing.
- Replacement makes sense when a filling is cracked, leaking, has decay under it, or the tooth is fractured, and sometimes for appearance.
- Every replacement removes some healthy tooth, so a tooth can only be refilled so many times.
- If you have many amalgam fillings, ask for a tooth-by-tooth assessment rather than a full replacement package.
How the Two Materials Compare
| Composite (white) | Amalgam (silver) | |
|---|---|---|
| Appearance | Matches the tooth | Silver, darkens over time |
| How it holds | Bonded to the tooth | Held mechanically by the shape of the cavity |
| Tooth removed to place it | Usually less | Usually more, to create retention |
| Placement | Needs a dry field, placed in layers and hardened with light | More tolerant of moisture |
| Durability in large back fillings | Good, can be lower in very large fillings or heavy biting | Long track record in large back fillings |
| Sensitivity after placement | Sometimes temporary sensitivity | Sometimes temporary sensitivity |
| Regulation | Standard choice | Phased out in the EU since 2025, except where strictly necessary |
Other tooth-coloured options exist for larger repairs, such as ceramic inlays and onlays. See inlays, onlays or a crown.
What Regulators Say About Amalgam
The European Union restricted dental amalgam in children under 15 and in pregnant or breastfeeding women from July 2018, and Regulation (EU) 2024/1849 ended its general use from 1 January 2025, except where a dentist deems it strictly necessary for a patient's specific medical needs. The main driver was reducing mercury in the environment, in line with the Minamata Convention.
The US FDA, in 2020, recommended that certain groups who may be at higher risk, such as pregnant women, nursing mothers, young children and people with certain neurological conditions, impaired kidney function or a known sensitivity to mercury, receive alternatives to amalgam where possible and appropriate. The FDA also states that it does not recommend removing or replacing existing amalgam fillings that are in good condition, unless considered medically necessary, because removal exposes you to additional mercury vapour and can damage healthy tooth.
When Replacing an Old Filling Makes Sense
- The filling is cracked, chipped or loose.
- There is new decay at the edge of or under the filling, seen clinically or on an X-ray.
- The tooth around the filling has cracked. See cracked tooth.
- You have a confirmed allergy to a component.
- The filling is visible when you smile and you want it changed, understanding that this is a cosmetic choice and removes some tooth.
A plan to replace every silver filling in one go, without a reason per tooth, deserves questions. See second opinion on a dental treatment plan.
Why Every Replacement Has a Cost
Each time a filling is replaced, the dentist removes the old material and usually a little more tooth. The cavity grows. A tooth that has been refilled several times may eventually need an onlay or crown rather than another filling. That is a good reason not to replace sound fillings purely on schedule.
Questions to Ask
- What is wrong with this specific filling?
- Is there decay under it, and how do you know?
- If I replace it, what material would you use, and why?
- Would this tooth be better served by a filling, an onlay or a crown?
- If I leave it, what should I watch for?
How Adil Dent Approaches It
Recommendations about existing fillings are made after an examination and any X-rays that are clinically needed. You receive a written treatment plan listing the procedures and the agreed cost before treatment starts. If you live abroad, you can send photographs and recent X-rays on WhatsApp first for preliminary information.
Conclusion
The move away from amalgam is real, but it applies to new fillings. An old silver filling that is intact and causing no problems is usually best left alone, and a good plan explains, tooth by tooth, why any filling should be replaced.
Ask on WhatsApp or request an appointment.