If you had any dental work done before the late 1990s — or if you grew up without regular access to a cosmetic-conscious dentist — you may have silver amalgam fillings in your back teeth. They work. They’ve probably worked reliably for years. But there are increasingly good reasons to consider replacing them.
This article covers what amalgam is, what composite resin offers instead, and when replacement makes clinical and aesthetic sense.
What amalgam actually is
Dental amalgam is an alloy containing mercury, silver, tin, and copper. It has been used in dentistry for over 150 years and has an extensive evidence base for safety and longevity. The mercury in amalgam is bound in a stable alloy — the amount of mercury vapour released during normal use is well below the levels associated with any harm in the vast majority of patients.
We say this clearly because misinformation around amalgam is widespread, and we don’t want patients to feel that existing amalgam fillings are a health emergency. For most people, they are not.
That said, the landscape is changing. The EU phased out amalgam for most dental uses in 2024. Several other countries are in the process of restricting its use. New fillings placed at Novo Care are exclusively tooth-coloured composite or ceramic — amalgam is no longer part of our practice. And for patients with existing amalgam who want it replaced for aesthetic or personal reasons, we offer a structured, safe replacement process.
The case for composite resin
Aesthetics. The most obvious advantage: composite resin is tooth-coloured. A back molar filled with composite looks like a tooth. A back molar filled with amalgam looks dark — and in a wide smile, it’s visible. For patients who are investing in their smile aesthetically, dark fillings at the back of the mouth work against that investment.
Bonding mechanism. Amalgam fillings are held in place primarily through mechanical retention — the cavity is shaped to lock the amalgam in. Composite resin bonds chemically to tooth structure, which means the preparation can be more conservative (less natural tooth needs to be removed to accommodate it). Over time, as a filling eventually needs replacement, this conservation of tooth structure matters.
No thermal expansion mismatch. Amalgam expands and contracts with temperature changes at a slightly different rate than natural tooth structure. Over many years, this can cause hairline fractures in the tooth around the filling. Composite, bonded to the tooth, moves with it more harmoniously.
Modern material quality. The composite resins available today are significantly stronger and more wear-resistant than those available 10 or 15 years ago. Concerns about composite longevity in load-bearing back teeth were more valid with older materials — modern composites in skilled hands perform very well in posterior teeth.
What the replacement process looks like
Amalgam removal is a more involved procedure than simply removing a filling and placing a new one. The removal process itself releases some mercury vapour, and at Novo Care we follow established safe removal protocols:
- Sectioning the amalgam into large chunks (rather than grinding) to minimise vapour
- Using high-volume evacuation throughout
- Protective covering for patient and clinician
- Air filtration in the room
The procedure is completed under local anaesthetic. Once the amalgam is removed, the cavity is prepared for composite, which is placed in layers and cured with light. Depending on the size of the original filling, a ceramic inlay or onlay may be a better choice than direct composite — your dentist will assess this and explain the options.
Should you replace amalgam fillings that aren’t causing problems?
This is the most honest question to answer: not necessarily, immediately. Existing amalgam fillings that are intact, with no decay at the margins, and functioning well do not need to be replaced urgently for health reasons.
The reasons to consider replacement are:
- Aesthetic: the fillings are visible in your smile and you find this bothers you
- Preventive: you are investing in comprehensive cosmetic work and want the overall result to be consistent
- Clinical: the filling is showing signs of wear, cracking, or marginal breakdown — at which point replacement is clinically indicated regardless of material preference
- Personal: you simply prefer not to have amalgam in your mouth, and that’s a legitimate choice
Replacing perfectly functional amalgam solely to eliminate amalgam from your mouth is a personal and aesthetic decision. We will support it — safely and well. We just won’t tell you it’s a health emergency if it isn’t.
Book an assessment at Novo Care to have your existing fillings evaluated. We’ll tell you honestly which ones need attention and which are still in good condition and we’ll let you decide what to do with that information.