Should amalgam (metal) fillings be removed? Mercury, health, removal and replacements

Amalgam is made by mixing silver, tin and copper powders with mercury. Durable and inexpensive, it was the standard filling for back teeth for many years. Its use is now falling for two reasons: aesthetic expectations and the environmental impact of mercury. Under the Minamata Convention on Mercury many countries are phasing it down; the European Union banned amalgam in new fillings from 1 January 2025, except where strictly medically necessary.

The main reason for these rules is the environment; they don't call for sound fillings to be removed.

Amalgam fillings release very small amounts of mercury vapour, especially during chewing and grinding. Research hasn't shown this to cause health problems in healthy adults. Even so, for some groups other materials are advised for new fillings where possible:

• Pregnant women, breastfeeding mothers and those planning pregnancy. See dental treatment in pregnancy, dental treatment while breastfeeding.
• Young children
• People with impaired kidney function and some neurological conditions
• People allergic to mercury

This advice is about new fillings. Even in these groups, removing sound fillings is generally not advised, because removal means brief exposure to more mercury vapour.

• Decay at its edge or underneath: If seen on an X-ray or at the examination.
• A broken filling or cracked tooth: Large amalgam fillings can weaken the tooth's walls. See cracked tooth syndrome.
• Allergy or a reaction in the mouth: Persistent white-red lesions on the cheek or tongue where they touch the filling.
• Appearance: Fillings visible when you smile and a grey shadow in the tooth. See black spots on teeth.
• As part of a wider treatment plan: For example if the tooth is going to be crowned anyway.

• Removing the filling in sections, generating as little heat as possible
• Plenty of water cooling and strong suction
• Isolating the tooth with a rubber dam where appropriate
• Suitable masks for the dentist and assistant
• Separating amalgam waste under medical waste rules

If several fillings are being replaced, the work can be split over several visits.

Details: white (composite) fillings, types of dental crowns. Brief sensitivity after a filling is normal; see pain after a filling.

At Dent32 we assess your amalgam fillings with an examination and X-rays and explain in writing which need replacing and which can wait, with the reasons. The decision to replace is yours. For fillings in Beylikdüzü, see dental fillings.

Dent32 Ağız ve Diş Sağlığı Polikliniği (Dent32 Dental Polyclinic) is at Barış Mah., Ginza Lavinya, E-5 Yanyolu No:30 D:179, 34520 Beylikdüzü, Istanbul and is open seven days a week. To book, call or WhatsApp +90 555 011 33 68, or use our contact page. At the examination we share the findings, the options and the approximate cost in writing; you are under no obligation to start treatment afterwards.

For clinic details, our dentists and the full list of treatments, visit Dent32, dental clinic in Beylikdüzü.