Yesterday, a patient came in with a request I don’t hear as often these days:
“Doctor, I want the metal filling — the old silver one. It’s stronger.”
He told me his old silver amalgam filling had lasted more than ten years. Recently, he had replaced it with a tooth-coloured one, but that fell out after only two months. To him, it seemed like proof that silver was the champion of fillings.
It’s true — silver amalgam fillings have been used for over a century, and they are incredibly durable. But dentistry has moved on, not because amalgam suddenly became “bad,” but because we’ve learned more about how teeth age, how materials behave in the mouth, and what’s healthiest in the long run.
Why We’ve Stepped Away from Silver Amalgam
1. More Drilling Means Less Tooth Left
Amalgam doesn’t stick to teeth — it’s held in by shape. That means we have to drill away healthy tooth structure just to make the filling stay in place. Over time, this can leave the tooth weaker and more prone to breaking.
2. Expansion and Cracks
Metal changes size with temperature. Every hot coffee and cold drink makes the amalgam expand and contract slightly. Over years, this movement can cause fine cracks in the tooth, which may lead to bigger problems later.
3. Mercury Content
Amalgam is a mix of metals — silver, tin, copper, and mercury. The mercury is stable when bound in the filling, but many patients prefer to avoid it entirely. Globally, there’s also concern about environmental mercury waste, which has led to a gradual phase-down in many countries.
4. No Bonding Support
Because amalgam doesn’t bond to the tooth, it doesn’t help hold the remaining tooth together. If the surrounding tooth chips or fractures, the filling can loosen or fall out.
5. Appearance
While health comes first, appearance matters too. A silver filling is visible whenever you laugh or talk, while modern dentistry aims to keep restorations as natural-looking as possible.
I explained all this to my patient. Yes, amalgam is strong, and yes, it can last many years — but it can also slowly weaken the tooth it’s protecting. Dentistry today isn’t just about a filling surviving; it’s about the tooth surviving for decades to come.
That’s why even though silver amalgam has served us well for generations, we now choose materials and techniques that protect the tooth structure, reduce long-term risks, and keep your smile looking natural.
