Silver amalgam fillings have been a very popular dental restoration for over 150 years. They are compromised of a mixture of mercury, silver, tin and copper. Amalgam fillings have enjoyed widespread use because they are fairly strong and last quite a few years before they need to be replaced. Luckily, modern dental technologies offer us many tooth-colored alternatives to the dark silver amalgam filling material.
Before we look at the alternatives to amalgam fillings, a discussion about when and how these fillings should be replaced is warranted. All dental restorative materials wear out at some point, just like a roof wears out on your house after so many years. There are some things to look for when deciding if a silver filling needs to be replaced. Some of these things will only be visible to a dentist under magnification or with x-rays. Other symptoms can be picked out by the patient. Here is a short list of these signs and symptoms:
- When there are cracks in the filling material or chips around the edges of the filling, that means bacteria can get under the amalgam.
- If the dentist sees shadows of a cavity under the silver filling on an x-ray, it is time to replace it.
- If the patient notices sudden cold or sweet sensitivity on the tooth with an amalgam filling, that generally indicates leakage of the filling.
- Sometimes the filling will loosen and shift around in the tooth.
- Noticing redness of the gum tissue, cheeks or tongue near the filling could indicate a sensitivity or allergy to one of the metals in the filling material.
- There are times when a whole chunk of tooth near the filling, or a large piece of the filling will just break out. This is a clear sign to get this old filling fixed.
All of these events would present a good opportunity to get the old amalgam filling out to protect the health of the tooth. Many times patients will just go ahead and have their old silver fillings removed to improve the aesthetics of their teeth, or for environmental and holistic health reasons. These are valid reasons also. It is the patient’s mouth, and they can decide which materials they want in their own mouths to fill their cavities.
When it is time to actually remove the old amalgam fillings, there are several precautions the patient and dentist may want to consider. To get the old fillings out, the dentist needs to drill out the amalgam metal. This creates little pieces of filling debris and filling dust. To keep the pieces from going down your throat, a device called a “rubber dam” can be used. It is a thin sheet of latex that isolates the tooth or teeth that the dentist is fixing keeping all debris on one side of the rubber dam. A high volume suction is used to suck up all the debris and water as the dentist works. The patient should consider safety glasses to keep any flying pieces from getting in their eyes.
When the fillings are being drilled, this can generate heat and create a mercury vapor. To eliminate this, the dentist should use lots of water spray to keep the metal filling cool, and to keep the dust down. Patients can take their amalgam filling removal precautions to one more level with chelation therapy. This is a process of detoxing or cleansing the body to help remove mercury from the system. There are not really any large studies that show the effectiveness of this treatment, but patients can do some research and decide if this is something for them.
As mentioned earlier, there are numerous aesthetic and highly durable options for replacing old amalgam fillings. Here is a list of some of them, sorted by increasing cost:
- Composite fillings – These tooth colored synthetic resins are the most common option for replacing small to medium sized silver fillings. They are placed directly into the tooth and hardened with a special light. This bonds the material to the tooth making it strong enough to last on average 10-15 years using the newer materials. The cost of a composite filling ranges from about $100 to several hundred dollars. In this same category, there are indirect composite fillings. An impression is made of your mouth so that the composite filling can created in the lab under ideal conditions. Then it is bonded back into the tooth. The advantage here is some added strength. The disadvantage is a little more cost than the regular composite, and it take a couple of appointments.
- Porcelain inlays – These white fillings tend to be stronger than composites, and they can look very natural. They work best to replace small to medium sized fillings and can last on average 15 – 20 years. They usually take two appointments like the indirect composites, because they are made in a lab and are bonded into the tooth at another appointment. They can range in cost from several hundred dollars up to almost $1000.
- Porcelain onlays and crowns – As we get older, our teeth get more brittle and are more susceptible to cracking. This tends to be more noticeable in back teeth with larger silver fillings. Instead of just filling the same area with white material, it is better to cover the cracked parts of the tooth at the same time to prevent breakage of the tooth down the road. The porcelain covers over the weak parts and strengthens the whole tooth. They can last 15-25 years and they can cost from several hundred dollars to over $1000.
Talk with your dentist to see what is best for your situation. Provided good planning, your teeth can last a lifetime.