Silver vs. Tooth Colored Fillings

OK, what is the skinny? What’s better and why?

First, silver/amalgam fillings have been around for almost 100 years and have performed well over that time. The accusations of amalgam poisoning, causing MS and other diseases are unfounded and not supported by the literature. In fact, it is considered “unethical” by the ADA to tell your patient that they could feel better by removing their amalgam fillings and replacing them with tooth colored or composite fillings. However it is considered ethical for the patient to “want” to have their silver fillings replaced with composite for the esthetic benefit.

Here are a few things/facts that you may want to consider when choosing the filling material you want:

1. Amalgam fillings need “retention” to stay in, meaning we need to take slightly more tooth structure away to get the filling to remain in your tooth. Composite fillings “bond” to the tooth and therefore we can remove less tooth structure and still have the filling stay in place.
2. On small sized cavities, either filling material is appropriate, but the larger the cavity, the harder it is to get the composite filling to adequately repair the tooth. It is difficult to get the composite to “touch” the adjacent tooth and if it doesn’t touch the adjacent tooth enough, you end up with an area where food tends to get stuck when you eat, which could, if you don’t floss after every meal, cause more problems than it solves.
3. On cavities above the gum line either material is fine, but below the gum line composite fillings have a hard time making a strong bond, hence they tend to “leak” and recurrent decay is the probable outcome. Amalgam fillings work just as well above and below the gum line.
4. Silver fillings actually get better with age, as they age the corrosion products actually fill the small gaps between the tooth and the filling and create a better seal. Composite fillings on the other hand, have the best bond on the day they are placed and that bond strength decrease everyday from there on. This is not to say that composite fillings are going to fail because of the bond strength, but it is something to consider.
5. Composite fillings are more expensive and are more time consuming to place.

In summary; I will be happy to place either filling material that you desire and I want you to have enough knowledge about the materials to make an educated decision. I will go with your decision.