Answer: I generally recommend the replacement of old amalgams when there is obvious decay (a cavity) around or under the filling, when there are cracks in the surrounding tooth structure, or there is a gap between the tooth and the filling. The vast majority of amalgams that are more than fifteen years old have cavities underneath them, and should probably be replaced. Most American adults have several of these old, “leaking” restorations in their mouths.
I haven’t personally used amalgam for the past seven years because I became convinced that there are better materials available for restoring teeth, and I wouldn’t want amalgam fillings in my own mouth or the mouths of my family members. It was the best available restorative material for many decades, and it helped dentists restore teeth that would have been otherwise removed. Unfortunately, it is often difficult to detect cavities lurking beneath old silver/mercury fillings, and problems can escalate rapidly, often without warning.
Additionally, amalgam creates a “metal wedge” within a tooth that tends to cause fracture of the tooth over time. Sometimes it causes cracks within the tooth, which can create pain to pressure, hot, or cold. It will often lead to catastrophic breakage creating the need for root canal therapy or removal of the tooth in question. These potential emergencies can usually be avoided by upgrading the amalgams preventatively.
There are several options for amalgam (silver/mercury fillings) replacement. Once the tooth has cracked or broken, restoration of the tooth with a crown or inlay is generally necessary in order to cover up the weak areas and hold the tooth together. In some cases, the tooth can be restored with a tooth-colored filling or an inlay. Any of these restorations can be very effective if done properly.
When amalgams are “upgraded” to new restorations, the choice of restoration is dependent upon several factors. These include, but are not limited to, how much tooth structure remains, which tooth is being restored, how the tooth “lines up with” the other teeth, and how much force the tooth will need to endure.
If you have a good relationship with your dentist, you should trust his or her recommendation as to when and how these old restorations should be upgraded. It’s just nice to know that there are excellent options available.
Dr. Jim Arnold is a practicing dentist in Chesterton and Valparaiso. He is also a clinical mentor with the Hornbrook Group and serves on the Advisory Board for the Academy of Comprehensive Esthetics as the Fellowship Chairman. You may send questions to his office at 1830 South 11th Street, Chesterton, IN 46304, or email them to drarnold@SmilesByArnold.com. More information on this or any other dental topics can be found at www.SmilesByArnold.com.