Why Dentistry Is Moving Away from Amalgam

For generations, dental amalgam, commonly known as the silver filling has been widely used to restore decayed teeth. Its strength, durability and affordability made it particularly useful for back teeth exposed to heavy chewing forces.

Today, however, dentistry is gradually moving away from amalgam. This transition is part of a worldwide effort to reduce the use and environmental release of mercury while encouraging mercury-free restorative materials and more preventive, minimally invasive dental care.

What is dental amalgam?

Dental amalgam is a mixture of metals containing approximately 50% elemental mercury by weight, combined with metals such as silver, tin and copper. Once mixed, it forms a strong restoration capable of functioning for many years.

The move away from amalgam does not mean that every amalgam restoration is suddenly considered unsafe. The global transition is primarily connected to reducing mercury use and its release into the environment throughout the material’s lifecycle.

THE GLOBAL PHASE-OUT

The Minamata Convention on Mercury is an international agreement created to protect human health and the environment from mercury pollution.

In 2025, countries participating in the Convention agreed to phase out the manufacture, import and export of dental amalgam globally by 2034, while retaining limited exceptions where a dental practitioner considers amalgam necessary based on individual patient needs.

What will replace silver fillings?

Dentistry already has several mercury-free restorative options, including:

• Composite resin – tooth-coloured and bonded to tooth structure.
• Glass ionomer cement (GIC) – chemically adheres to the tooth and releases fluoride.
• Resin-modified glass ionomer and other adhesive restorative materials -useful in selected clinical situations.

The dentist selects a restorative material according to the size and location of the lesion, remaining tooth structure, moisture control, biting forces, caries risk, age and patient cooperation.

FROM REPLACING AMALGAM TO PREVENTING RESTORATIONS

What does this mean for children?

The change is particularly relevant to pediatric dentistry. International mercury-reduction measures have specifically targeted amalgam use in primary teeth and younger patients, except where its use is considered necessary by the dental practitioner.

But the bigger change in children’s dentistry is not simply:

Silver filling → Tooth-coloured filling

It is:

Restoration-focused dentistry → Disease-focused dentistry

Instead of waiting for early caries to progress into a large cavity, modern pediatric dentistry aims to identify disease earlier and intervene according to the child’s caries risk and lesion activity.

Management may include fluoride therapy, pit-and-fissure sealants, remineralization, silver diamine fluoride (SDF) for appropriate lesions, glass ionomer restorations, selective caries removal, dietary modification and improved plaque control.

The objective is simple:

Prevent → Remineralize → Arrest → Preserve → Restore when necessary

Do existing amalgam fillings need to be removed?

Not simply because amalgam is being phased out.

An existing restoration should be assessed clinically. If an amalgam restoration remains functional and the surrounding tooth is healthy, the global phase-out alone is not a reason for automatic replacement.

Unnecessary removal may sacrifice additional healthy tooth structure and result in a larger restoration.

A dentist should instead evaluate:

Restoration integrity • recurrent caries • marginal defects • cracks/fractures • symptoms • remaining tooth structure

Repair or replacement can then be recommended when there is an actual clinical indication.

A new direction for dentistry

The disappearance of amalgam represents something larger than changing filling materials.

The traditional approach was often:

Caries → Drill → Fill

Modern dentistry increasingly aims for:

Risk assessment → Prevention → Early detection → Remineralization → Caries arrest → Minimal intervention → Conservative restoration when required

Dental amalgam has served restorative dentistry for generations. Its global phase-out marks a transition toward mercury-free materials and more conservative dental care, rather than a reason for patients with existing silver fillings to panic. The future is not simply about finding a new filling. It is about needing fewer fillings in the first place. The best tooth structure is the natural tooth structure we preserve.