Should You Replace Your Amalgam Fillings?

You might expect a mercury-free dentist to tell you every silver filling has to go. I am not going to tell you that. Some amalgams should come out. Some are better left exactly where they are. Here is how I tell the difference.

By Tamatha Johnson, DDS · Sep 01, 2026 · 9 min read

If you have silver fillings in your mouth, you have probably wondered whether they should come out. Maybe you read something that worried you. Maybe you saw the news that the 153 Parties to the Minamata Convention agreed last November to phase out the manufacture, import, and export of dental amalgam by 2034, with an exception for cases where a dentist determines its use is necessary based on a patient's needs. That followed the European Union, which largely phased out the use of dental amalgam beginning January 1, 2025, with limited exceptions for specific medical needs.

At Brentwood Dental Designs here in Epping, safe mercury amalgam removal is one of the services I offer. I am accredited by the International Academy of Oral Medicine and Toxicology, and I have spent years building a practice around biocompatible, mercury-free dentistry.

So you might expect me to tell you that every silver filling in your mouth needs to go, today.

I am not going to tell you that. The truth is more useful than that, and it deserves a real conversation.

The Short Answer

The Honest Answer: Not Always, and Not All at Once

Here is what the FDA said in its September 2020 safety communication on dental amalgam.

"The FDA is not recommending anyone remove or replace existing amalgam fillings in good condition unless it is considered medically necessary because removing intact amalgam fillings can cause a temporary increase in exposure to mercury vapor and the potential loss of healthy tooth structure, potentially resulting in more risks than benefits."

U.S. Food & Drug Administration · September 24, 2020

I think that is a fair statement, and I say so as a dentist who removes amalgam for a living.

The reason comes down to physics. Amalgam releases small amounts of mercury vapor, and that release can increase when the filling is disturbed, particularly during placement or removal. The IAOMT puts it plainly: the process of drilling out amalgam liberates mercury vapor and fine particulates that can be inhaled and absorbed through the lungs. On top of that, no removal is perfectly conservative. Taking out an old filling always costs you a little healthy tooth structure, because the filling has to be cut out and the tooth underneath has to be cleaned up before something new goes in.

That means the question is never simply "is mercury bad?" The question is whether the benefit of taking a particular filling out, on a particular day, in a particular body, outweighs the cost of the procedure itself. That is a clinical judgment, and it changes from tooth to tooth.

It is worth knowing that this holds even for patients in the higher-risk groups the FDA identifies. The FDA's guidance is that intact amalgam should not be removed simply to prevent disease unless removal is medically necessary. Being in a higher-risk group is a reason to discuss non-amalgam alternatives for new work, not an automatic reason to take out fillings that are doing their job.

What I Examine

What "In Good Condition" Actually Means

The FDA's language turns on those three words, and they are worth unpacking. When I evaluate an existing amalgam, I am looking at specific things.

› The margins Where the metal meets the tooth, is the seal intact, or has it opened up? Open margins let bacteria in underneath, where you cannot brush.
› Decay underneath Decay can develop beneath an old filling, in a place you cannot see or reach with a brush. When it does, the restoration has to come out so the decay underneath can be cleaned up.
› Cracks I look for craze lines and cracks in the walls of the tooth around a filling. Unlike a bonded composite, amalgam is held in place mechanically rather than chemically bonded to the tooth, so finding a crack around an old amalgam changes what I would use to rebuild that tooth.
› Size relative to the tooth A small amalgam in a molar is a very different situation than an amalgam so wide that only thin shells of enamel are holding it in. How much sound tooth structure is left shapes what kind of restoration that tooth can carry.
› Symptoms Cold sensitivity or pain on biting can be clues that a filling, or the tooth beneath it, needs evaluation. A metallic taste can have many possible causes and is not by itself proof that an amalgam is failing.
› Your health history A documented sensitivity or allergy to mercury or another amalgam component, impaired kidney function, certain neurological conditions, or pregnancy and plans for pregnancy can all change the conversation. The FDA recommends that people in higher-risk groups discuss non-amalgam alternatives with their dentist.

