Should silver amalgam filling be replaced with other restorations?

Silver amalgam is a dental filling material which is used to fill the tooth cavities that may be caused due to tooth decay. It as been widely used as a dental filling material for more than 150 years in many patients all over the world. Dental amalgam is an mixture of liquid containing mercury and powdered alloy consisting of silver, tin, copper. Mercury reacts with silver , copper, tin and binds together the alloy particles to form amalgam.

However in the last few decades concerns over potential toxicity of silver amalgam have made dentist to look out for other options giving rise to the need for replacement of silver amalgam filling with other restorations like composite. Mercury in the amalgam remains topic of great concern. Mercury is a highly toxic material. Silver amalgam contains elemental mercury. it releases low levels of mercury in the form of vapours that can be inhaled and absorbed by the lungs. Mercury vapour inhalation may cause various respiratory symptoms like bronchitis, fever with chills dyspnea, pulmonary oedema , fibrosis leading to pulmonary failure. It also has harmful effects on nervous system, digestive system, immune system causing a variety of health issues such as immune system disorders, hormone problems and other systemic problems.

When amalgam filling gets dislodged from the tooth, metal particles can enter the body through inhalation or ingestion.

Over a period of time amalgams fillings show wear causing secondary microleakage. If a decay is seen surrounding the filling or if the fillings become gets slightly dislodged from the walls of the tooth bacteria may enter in and may reach the root causing infection of teeth which may eventually require root canal treatment. Teeth sensitivity can also occur which clearly indicates that the amalgam filling needs to be replaced .

In addition amalgam fillings which are made of metal expand and contract due to hot or cold food respectively. This may lead to fracture of teeth or cracking of teeth and loosening of the filling creating gaps for the bacteria to get in .  Amalgam filling a also require preparation of cavity that involves more loss of tooth structure  in contrast to the tooth coloured restoration(composite) that are done with very conservative cavity preparation.

Dental amalgam fillings are silver coloured which affects the aesthetic of an individual. So considering the cosmetic reasons there is a need of replacement of metal filling with other tooth coloured restoration. But if the amalgam fillings are in good condition and are not worn out or broken there is no  need to replace such fillings because removal of such fillings may lead to unnecessary mercury exposure .

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Conclusion to Amalgam Filling!

In short if there are signs of decay, dislodgement of filling, cracking or poor margins, fracture filling dental amalgam filling should be replaced by other restorative materials but an intact filling with no defect can be left as it is unless it poses a cosmetic concern for a patient.

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