Are Silver (Amalgam) Fillings Safe, and Should You Replace Them?

Are silver amalgam fillings safe?

For most people, yes, according to the FDA. Its amalgam page says most evidence shows that mercury from amalgam does not lead to negative health effects in the general population. The page also calls amalgam strong, long-lasting, and the least expensive filling material (FDA, 2021).

That does not mean "safe for everyone." The FDA names groups it sees as more at risk from mercury, listed below. The page also notes that how long a filling lasts depends on many things besides the material.

The page we reviewed is marked "current as of" February 18, 2021. The FDA says it will update the public if significant new information appears. Check fda.gov for the current wording.

What is a silver filling made of?

A silver filling is dental amalgam, a mix of metals. Despite the silver color, about half of it (50 percent) is elemental mercury by weight, the FDA says. The rest is a powdered alloy, mostly silver, tin, and copper. Dentists have used amalgam for more than 150 years, according to the ADA.

The ADA describes amalgam the same way: liquid mercury mixed with a powdered alloy of mostly silver, tin, and copper (ADA, 2023). The mercury is why safety questions come up. It is also why the FDA gives specific advice for certain groups and for removal.

Who does the FDA say should avoid new amalgam fillings?

In September 2020, the FDA recommended that certain high-risk groups avoid getting dental amalgam whenever possible and appropriate. This advice is targeted. It is not meant for the whole public. These are the groups the FDA named in its announcement (FDA, 2020):

• Pregnant women and their developing fetuses

• Women who are planning to become pregnant

• Nursing women and their newborns and infants

• Children, especially those younger than six years of age

• People with pre-existing neurological disease, such as multiple sclerosis, Alzheimer's disease, or Parkinson's disease

• People with impaired kidney function

• People with a known heightened sensitivity (allergy) to mercury or other components of dental amalgam

The advice covers getting new amalgam. The same announcement says the FDA does not recommend removing existing fillings in good condition. The exception is when a health care professional says removal is medically necessary.

What does the ADA say, and is anything changing?

The ADA says amalgam remains an important option for certain patients, and it backs the dentist's judgment on when to use it. In July 2026, the chair of the ADA Council on Scientific Affairs said that replacing serviceable amalgam only because it contains amalgam is not supported by scientific evidence.

The ADA's amalgam page calls the material safe, durable, and affordable (ADA, 2023). On July 22, 2026, the Center for Medicaid and CHIP Services emailed state Medicaid directors. It encouraged them to restrict or end coverage for amalgam procedures. The ADA replied that dentists should be able to choose the right evidence-based treatment for each patient. The email is not a requirement, and states decide coverage (ADA News, 2026).

Should I replace my silver fillings?

Replace a silver filling when the filling or the tooth has a problem, not because of the material alone. The FDA does not recommend removing fillings in good condition. Removal also costs healthy tooth structure and briefly raises mercury vapor. A dentist can tell you if your filling needs work.

This table shows how common situations tend to play out.

A 2025 meta-analysis pooled 13 studies. It found no clear difference in how often amalgam and composite fillings failed (risk ratio 0.96). The authors named secondary decay (new decay at the edge of a filling) and fracture as common reasons for failure. They urged caution, since studies defined failure in different ways and results varied widely (Al-Sulimmani et al., 2025). A lost filling or crown is a reason to call, whatever it was made of.

Questions to ask at your exam

1. Does this filling show decay, a crack, or a gap at the edge?

2. Does the tooth still have enough strength, or does it need a crown?

3. Does anything in my health history, such as pregnancy or kidney disease, change the plan?

4. If you replace it, what material would you use, and why?

5. How much natural tooth will be removed?

How is amalgam removed safely?

Safe removal means limiting the mercury vapor and dust made while the old filling is drilled out. Common precautions include a rubber dam to isolate the tooth, water spray, and high-volume suction. The FDA page does not list step-by-step precautions, so ask your dentist what the plan will be.

The FDA warns that removal briefly raises your exposure to mercury vapor (FDA, 2021). The ADA says a dental dam may have some use in reducing exposure, though the data are limited. It also notes that the World Dental Federation (FDI) recommends high-volume suction with traps or filters when removing amalgam (ADA, 2023).

Two studies support these steps. A 1997 study followed 28 people. Right after removal, only the group treated without a rubber dam had a significant rise in mercury in blood plasma and urine (Berglund and Molin, 1997). In a 2013 lab test, mercury vapor stayed below the workplace ceiling when both water spray and suction were used. With neither, more than a third of readings went over it (Warwick et al., 2013). That test used artificial teeth, so it shows the principle, not what happens in a mouth.

What are the alternatives to amalgam fillings?

The main options are composite resin, glass ionomer, and indirect restorations made of ceramic or gold. Composite and glass ionomer are tooth-colored. Each has strengths and limits. The right choice depends on the size of the cavity and how hard the tooth works.

The table below summarizes the FDA's descriptions (FDA, 2020; FDA, 2021).

For a deeper comparison, see our guide to modern dental fillings and how long they last. You can also read about tooth-colored fillings, fillings in general, and crowns and bridges for teeth that need more coverage. Ask us which options we use for your case.

