Restorative Care

Should I Replace My Old Silver Fillings?

Updated October 18, 2026

A lot of people over 50 still have silver fillings from decades ago. Then a new dentist looks at them and says they should all come out. It’s common enough that people search it word for word: “my dentist wants to replace all my fillings.”

Sometimes that’s the right call, and sometimes it isn’t. Here’s how I decide.

The short answer: if an old silver filling looks clinically acceptable, with no obvious breakdown or decay around it and no cracks in the tooth, I keep monitoring it. No filling lasts forever, though, and there are good reasons to replace one. And if you want yours out, I’ll replace them.

When I leave them alone

An old silver filling that’s doing its job doesn’t need to come out just because it’s old or silver. When I look at one, I’m checking three things:

The edges. Is the filling breaking down where it meets the tooth?
Decay. Is there any new decay around it or under it?
Cracks. Is the tooth itself cracking around the filling?

If the answer to all three is no, I keep watching it at your regular visits.

When I replace them

Breakdown or decay at the edges or underneath.
A crack in the tooth. A crack doesn’t heal, and it can keep growing even when it doesn’t hurt. Why a crack around a filling matters.
A neighbor needs work. No restoration lasts forever, and depending on when the old filling was placed, if the tooth next to it has a problem, it may make sense to replace both, especially when the two fillings sit right against each other. Making two new restorations at the same time lets me rebuild the spot where the teeth touch the way it should be. That’s a recommendation, though. Which teeth get treated is always your choice.

What usually replaces it

Unless the old filling is very small, the tooth will often need full coverage, usually a crown. The alternative is an even larger filling, and very large fillings don’t seem to last as long. How crowns work.

When a filling is the right answer, it’s tooth-colored composite. That’s the only kind of filling we place. More on fillings.

If you want them out anyway

Some people want their silver fillings out even when they’re holding up fine, and I’ll replace them if you ask. We always remove them under water spray, never dry, with high-volume suction. Beyond that we don’t use any special protocols, and I work to remove the old filling as quickly as possible.

The FDA doesn’t recommend removing silver (amalgam) fillings that are in good condition. Its reasons are that removal takes healthy tooth structure along with the filling, and that it briefly increases the mercury vapor released.

The research on that vapor is reassuring, though:

Water spray and suction together kept mercury vapor consistently below the safety limit in a dental school study. Drilling without them is what pushed it over.
With high-volume suction, mercury vapor in the dentist’s breathing zone while old fillings were removed measured far below the occupational safety limit.
Running the suction for one more minute after the drilling cut the mercury released by about 90% in a lab study.
In a treatment room, mercury vapor returned to background levels within 10 to 20 minutes when the room was ventilated, and within 20 to 30 minutes even when it was poorly ventilated.

That’s why water spray and high-volume suction are what we use.

U.S. Food and Drug Administration. Dental Amalgam Fillings. fda.gov, content current as of February 18, 2021.
Pohl L, Bergman M. The dentist’s exposure to elemental mercury vapor during clinical work with amalgam. Acta Odontol Scand. 1995;53(1):44-48.
Engle JH et al. Quantitation of total mercury vapor released during dental procedures. Dent Mater. 1992;8(3):176-180.
Ferracane JL et al. Reduction in operatory mercury levels after contamination or amalgam removal. Am J Dent. 1994;7(2):103-107.
Warwick R, O’Connor A, Lamey B. Mercury vapour exposure during dental student training in amalgam removal. J Occup Med Toxicol. 2013;8(1):27.

“Another dentist wants to replace all my fillings”

If you’ve been told your fillings all need to come out and you’re not sure, I take photos so you can see what I’m seeing, and we talk about two separate questions:

Do the teeth clinically need it? Breakdown, decay, cracks.
What do you want? Some people want them out regardless, and that’s a fair choice too.

Both answers matter, and it helps to keep them apart. If you have recent X-rays or the other office’s treatment plan, bring them.

Where to start

If you have old silver fillings and want an honest look at them, call 702-734-0776 or tell us what’s going on.

General education, and not a substitute for an exam.

Common Questions

Should I replace my old silver fillings?

Not just because they’re old. If a silver filling looks clinically acceptable, with no obvious breakdown or decay around it and no cracks in the tooth, I keep monitoring it. I replace one when it’s breaking down, there’s decay around it or under it, the tooth is cracking, or the tooth next to it needs work.

My dentist wants to replace all my fillings. Is that necessary?

Sometimes, but it’s worth a second look. I take photos so you can see what I’m seeing, and we talk about two separate questions: whether the teeth clinically need it, and what you want. If you have recent X-rays or the other office’s treatment plan, bring them.

Will you replace silver fillings if I want them out?

Yes. We always remove them under water spray, never dry, with high-volume suction, and I work to remove the old filling as quickly as possible. Beyond that we don’t use any special protocols. The FDA doesn’t recommend removing amalgam fillings that are in good condition, because removal takes healthy tooth structure and briefly increases mercury vapor. Research shows that with water spray and suction, vapor levels stay below safety limits and clear the room within minutes.

Is it safe to remove silver fillings?

The FDA says removal briefly increases the mercury vapor released. Studies found that with water spray and high-volume suction, vapor stayed below occupational safety limits, and in a treatment room it returned to background levels within 10 to 20 minutes with ventilation. We always remove them wet, never dry.

Why replace a filling that isn’t causing problems?

Sometimes because the tooth next to it needs work. Depending on when the old filling was placed, if the neighboring tooth has a problem and the two fillings sit against each other, making two new restorations at the same time lets me rebuild the spot where the teeth touch the way it should be. It’s a recommendation, though. Which teeth get treated is always your choice.

Will I need a crown instead of a new filling?

Often, yes. Unless the filling is very small, the tooth will often need full coverage, usually a crown, because the alternative is an even larger filling, and very large fillings don’t seem to last as long.

What do you replace silver fillings with?

When a filling is the right answer, tooth-colored composite. It’s the only kind of filling we place. Unless the old filling is very small, the tooth often needs a crown instead.