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Should you replace old amalgam fillings with white fillings?

Amalgam filling replacement

Are you thinking of replacing your old amalgam fillings with white ones? Here are some points to consider.

Amalgam fillings have been around for 150 years. They do have good physical properties and are strong and can last a long time. However, amalgam fillings only plug the hole in your tooth but won't strengthen it. The tooth around an amalgam filling will continue to flex and this may cause leakage or cracks to develop in the tooth. A crack may result in a portion of the the tooth fracturing and then a larger filling or crown is needed. In the worst case a tooth can completely fracture and need extraction.

Composite (tooth coloured) fillings are a popular alternative to amalgam and have the advantage of strengthening the tooth, which will prevent it from flexing. This is because they bond to tooth and become an integral part of it. High aesthetics and less tooth preparation (as they don't need undercuts to keep them in place) make them today's minimally invasive choice of filling material.

Patients frequently question the safety of amalgam since it contains mercury and other metals like silver, copper and tin. Mercury in its free state is a toxic heavy metal which has adverse effects on the central nervous system. It used to be used in the manufacture of hats in the 19th century and the phrase "as mad as a hatter" originates from this time. The mercury in amalgam fillings is bound to atoms of silver and tin and there is no scientific evidence to show that amalgam fillings are responsible for any diseases or ailments. However, public perception and environmental concerns have resulted in amalgam fillings now being slowly phased out of use and replaced with composite and glass ionomer fillings.

So when considering whether to replace your old amalgam fillings with white ones:

1. Remember that any treatment can cause a symptomless tooth to become symptomatic especially if you have to use a drill.

2. Removing amalgam fillings will not alleviate or cure any diseases or ailments.

3. Generally replace fillings only when they need replacement ie portion of filling has broken off or has decay underneath it.

4. If you are replacing a filling for aesthetic purposes check to see if it is visible when you smile. If it is an upper tooth at the back of the mouth then the chances are that no one sees it even if you smile very wide.

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