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By Dr. Rob Gausmann, DDS  – Printed December 2014

Q. I've had silver fillings for 20 years, should I get them replaced with the new "white" fillings?

A.  This is a fantastic question that is commonly asked by patients. Many opinions on this dental subject are shared on the internet with variable levels of accuracy. This article will attempt to present an answer based on suggestions and findings by the FDA (Food and Drug Administration). Based on conversations with the dentist and personal comfort, the ultimate answer lies with the patient. 

After a dentist has removed a cavity from a tooth, the open space needs to be filled to match the original shape and size. The requirements for materials used to fill that space are high. Just a few include the ability to survive in a wet environment, stay intact for the life of the tooth, and be safe for the patient. Approved material must also hold together despite the strong forces of chewing. Regulated by the FDA, the choices include:

GOLD – Gold has been used as a filling material for many years.  It is traditionally placed by tightly layering small gold foil pieces, which bond together to fill the space.  It is not uncommon for adult patients to have gold fillings still present that were placed during their younger years.  Gold still remains a solid and long lasting dental material. 

AMALGAM (Silver fillings) – Amalgam is another material that has been used for over a century and can still be seen intact after many years of use.  This material is often called “silver fillings” due to the observed color from mixing several metals.  Amalgam is a strong material and has had minimal changes in composition since creation.

COMPOSITE RESIN (Tooth colored material) – Resin is a more recent material that was developed to fulfill the need for more esthetic or cosmetic fillings.  It is often referred to as “white fillings”.  The color appears more tooth-like due to the composition being similar to plastic.  Resin material has been modified to meet the high requirements of both front (esthetic concern) and back teeth (chewing forces). 

OTHERS – Other materials exist that can be used as filling material. These often use some of the main properties of the above materials, but have been modified slightly.  Porcelain or other glasslike materials can be fabricated to match the same shape as the cavity, and then cemented in the tooth as a single unit.

Each material has advantages and disadvantages when compared with each other – cost, strength, esthetics, location of proposed use, etc.  The FDA classifies gold as class I (least risk) and amalgam and composite resin as class II (more risk).  One material in amalgam is mercury. To date, the FDA states that no sufficient evidence has been shown to link amalgam and adverse health risks. The FDA also recommends that if amalgam fillings are intact with no cavities, they should only be replaced if an allergy is suspected. 

The decision to replace silver fillings with white fillings should consider the above information and a discussion with the dentist to evaluate all options. Ultimately, the best treatment will be accomplished with patient involvement and confidence.

Dr. Rob Gausmann, DDS  – Gausmann Family Dental

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