Modern technology has increased a dentist’s choices with added materials to fill decayed, worn or broken teeth. Tooth colored composite resins have been in use and improving for the past 60 years. With patient demands for esthetic dental restorations and concerns about mercury in silver amalgam fillings, what is best for the patient and what are the benefits and risks?

Q: How long have dentists been using silver fillings?

A: Dentists have used silver amalgam to replace decayed tooth structure since before the Civil War. Dental amalgam has been used in over 100 million Americans. Amalgam is still in use today.

Q: What is in silver amalgam?

A: Dental amalgam is an alloy. It contains silver, copper, tin and as much as 51 percent elemental mercury. When mixed it is a hard, stable and safe substance.

Q: Are dental amalgams in my mouth safe?

A: According to the American Dental Association, studies have failed to find any link between amalgam restorations and any medical disorder. Amalgam continues to be a safe restorative material for dental patients.

Q: What options do I have for dental fillings?

A: There are many choices with the new materials developed over the past two decades. These filling materials include amalgam, composite resins, all porcelain, ceramic, metal and gold alloys. Factors include the condition of the remaining tooth structure as well as overall oral health, cosmetics, durability, longevity, cost and number of dental visits required. Consult with your dentist before treatment begins on the best options for you.

The most common option is the use of tooth colored composite material. Bonded composites require minimal tooth to be removed in preparation for the filling and may result in a smaller filling than an amalgam. It adheres to the tooth cavity to prevent future leakage or new decay. I haven’t placed an amalgam filling in 20 years.

Q: Why no more silver fillings?

A: In America, the individual dentist must take the responsibility in dental amalgam use. There are concerns about dental occupational health hazards in handling mercury. Each dentist must evaluate the benefits versus the risk and determine which treatments are necessary. He must address the concerns on human health and the adverse environmental impact from mercury.

When technology gave me a way to totally bond composite to the remaining tooth structure in the early 1990s, I went with the technology.

Environmental awareness has now classified the mercury filling materials before mixing as dangerous before placement in the mouth. Remaining scrap and removed old filling material from the mouth are also hazardous. With other materials available, I see no reason to use a material deemed hazardous before and after use in the mouth.

The dentist is now the decision maker in phasing out amalgam.

Q: Why would my old filling need to be replaced? It is still in place and doesn’t hurt.

A: Your mouth places your fillings or restorations in a constant environment of hot then cold, 100 percent humidity, acidity, constant pressure from chewing, grinding and clenching. The seal between tooth enamel and filling does break down. Fillings do not last forever. I’m shocked that in the environment of the mouth they last as long as they do. We do not know how long these bonded composites materials will function, as this is a problem with new techniques. Silver fillings at 12-15 years usually exhibit breakdown and food particles and decaying bacteria work their way under the restoration. This results in additional decay in that tooth. Decay left untreated progresses and can result in infection of the dental pulp, toothache and abscess.

Large restorations with extensive recurring decay may not leave enough healthy tooth structure to support a replacement filling. A crown or ceramic onlay may be needed to restore the tooth so it can function.

Will composite resin replace all silver amalgam use? The ultimate decision about what materials to use is determined between the patient and dentist.