How we approach this at Gardens

At Gardens Implant & Cosmetic Dentistry, the first question is the condition of the tooth. The material comes second. We start with your health history. That includes pregnancy, kidney or neurological conditions, and known allergies, so we can see if you fall into one of the FDA's groups.

During the exam, we check each older filling and the tooth around it. We look for decay, cracks, worn or open edges, and symptoms such as pain with chewing or temperature. X-rays help us see decay hidden under or beside a filling. We compare what we find with the FDA and ADA positions, which say sound fillings generally do not need to come out.

If a filling needs work, Dr. Hans Almanzar, DDS, reviews the options with you. That includes the material, how much tooth is involved, and whether a crown makes more sense than a new filling. If you are expecting, we coordinate timing with your other providers where needed. Ask us which materials and removal precautions we would use for your case.

When to call right away

An old filling with a problem can turn painful or serious. Do not wait for it to get worse. Call a dentist promptly if you notice any of the following. If you are pregnant, our guide on dental emergencies while pregnant explains what to do.

• Pain, swelling, or a bad taste near a filled tooth

• A broken or lost filling, or a tooth that has cracked

• Sharp pain when biting, or with hot or cold, that does not fade

• A rash, hives, or mouth sores that you think may be linked to a filling

If swelling spreads to your face or neck, or you have trouble breathing or swallowing, call 911 or go to an emergency room right away.

Frequently asked questions

Does the FDA tell everyone to avoid amalgam fillings?

No. In September 2020 the FDA recommended that certain high-risk groups avoid getting dental amalgam whenever possible and appropriate. For everyone else, the FDA page says most evidence shows mercury exposure from amalgam does not lead to negative health effects. The choice of material is made between you and your dentist.

Can silver fillings make me sick?

For most people, the FDA says the evidence shows no negative health effects from the mercury in amalgam. A small number of people are allergic or very sensitive to mercury or other parts of amalgam. The ADA notes that removing amalgam normally relieves allergy symptoms. Talk with your dentist and physician if you suspect a reaction.

Is it safe to have silver fillings removed during pregnancy?

The FDA does not recommend removing amalgam fillings in good condition. It says removal briefly raises mercury vapor exposure. It also lists pregnant women among the groups that should avoid getting new amalgam. If a tooth has a real problem during pregnancy, talk with your dentist and your obstetric provider about timing and options.

What are mercury-free fillings made of?

The FDA names composite resin and glass ionomer cement as the main non-amalgam options. Composite is tooth-colored plastic reinforced with glass, and glass ionomer is a tooth-colored cement that releases fluoride. Indirect restorations (caps) made of ceramic or gold are other options. Your dentist can match the material to the tooth.

Will my insurance or Medicaid stop covering amalgam?

Not automatically. On July 22, 2026, a federal Medicaid office encouraged state Medicaid directors to consider restricting amalgam coverage. The guidance is not a requirement, and states make their own coverage choices. Private dental plans vary, so check your plan or ask our office to help you read it.

Can I just have my silver fillings replaced for cosmetic reasons?

You can discuss it, but there are trade-offs. The FDA says removing intact amalgam fillings means unnecessary loss of healthy tooth structure and a brief rise in mercury vapor. In 2026 an ADA council chair said replacing sound fillings only for their amalgam is not supported by evidence. Weigh the cosmetic benefit against those costs.

Sources

1. U.S. Food and Drug Administration, "Dental Amalgam Fillings" (content current as of February 18, 2021), https://www.fda.gov/medical-devices/dental-devices/dental-amalgam-fillings

2. U.S. Food and Drug Administration, "FDA Issues Recommendations for Certain High-Risk Groups Regarding Mercury-Containing Dental Amalgam" (press announcement, September 24, 2020), https://www.fda.gov/news-events/press-announcements/fda-issues-recommendations-certain-high-risk-groups-regarding-mercury-containing-dental-amalgam

3. U.S. Food and Drug Administration, "Treatment Options for Dental Caries" (content current as of September 29, 2020), https://www.fda.gov/medical-devices/dental-amalgam-fillings/treatment-options-dental-caries

4. American Dental Association, "Amalgam" (Oral Health Topics, last updated June 21, 2023), https://www.ada.org/resources/ada-library/oral-health-topics/amalgam

5. ADA News, "Center for Medicaid and CHIP Services encourages states to restrict amalgam coverage", July 2026, https://adanews.ada.org/ada-news/2026/july/center-for-medicaid-and-chip-services-encourages-states-to-restrict-amalgam-coverage/

6. Al-Sulimmani W, et al., "Failure Risk of Composite Resin and Amalgam Restorations: A Systematic Review and Meta-Analysis", International Dental Journal, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC12246595/

7. Berglund A, Molin M, "Mercury levels in plasma and urine after removal of all amalgam restorations: the effect of using rubber dams", Dental Materials, 1997, https://pubmed.ncbi.nlm.nih.gov/9823089

8. Warwick R, O'Connor A, Lamey B, "Mercury vapour exposure during dental student training in amalgam removal", Journal of Occupational Medicine and Toxicology, 2013, https://pmc.ncbi.nlm.nih.gov/articles/PMC3850894/