The Decision

When Replacement Makes Sense, and When It Doesn't

Given all of that, here is the framework I actually use in the chair. Waiting is a real option, not a consolation prize, and sometimes it is what I recommend.

I would recommend replacing it

Replacement Is the Right Call

›The filling is failing. Fractured metal, a worn or dished surface, an open margin, or decay underneath.
›The tooth needs a different kind of restoration. When a tooth is cracked, or has little sound structure left around a large amalgam, I would rebuild it differently than with another direct filling.
›You have symptoms I can trace to it. Cold sensitivity, pain on biting, or a galvanic sensation where dissimilar metals are in contact.
›Your medical history warrants it. A documented sensitivity or allergy to mercury or another amalgam component, impaired kidney function, certain neurological conditions, or a pregnancy you are planning ahead of.
›The tooth needs work anyway. If a molar is already getting a crown, the amalgam comes out as part of that treatment. This is the easiest decision in dentistry.
›You have made an informed decision. Some patients want a mercury-free mouth for their own reasons. Once you understand the process and the trade-offs, that is your call to make.

I would leave it alone for now

Watching Is the Better Choice

›The filling is stable. Small, sealed, symptom-free, and unchanged for years. We keep an eye on it at your regular hygiene visits.
›You are in the middle of a health challenge. We may want to sequence the dental work into a broader plan alongside your physician rather than rushing it.
›You want more time. A stable filling does not necessarily require immediate replacement, and a plan you feel good about beats a plan you were rushed into.

Important

Elective Removal Waits Until After Pregnancy and Nursing

The IAOMT recommends against amalgam removal during pregnancy or breastfeeding, because removal temporarily increases mercury-vapor exposure. The FDA likewise identifies pregnant women and nursing mothers as higher-risk groups and recommends discussing non-amalgam alternatives when new restorations are needed. If you are pregnant or nursing and concerned about a filling you already have, talk it through with your dentist rather than having a sound filling removed simply because it contains amalgam.

Have a question about a filling you already have? Call the office at (603) 506-5181 and we will talk it through.

The Part That Matters Most

Why How Matters More Than When

This is the part I most want you to take away.

The mercury vapor that concerns people is released when amalgam is disturbed, and exposure can be higher during placement or removal. So the most important variable is not whether your amalgams come out this year or in five years. It is whether, when they do come out, it is done under a protocol designed to contain what is released.

An unprotected amalgam removal is the version of this procedure I want you to avoid. That is why our office follows the Safe Mercury Amalgam Removal Technique developed by the IAOMT. The IAOMT describes SMART as a set of recommendations rather than a required standard of care, and every dentist still has to apply clinical judgment to the tooth in front of them. In practice, in our office, that means:

›Protective barriers to isolate the tooth and keep debris and vapor out of your mouth and airway
›A separate source of clean air for you to breathe during the procedure
›High-volume suction and HEPA air filtration at the chair to capture vapor and particulate
›Full protective equipment for you and for my team
›An amalgam separator, so the mercury we remove is captured and recycled rather than sent down the drain

Depending on the tooth and the treatment plan, we may also use ozone as part of how we prepare the tooth before the new restoration goes in. That is our practice's approach rather than a required part of SMART.

None of that is exotic. It is just careful. The goal is to minimize the additional mercury-vapor exposure that can occur during removal while protecting the tooth and the tissue around it.

Your Plan

We Do Not Have to Do It All in One Day

When replacement is the right call, it rarely needs to happen all at once. We can start with the fillings that are failing or putting a tooth at risk and plan the rest from there. That lets us work in order of clinical urgency, keep the treatment manageable, and fit it around your schedule and your budget.

We also talk about what goes back in. A biocompatible, mercury-free and fluoride-free restoration is not a single product, and choosing between a composite, a ceramic inlay, or full coverage depends on how much tooth is left and how hard you chew. That conversation is part of the plan, not an afterthought.

Next Step

Let's Look at Your Actual Teeth

Everything above is a framework. Your mouth is specific, and the only way to answer the question at the top of this page is to look at your fillings, your history, and your goals together.

I will show you what I see, tell you which fillings I would leave alone, explain which ones I would address and why, and give you a plan you can take at your own pace. You will leave knowing what is in your mouth and what your options are.