Silver Fillings or White Fillings
Silver amalgam and composite resin are the two most common materials used
to restore teeth damaged by decay. There are situations where one material
is preferable over the other, and similarly, there are disadvantages to
both of these filling materials. Additionally, there are some health experts
who question the safety of amalgam fillings and say they should not be
used under any circumstances.
Silver amalgam—a health hazard?
The American Dental Association's official position regarding silver amalgam
is that it is a "safe, durable and cost-effective material that dentists
have used in tooth restorations for more than 150 years." But there are
some practitioners who have expressed serious concern over the safety of amalgams,
and the controversy over its use continues.
What is causing such concern?
It's the fact that amalgam is composed of 35 percent silver, 15 percent tin
or tin mixed with copper, a trace of zinc, and 50 percent mercury—a highly
toxic heavy metal.
Anti-amalgam dentists point out that the amalgam releases mercury vapor when
there is friction on the surface of the filling, such as when you chew. Mercury
vapor is cyto-toxic, which means that it kills cells, even when the exposure is
Mercury is absorbed through the lungs and into the arterial blood and is
stored by your body, primarily in your kidneys, liver and brain. And no
level of this mercury vapor is considered safe. However, the ADA counters
that, once bound to the other metals, the mercury in dental amalgam is
While "it is highly unlikely that such small concentrations of mercury
can or do harm the typical human, there is a remote chance that persons who
have immunocompromised systems could have some negative influence from this
mercury presence, or the presence of other metals," said Gordon J.
Christiansen, D.D.S., M.S.D., Ph.D. Also, those allergic to mercury should not
have amalgam fillings placed in their mouths.
It's important to note that no controlled scientific studies have been
conducted that demonstrate ill effects to human health resulting from amalgam
fillings. The evidence, to date, is all anecdotal. The World Health
Organization has stated that it recognizes the importance of continued
monitoring of the safety and effectiveness of all dental restorative materials,
including dental amalgam.
Silver amalgam is a more durable tooth
filling material than composite resin in teeth that are subjected to a lot of
An amalgam filling costs considerably less
than a comparable composite filling.
The disadvantages of amalgam
- Silver fillings are less attractive than tooth-colored composite resin
fillings; for this reason, they're typically not placed in teeth located
near the front of your mouth.
- The mercury in amalgam fillings expands and
contracts with heat and cold (think of the mercury in a thermometer). This
can eventually cause the filling to fracture your tooth, so a crown will
be required to restore its functionality.
- Silver fillings will eventually corrode and
leak, which can cause new decay to develop underneath the filling. The leakage
can also give a gray appearance to the entire tooth.
Tooth-colored composite resins—the pros and cons
Resin fillings result in a natural-looking smile. The color can be closely
matched to your natural teeth, so the restorations are nearly undetectable. And
because the resin compound actually bonds to your tooth, the seal is tighter
and the restored tooth can be even stronger than it was before.
Composite resin fillings can also be made much smaller than an amalgam
filling used to restore the same amount of decayed tooth, so less natural tooth
structure is lost. The durability of resin tooth-filling material has not been
time-tested, but continual improvements in the product have made resins nearly
as durable as amalgam fillings.
So where's the catch?
In the cost. A resin filling costs about 150 to 200 percent more than a
comparable silver filling. Most insurance benefits don't cover the additional
cost of composite fillings, so you must pay the difference.
Which to choose?
Overall, resin fillings are a more conservative treatment, because less of
your natural tooth structure needs to be removed in preparation for their
placement. They also do a better job of protecting your tooth in the long run,
as there's less chance that your tooth will fracture and require a crown in the
Ultimately, the choice is a personal one for both dentists and patients. Do
amalgam's benefits outweigh the possible risks? Are tooth-colored fillings
worth the significant extra cost? Which filling material will prove to be most
cost-effective in the long run? We recommend that you research your options,
discuss them with your dental healthcare providers, and choose the filling
material that's right for you, based on what you've learned.
You may also be interested in:
- How does cavity get started?
- Alternatives to dental fillings
Disadvantages of Metal Fillings
- Replacing Silver Fillings
- Worn White Fillings on Front Teeth
- Prevention of Postoperative Sensitivity After Dental Fillings
- Dental air abrasion
- Overcoming the fear of the drill
- Hard tissue laser
- One-visit porcelain onlay and inlay