Drilling out healthy amalgam fillings because you’re worried about mercury can do more harm than good. Amalgam is strong, long-lasting, and the least expensive filling material, but it’s silver, takes more tooth to place, and contains mercury, and the FDA says the evidence doesn’t show it harms the general population.
The FDA doesn’t recommend removing amalgam fillings in good condition, because removal takes away healthy tooth and briefly increases your exposure to mercury vapor. It does recommend that certain higher-risk groups avoid new amalgam fillings whenever possible and appropriate. Here’s how to weigh it.
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What’s in an Amalgam Filling?
Dental amalgam is a mix of liquid mercury and a powdered alloy of silver, tin, and copper, sometimes with zinc. About half of it is mercury by weight. The mercury binds the alloy particles together into a strong, solid filling that hardens quickly after it’s packed into the tooth.
Amalgam has been used for more than 150 years, in hundreds of millions of patients. It’s often called a “silver filling,” but the FDA discourages that name because it doesn’t describe what the filling is made of.
The Pros of Amalgam Fillings
- Strong and long-lasting. The FDA describes amalgam as strong and long-lasting, so it’s less likely to break than some other fillings.
- The least expensive filling material. Both the FDA and the ADA describe amalgam as costing less than tooth-colored or gold fillings.
- Works when the tooth is hard to keep dry. Tooth-colored materials don’t bond well when saliva is present, and amalgam doesn’t have that problem, which helps with fillings near the gumline.
- Suited to big fillings in back teeth. The FDA says amalgam has advantages for large fillings in back teeth, where biting forces are high, and for patients at higher risk of decay.
- Quick to place. It takes less time to place than resin fillings and is done in a single visit.
The Cons of Amalgam Fillings
- It’s silver. It doesn’t match your teeth, which matters most near the front of the mouth.
- More tooth is removed. Placing amalgam usually means removing more healthy tooth structure than a tooth-colored filling.
- It contains mercury. Amalgam releases low levels of mercury vapor, and the release may be highest while a filling is being placed or removed.
- Allergy, rarely. The ADA puts amalgam allergy at under 1% of patients, but the FDA says anyone allergic to its metals shouldn’t get it.
Amalgam vs. Tooth-Colored Fillings at a Glance
| Amalgam | Composite (tooth-colored) | |
|---|---|---|
| Color | Silver | Matches the tooth |
| Healthy tooth removed | More | Less |
| Cost | The least expensive filling material | Costs more than amalgam |
| Moisture during placement | Not a problem | Saliva can weaken the bond |
| Durability | Strong and long-lasting | Older trials found more failures, mostly from new decay; newer reviews are mixed, and composites have improved |
| Mercury | Contains mercury | Contains no heavy metals |
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Have old fillings you’re unsure about?
A routine exam is where their condition gets checked.
Are Amalgam Fillings Safe?
For most people, the FDA says the evidence doesn’t show harm: studies don’t show conclusive evidence that amalgam causes harmful health effects in the general population. People with several amalgam fillings may have slightly higher mercury levels, but they usually stay at a level considered safe. The ADA and the National Institute of Dental and Craniofacial Research also consider amalgam safe for most people. The FDA notes that some questions remain open, such as safe exposure levels and how much mercury builds up in the body.
Who the FDA says should avoid new amalgam fillings
In 2020, the FDA named these groups as potentially at higher risk from mercury in amalgam:
- Pregnant women and their developing fetuses
- Women who are planning to become pregnant
- Nursing women and their newborns and infants
- Children, especially those younger than six years of age
- People with pre-existing neurological disease, such as multiple sclerosis, Alzheimer’s disease, or Parkinson’s disease
- People with impaired kidney function
- People with known heightened sensitivity (allergy) to mercury or other components of dental amalgam
For these groups, the FDA recommends avoiding dental amalgam whenever possible and appropriate. It strongly encourages non-amalgam fillings, such as composite resin or glass ionomer, when the dentist thinks they suit the tooth and the patient isn’t allergic to them. This advice is about new fillings, not removing the ones you have. If you’re concerned about your fillings and your health, talk to your dentist or doctor.
