Modern technology has increased the dentist’s choices with new materials to fill decayed, worn or broken teeth. With all the changes and improvements what is best for the patient and what are the benefits and risks?

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 used in some dental offices today. Dental amalgam is an alloy. It contains silver, copper, tin and as much as 51% elemental mercury. When mixed it is a hard, stable and safe substance.

The safety of dental amalgams in your mouth, 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.”

There exist other options for dental fillings. The many choices with the new materials developed over the past three decades. These include composite resins, all porcelain, all ceramic, lab made indirect composites. 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 or filled resin material. These materials require less tooth structure to be removed in preparation for the filling and may result in a smaller filling than an amalgam. It is bonded or adhered to the tooth cavity to prevent future leakage or new decay. I haven’t placed an amalgam filling in over 30 years.

As a Dentist I’m responsible for a thorough examination and proper diagnosis to determine the best treatment for the patient, evaluate the benefits versus the risk and determine which treatments are necessary. Patients want tooth colored restorations and when technology gave me a way to totally bond composite to the remaining tooth structure in the early 1990s I went with the technology. Techniques, bonding materials and composite filling materials are even better today.
Environmental awareness has now classified the mercury filling materials before mixing as dangerous before placement in the mouth as well as remaining scrap and removed old filling material from the mouth as also hazardous. Waste must be properly filtered from suction lines, along with remaining scrap material hauled away for proper disposal. No amalgam waste is to enter the sewer liners, trash dumps or be incinerated with other medical waste. With other materials available, I see no reason to use a material deemed hazardous before and after use in the mouth.

Reasons why old filling need to be replaced, even if it is still in place and doesn’t hurt yet. Your mouth places your fillings or restorations in a constant environment of hot then cold, 100% humidity, acidity, constant pressure from chewing, grinding, 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, this is a problem with new techniques, no one knows. 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 ceramic crown or onlay may be needed to restore the tooth so it can function.

There exist many choices in restoring your teeth to proper function. The ultimate decision about what materials to use is determined between the patient and dentist.