I don't want silver or mercury in my fillings. What's in the alternatives?

By: Ash Estafan, D.D.S.


Is dental amalgam still used to fill teeth?

The short answer is yes, dental amalgam is still commonly used to fill teeth in many countries around the world. Dental amalgam is a durable and long-lasting material that has been used in dentistry for over 150 years. It is a mixture of metals, including mercury, silver, tin, and copper, which is used to fill cavities caused by tooth decay.

However, it's worth noting that the use of dental amalgam has become somewhat controversial in recent years due to concerns about the potential health risks associated with mercury exposure. Some studies have raised concerns about the release of low levels of mercury vapor from dental amalgam fillings, although the evidence is mixed and the majority of research suggests that dental amalgam is safe for most people, especially when used in appropriate clinical settings.

In some countries, there are restrictions or guidelines in place regarding the use of dental amalgam, particularly for certain populations such as pregnant women, children, and individuals with specific health conditions. Additionally, there has been an increasing trend towards the use of alternative materials for dental fillings, such as composite resins, glass ionomers, and ceramics, which are tooth-colored and may be considered more aesthetically pleasing.

Ultimately, the decision to use dental amalgam or an alternative material for dental fillings is based on various factors, including the dentist's clinical judgment, patient preference, and local regulations or guidelines. It's best to consult with a qualified dental professional to determine the most appropriate treatment option for your specific dental needs.

What are alternatives to dental amalgam?

There are several alternatives to dental amalgam for filling teeth. Some of the commonly used alternatives include:

Composite Resins: Composite resins, also known as tooth-colored or white fillings, are a popular alternative to dental amalgam. They are made of a mixture of plastic and glass materials and can be matched to the color of the tooth, providing a natural appearance. Composite resins are adhesive in nature and can be used for both small and large cavities. They are often used in visible areas of the mouth due to their aesthetic appeal.

Ceramics: Ceramics, such as porcelain or ceramic-filled composites, are used as an alternative to dental amalgam for larger restorations, such as inlays, onlays, and crowns. They are known for their durability, strength, and natural appearance. It's worth noting that ceramic restorations need to be cemented to the tooth. That cement is likely a composite resin cement. 

Gold Alloys: Not so popular any more - except for some who are making a cultural statment. Nevertheless. gold alloys have been used in dentistry for many years and are known for their durability and longevity. They are often used for large restorations in areas of the mouth that are not highly visible.

It's important to note that the choice of filling material depends on various factors, including the size and location of the cavity, the patient's oral health needs, aesthetic considerations, and the dentist's clinical judgment. A qualified dental professional will be able to recommend the most appropriate alternative to dental amalgam based on individual circumstances.

Dangerous Chemicals

Are there any unhealthy chemicals in dental composite?

Dental composite resins, which are commonly used as an alternative to dental amalgam, are generally considered to be safe for dental restorations. However, like any dental material, composite resins do contain various components that can potentially have health implications if not used properly or if a patient has specific allergies or sensitivities. Some potential concerns related to the chemicals in dental composite resins include:

Bisphenol A (BPA): BPA is a component used in some dental composites, particularly in the production of the resin matrix. BPA is a known endocrine disruptor and has been associated with potential adverse health effects, particularly in high doses. However, the BPA content in dental composites is typically low and considered to be safe for most patients, as the exposure levels are significantly below the established safety limits.

Methacrylates: Dental composites contain methacrylate monomers, which are polymerized during the curing process to harden the material. Methacrylates can cause skin or mucosal irritation or allergic reactions in some individuals, although these reactions are relatively rare.

Initiators and Accelerators: Dental composites also contain initiators and accelerators, which are chemicals used to initiate the polymerization process. These chemicals are generally safe when used as directed, but they can potentially cause skin irritation or allergic reactions in some individuals.

Filler Particles: Dental composites also contain filler particles, such as glass or ceramic, which provide strength and other physical properties to the material. While these filler particles are typically inert and stable, there have been concerns about potential release of nanoparticles or other filler-related issues, although the clinical significance of these concerns is still under investigation.

It's important to note that dental composites are regulated and approved by dental regulatory authorities in various countries, and their safety has been extensively evaluated through research and clinical use. The risk of adverse health effects from dental composite materials is generally low, and the benefits of using composite resins for dental restorations, including their tooth-colored appearance and ability to bond to tooth structure, often outweigh the potential risks. However, it's always important to discuss any concerns or potential allergies or sensitivities with your dentist or healthcare provider before undergoing any dental treatment.

Oh no cavity!

Do dental composite fillings last as long as dental amalgam fillings?

The longevity of dental composite fillings compared to dental amalgam fillings can vary depending on various factors, including the size and location of the filling, the patient's oral hygiene habits, diet, and other individual factors. In general, dental amalgam fillings have been reported to have a longer track record of durability and longevity, with some studies suggesting that they may last slightly longer than composite fillings on average.

Dental amalgam is a durable and strong material that has been used for many decades, and it has a proven track record of longevity. Amalgam fillings are known to withstand the forces of chewing and grinding well, and they are less prone to wear or fracture compared to composite fillings. Dental amalgam is also less technique-sensitive during placement, which can contribute to its long-term success.

Composite fillings, on the other hand, are made of a resin material that is bonded to the tooth structure. While composite resins have improved significantly in terms of their strength and durability over the years, they may not be as durable as dental amalgam in certain situations, particularly for larger restorations or areas of the mouth with high chewing forces. Composite fillings may be more susceptible to wear, staining, or chipping over time, although their aesthetic advantages, such as tooth-colored appearance and ability to bond to tooth structure, are often considered beneficial.

