Do I need to replace all my metal fillings?

At Johnston Dental, we believe in only replacing metal fillings when needed. The ADA, The New England Journal of Medicine, Mayo Clinic, FDA, and the medical/dental field in general find that metal (also called amalgam) fillings are not found to be a risk to health. It is true that mercury is an ingredient in amalgam fillings, but it is in such a low amount it has been found to be harmless. There is no need to panic and remove all metal fillings at once. However, metal fillings are outdated and often need to be replaced, and we now have better materials for fillings that bond tightly to the tooth. We often recommend replacing metal fillings, but only when warranted!
Good reasons to replace a metal filling:

Flex with Heat and Cold-The metal in the filling is temperature sensitive and will shrink with cold and expand with heat. Over time these small adjustments weaken the tooth and can lead to cracks. In addition, some people feel this hot and cold conduction as temperature sensitivity in their teeth. We want you to enjoy your ice cream!

Age and Wear-Unfortunately, fillings do not last forever. Often, metal fillings are over 30 years old and have definitely served their purpose. Some amalgams that span between teeth are misshapen or worn and create a “catch” that shreds floss and gives cavity causing bacteria a home. A new filling that is shaped to the tooth can help protect the tooth from cavities and also protect the gum health by removing the source of constant inflammation.

Leakage-Gaps can form between the edges of the filling and the tooth. This allows food particles and decay causing bacteria to creep in underneath the filling.The doctor may note some gray areas around the tooth that indicate decay has formed underneath the filling. We want to remove the decay and seal and protect the tooth with a new filling that has a smooth junction between it and the tooth to keep that bad bacteria out.

Large Cracks and Risk of Fracture-Metal fillings do not flex with the tooth when you bite. This puts pressure on the corners of the tooth (the pointed cusps). We often see teeth with large metal fillings and an entire tooth cusp broken off. If we see signs of wear on the filling and crack lines on the tooth, we will generally recommend replacing the filling. It’s always most comfortable to take care of this issue before the tooth breaks! Sometimes when these large metal fillings are removed and decay is removed, there is not enough tooth structure left to safely hold in a filling. When this happens, replacement is not another filling, but rather a crown or cap. This is a long term solution that helps hold the tooth together and protect the cusps from breaking. Sometimes, there is enough tooth structure left to do a ¾ crown, an onlay or inlay. Your doctor will discuss with you the possibilities ahead of time.

Esthetics-Sometimes the metal of a filling shows in a smile and patients want to replace it with a tooth colored filling instead. These are practically invisible and can give people a boost of confidence! Now you when you laugh and smile you can dazzle with how white your teeth are instead of flashing silver!

Allergy-Although rare, some people are allergic to the metals in amalgam and feel gum irritation around the tooth.

Patient’s choice– Some people want to replace all their metal fillings right away, and some patients would rather wait until a worn out filling has decay or breaks. This is your mouth and your decision! We are here to give you our professional recommendation and assist you in making healthy decisions for your mouth, but we understand it is your choice too. We are happy to discuss with you what works best for your mouth and budget and come up with a plan.
How do I find out if my fillings have issues?

During your exam, your doctor will feel around your teeth and fillings with an instrument called an explorer. This allows him to feel if there are any broken areas in the filling or any gaps in the seal between filling and tooth. We will also examine the tooth with a digital image (xray) as this will allow us to see if there is decay underneath the filling. From there, the doctor will let you know if the filling is holding up well, needs to be monitored, or needs to be replaced.
If you have any questions, please give us a call! We would love to see you for an exam and consultation regarding your metal fillings, or anything else we can help with.

ADA sources for further reading

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