Key takeaways
- A sound, sealed old silver filling that is doing its job does not need replacing just because it is old or silver.
- In a set filling the mercury is bound into the material, and removing healthy amalgam purely out of health worry is not recommended.
- Replacing one is sensible when there is a real reason: it is cracked, worn or leaking, there is decay underneath, the tooth is cracking, or you want a tooth-coloured result.
- Tooth-coloured composite is the usual choice today; on very large back-tooth cavities the dentist advises what lasts best, which is decided case by case.
A lot of people look at an old silver filling in the mirror and wonder whether they should have it swapped for a tooth-coloured one. Some ask for looks, others because they have read something worrying online. It is a fair question, and the honest answer is more measured than either extreme. Old fillings are not all ticking problems that must come out, nor are they all fine forever. The sensible approach is to judge each one on its merits.
Are old silver fillings a problem?
Silver, or amalgam, fillings have been used in dentistry for well over a hundred years, and they are hard-wearing and long-serving. In a set filling, the mercury is bound into the material rather than sitting loose in the mouth. The major dental bodies do not recommend removing healthy amalgam fillings out of general health concern, for a simple reason: drilling out a sound filling sacrifices healthy tooth and offers no established benefit. So the starting point is not fear, but assessment.
When it is fine to leave a filling alone
If an old filling is sound, sealed at its edges, not causing symptoms and the tooth around it is healthy, the usual advice is to leave it be and keep an eye on it at your regular check-ups. Replacing it would mean removing more of your natural tooth for no real gain. Good dentistry is often about knowing when not to intervene.
When replacing one genuinely makes sense
There are, of course, real reasons to replace an old filling, and these are about the tooth rather than the material:
- The filling is cracked, worn down or leaking at the edges
- There is new decay underneath or alongside it
- The tooth is beginning to crack around a large old filling that no longer supports it well
- The filling is failing or has come loose
- It is on a tooth that shows when you smile and you would prefer a natural, tooth-coloured result
Any of these is a sound reason to act. Wanting a tooth to look better is a perfectly valid one too; it is simply a choice rather than a necessity, and a good dentist will be clear about which is which.
The tooth-coloured alternative, and the honest trade-offs
When a filling does need replacing, the usual modern choice is a tooth-coloured composite filling, which bonds to the tooth and blends in so it is hard to spot. For most everyday and moderate cavities it performs well and looks natural. The honest caveat is size: on a very large, heavily loaded back tooth, a big direct filling of any material is working hard, and the dentist may advise a stronger restoration such as an inlay, onlay or crown to protect what remains. Which route lasts best depends on your particular tooth, which is why it is decided after looking rather than in advance. Our guide to the types of dental fillings explains the materials in more detail.
Leave it or replace it, at a glance
| Usually leave it alone when | Consider replacing when |
|---|---|
| The filling is sound and sealed at the edges | It is cracked, worn or leaking |
| There are no symptoms and no decay around it | There is new decay underneath or alongside |
| The tooth around it is strong | The tooth is starting to crack around a large old filling |
| Your only reason is that it is old or silver | You want a natural, tooth-coloured result on a visible tooth |
The sensible next step
Rather than deciding from the mirror, the useful thing is to have your old fillings looked at. A dentist can tell you which are perfectly sound and best left alone, and which have a genuine reason to be replaced, and then talk you through the tooth-coloured options for any that do. You can book a check-up to have yours assessed honestly, with no pressure to replace anything that does not need it.
Sources & further reading
American Dental Association (MouthHealthy) · NIDCR, US National Institute of Dental & Craniofacial Research · NHS, Dental Health · Indian Dental Association
Replacing old silver fillings: your questions answered
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