It's important to note that proper oral hygiene, regular dental check-ups, and good dental care practices, such as avoiding biting on hard objects or teeth grinding, can significantly impact the longevity of any type of dental filling. Regular dental follow-up appointments and maintenance can help detect and address any issues with dental fillings early, which can help extend their lifespan.

Ultimately, the choice of dental filling material, whether it's dental amalgam or composite resin, should be made based on various factors, including the patient's oral health needs, aesthetic considerations, the size and location of the filling, and the dentist's clinical judgment. A qualified dental professional can provide personalized recommendations for the most appropriate dental filling material for an individual's specific circumstances.

Are dental composite and dental amalgam equally moisture sensitive during placement?

This is a challenge for the dentist.  It's not always easy to isolate the cavity preparation (after the cavity is removed but before the filling goes in) from moisture. Frequently there is saliva, blood or natural fluid that comes from the gums. Dental composite and dental amalgam have different moisture sensitivity during placement. Dental composite is highly moisture-sensitive compared to dental amalgam.

Dental composite fillings are typically placed using an adhesive bonding technique. The tooth is conditioned, and a bonding agent is applied to create a bond between the tooth structure and the composite material. During this process, the tooth needs to be kept dry and free from saliva or other moisture to ensure proper bonding of the composite material. Moisture contamination during composite placement can compromise the bond strength and longevity of the filling, leading to potential issues such as marginal leakage, postoperative sensitivity, or premature failure of the restoration.

On the other hand, dental amalgam is a self-sealing material and is less moisture-sensitive during placement. Dental amalgam relies on mechanical retention for its stability and does not require the same level of moisture control during placement as composite. Dental amalgam is mixed, packed into the cavity preparation, and condensed to adapt to the tooth structure. Any moisture contamination during the placement of dental amalgam is less likely to have a significant impact on its clinical performance compared to dental composite.

That being said, it's important to note that proper moisture control is still essential during any dental procedure to achieve optimal results, whether it's placing composite or amalgam restorations. Dental professionals take necessary steps to isolate the tooth and maintain a dry field during composite placement to minimize the risk of moisture contamination and ensure successful bonding. Techniques such as rubber dams, isolation devices, or absorbent materials may be used to achieve adequate moisture control during composite placement. Following proper clinical protocols and techniques is crucial to ensure the longevity and success of dental restorations, regardless of the material used.

Not all teeth are the same and no two people have the same diet and hygiene habits. Some people have “soft teeth” and get cavities no matter how well they clean their teeth and how often they visit the dentist. In patients who are prone to tooth decay, amalgam fillings are likely to resist decay for longer than composite fillings. This difference between the two materials becomes much more significant in cavities that are under the gumline.  Silver fillings don’t look as good, but on the average they last longer than composite fillings. 

Patients don’t love the look of silver fillings. And who could blame them? Silver vs tooth-color is an easy choice to make. It’s common for patients to cite “mercury toxicity” as a reason for declining the silver filling in favor of composite. But curiously, patients rarely ask what’s in the tooth-colored filling. Dental composite resin is a form of plastic. Here we are avoiding the mercury in amalgam and using metal and glass whenever possible to avoid dangerous chemicals in plastic, but we blindly accept plastic fillings we will carry around in our heads potentially for decades?

Silver filling

Does dental composite resin contain BPA?

Dental composite resins are a type of dental filling material that is commonly used to restore teeth that have been damaged due to decay, fractures, or other dental issues. Composite resins are usually made from a mixture of organic and inorganic materials, such as polymerizable monomers, filler particles, and other additives. Some dental composite resins may contain bisphenol A (BPA) as a component of the polymerization reaction.

BPA is a chemical that has been used in the production of certain plastics and resins, including some dental composite resins. BPA has been a topic of concern due to its potential endocrine-disrupting properties, which means it may interfere with hormonal functions in the body. However, dental composite resins that contain BPA typically undergo a polymerization process during which the BPA is chemically bound to the resin matrix, reducing the potential for BPA to be released from the material after it has been cured.

Do dental composite resins contain PFAs?

Dental composite resins do not typically contain perfluoroalkyl and polyfluoroalkyl substances (PFAS). Dental composites are typically composed of polymerizable monomers, filler particles, and other additives, but PFAS are not commonly used as ingredients in dental composite resins.

PFAS are a group of synthetic chemicals that have been used in various industrial and consumer products due to their unique properties, such as resistance to heat, water, and oil. However, PFAS have raised environmental and health concerns due to their persistence in the environment, potential bioaccumulation, and potential adverse health effects.

Dental materials, including composite resins, are subject to regulations and standards set by health and safety agencies in various countries. Manufacturers of dental composite resins are required to comply with these regulations, which typically include rigorous testing and assessment of the materials' safety and biocompatibility. However, it's always recommended to consult with your dentist or dental professional regarding the specific materials they use in their practice, as dental products and regulations may vary by region or country. They can provide you with up-to-date and accurate information about the composition of dental composites and address any questions or concerns you may have.

BPA free

That said, not all dental composites are the same. Several years ago Dr Estafan began using one particular composite that is BPA free as an adjunct to the composite he had been using for years. He realized it handles well during placement and that he was satisfied with the final results.  When patients returned for their check-ups over the next few months, the BPA free composite fillings were indistinguishable from the conventional composite fillings. That’s when he switched completely to the BPA free composite for fillings. Although composites still don’t usually last as long as amalgam fillings, at least we are not acquiring dangerous chemicals when we get composite fillings. 

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.