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Are amalgam fillings dangerous?

Updated: Oct 1, 2024



Amalgam fillings, sometimes referred to as silver or metal fillings due to their colour and components, have been used in cavities since the late 1800s. They contain a mixture of silver, copper, tin and zinc, and are around 50% mercury by weight. Their effectiveness, durability, and affordability have maintained their popularity in many countries.


However, concerns about the health and environmental impact of amalgam fillings have grown in recent years, leading to the Minamata Convention on Mercury in 2013 and the European Parliament's vote to ban dental amalgam starting January 1st, 2025. Consequently, new regulations in the UK and the European Union (EU) that restrict the use of mercury came into law in 2018. These regulations are part of a worldwide agreement to reduce global environmental pollution caused by mercury released during the production, use and disposal of mercury products, including dental amalgam.



Are amalgam fillings safe?


While the Food and Drug Administration (FDA) in the US and the National Health Service (NHS) in the UK consider amalgam fillings generally safe, restrictions exist. Since 2018, the UK limits amalgam use in children under 15, pregnant women, and breastfeeding mothers. The FDA goes further, advising against amalgam for those with kidney or nervous system disorders. This raises a key question: if amalgam isn't considered universally safe, why use it at all?


Dental amalgam releases small amounts of mercury vapor, influenced by the number and age of fillings, as well as activities like chewing or grinding. However, exposure is low -  5 to 30 times lower than safe workplace limits and far below levels causing long-term health effects.


Vapour release is most potent when placing a new filling, or removing an old filling.


It's important to note that mercury is a naturally occurring element, and everyone has some exposure through air, water, or food like tuna. Therefore, low-level exposure from amalgam isn't drastically different from everyday sources.


Some studies, like those by Joachim Mutter, suggest potential health risks from amalgam fillings. However, many of these studies are biased, and their statistical results aren't strong enough to draw definitive conclusions. Additionally, millions of people with amalgam fillings haven't developed related health problems. Overall, the evidence linking amalgam fillings to health issues is weak, with most reported harms based on limited studies.


So, why is the EU banning amalgam if the health risks are unclear? It's primarily an environmental decision. While mercury in fillings is stable, microorganisms in soil can convert it into a form that accumulates in fish and the food chain, potentially causing human health problems.


The limitations placed on certain groups by the FDA and NHS, coupled with the EU ban, raise a valid point: if some shouldn't have amalgam fillings, should anyone? This highlights the ongoing debate, balancing potential health concerns (though not conclusively proven) with the environmental impact and the effectiveness and affordability of amalgam fillings.



Should I get my amalgam fillings removed?


While amalgam fillings have been a source of concern due to mercury content, removing them if they are not worn, damaged or leaking, can actually expose you to more mercury vapour than leaving them in. Additionally, removal can lead to unnecessary loss of healthy tooth structure. Therefore, amalgam fillings shouldn't be removed for preventative reasons unless deemed medically necessary by a healthcare professional.


However, if you have a pre-existing health condition like mercury sensitivity, neurological or kidney disease, discuss removal and replacement options with your dentist or doctor. Techniques like SMART amalgam removal minimise vapour release during the process - inquire if your dentist is certified. If your dentist cannot perform the full SMART protcol, then at least ask that a rubber dam is placed. This will shield your airway from the amalgam, and prevent swallowing of amalgam particles. It is also important the amalgam is removed in sections, rather than drilled out completely.

Large metal, amalgam or silver fillings in a patient's back teeth. They are very large, comprising almost the whole teeth, with cracks, fractures and leaking areas
Large amalgam fillings in a patient's back teeth

It's understandable to question the safety of having amalgam in your mouth. However, research shows the low levels of mercury released pose no significant health threat. Studies indicate exposure from fillings is lower than what most people encounter daily through the environment or food.


If you have lingering concerns about heavy metal toxicity, your doctor can perform heavy metal tests with blood or hair samples, or there are at-home testing kits available online. Note: higher levels than normal may not necessarily be due to your amalgam fillings.






What are the alternatives to amalgam fillings?


  1. Composite -Resin-based fillings, also known as white fillings, offer a strong and durable alternative to amalgam fillings for back teeth. While free of heavy metals, they do contain methacrylate monomers, which can trigger allergic reactions in some individuals. Proper placement is crucial, requiring a high level of skill from the dentist to minimise the risk of future decay and sensitivity beneath the filling. Despite potentially longer placement times, resin fillings require removing less healthy tooth structure compared to traditional amalgam fillings.

  2. Admira Fusion - a new filling material - This is the first ceramic based restorative material, that contains no classic monomers such as Bis-GMA, TEGDMA or UDMA. In studies it has similar strengths to traditional composite materials, and may be appropriate for patients who are concerned about allergies caused by monomer materials.

  3. Ceramic - Large fillings can weaken the tooth, increasing the risk of fracture for both the filling and the tooth itself. To prevent this, onlays or ceramic crowns offer a more robust solution.

  4. Gold - Gold is inert, so the body does not react to it, and has good durability when used as a filling or crown material. It seals perfectly to the tooth due to its malleability, and can also be used in very thin layers, meaning less healthy tooth needs to be removed. Gold crowns have a 95% survival rate over 10 years, but with regular care and reviews, they can last decades. The only issue is the affordability of the material, with costs rocketing over the last few decades.

What should I do?


Have concerns about the type of filling material your dentist recommends? That's perfectly normal! Open communication is key. Your dentist should discuss the various options in light of your needs, budget, and any health considerations you may have. Remember, every treatment has its own potential benefits and risks. By being informed, you can make the best decision for your oral health.


The most important thing you can do for your teeth? Prevent fillings altogether! No filling material, no matter how advanced, can fully replicate the strength and function of your natural tooth.


By following the latest advice on preventing or even reversing decay, you can significantly reduce your risk of needing fillings. Additionally, regular checkups and following your dentist's personalised oral care plan are crucial for maintaining healthy teeth throughout your life.


This information is for educational purposes only. This content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your dentist, doctor or other qualified healthcare provider.



Would you have an amalgam filling placed?

  • Yes

  • No



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© 2023 Dr Harriet Beaty

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