Should You Replace Your Amalgam Fillings?
Not if they’re in good condition. The FDA doesn’t recommend removing or replacing amalgam fillings that are in good condition, with no decay beneath them, unless it’s medically necessary. Removing them means losing healthy tooth structure and a temporary increase in exposure to mercury vapor. That applies to the higher-risk groups too. The ADA agrees, and says removing sound amalgam just to replace it with a mercury-free material is unwarranted.
The FDA’s example of medical necessity is a documented allergy to amalgam. A filling that’s broken or has decay underneath is a different matter: that’s a reason to have your dentist look at it. Fillings don’t last forever. In a 2025 review of trials on fillings covering two or more surfaces of a back tooth, the most common reasons amalgam fillings failed were new decay around the filling and a cracked tooth.
How Long Do Amalgam Fillings Last?
There’s no single number, but amalgam is among the most durable filling materials. The ADA’s summary of the research puts amalgam survival at about 94.5% after seven years. Like any filling, it won’t last a lifetime, and how long it lasts also depends on your diet, oral hygiene, and regular checkups.
Compared with composite, older trials found tooth-colored fillings in back teeth failed more often, mainly from new decay. Newer reviews are mixed, and composites have improved since those trials.
Is Amalgam Still Used?
Yes, though less than it used to be, as more alternatives are used effectively. It’s still common: one study cited by the National Institute of Dental and Craniofacial Research estimates that over half of restored permanent teeth in the US contain amalgam.
It isn’t banned. The FDA’s guidance, last updated in 2021, says it doesn’t support a ban at this time. But policy is shifting:
- In February 2026, the Indian Health Service said it will stop using amalgam in its facilities by 2027.
- In July 2026, HHS said the Centers for Medicare and Medicaid Services had urged state Medicaid programs to phase amalgam out by restricting or ending coverage for it.
- Internationally, the parties to the Minamata Convention on mercury agreed in November 2025 to phase out the manufacture, import, and export of amalgam by 2034, with an exception where a dentist judges it necessary.
Dental offices that place or remove amalgam must also use an amalgam separator, under an EPA rule, to keep mercury out of wastewater.
How Insurance Treats Amalgam and Tooth-Colored Fillings
Some dental plans have a “least expensive alternative treatment” clause. When more than one acceptable treatment exists, the plan pays only for the cheapest. The most common example is paying for a tooth-colored filling on a back tooth at the amalgam rate, with you paying the difference. The ADA points out that the cheapest option isn’t always in your best interest and that the choice belongs to you and your dentist. A pre-treatment estimate from your plan can show what you’ll owe.
Icon Dental Center is in network with Delta Dental/WDS, Regence, Premera, Aetna, and Cigna.
Questions about your fillings or what your plan covers? Call our Everett dental office to schedule a visit.
Talk It Through at Your Next Visit
The right filling depends on the tooth, the size of the cavity, your health, and your preferences, and your dentist can check the condition of fillings you already have at a routine exam. At Icon Dental Center in Everett, dental fillings are done by Dr. Nadia Aboulhosn, Dr. Joanna Valentine, and Dr. Fiona Kwok.
Common Questions About Amalgam Fillings
Is a broken amalgam filling dangerous?
Not if you swallow a small piece: the FDA says there are no known health risks from swallowing small particles of amalgam. Still, call your dentist if a filling breaks, so it can be checked and repaired or replaced.
Is the mercury in fillings the same as the mercury in fish?
No. Amalgam contains elemental mercury, which gives off a vapor absorbed mainly through the lungs, while fish contain methylmercury. The FDA notes that some studies suggest the two forms can convert into each other in the body.
What if I’m pregnant and need a filling?
Tell your dentist. The FDA includes pregnant women and their developing fetuses among the groups who should avoid new amalgam fillings whenever possible and appropriate, and says clinical data on long-term outcomes in pregnancy are very limited. It doesn’t recommend removing existing fillings in good condition during pregnancy.