In early dentistry and up until the advent of bonding in the early 1980’s virtually every groove with a stain was considered at risk and therefore filled. The fillings were made even larger by the a treatment philosophy called “extension for prevention” which meant if there was a groove near the decay you drilled it out and filled it also. In addition the filling material itself, silver amalgam needed a specific thickness and width to be strong enough to function. This produced large silver fillings that many of us baby boomers have in our mouths today. The good news is that they may not be pretty but a well done silver filling lasts for decades. I have seen silver fillings that are over sixty years old.
Are silver fillings a health risk?
Some claim that all silver fillings should be removed because they are toxic or can break teeth(see cracked tooth). Passionate arguments are made by advocates for and against silver fillings. The scientific and academic communities have studied the question and have not found conclusive scientific evidence against silver fillings. In fact according to the American Dental Association a dentist who claims to a patient he is removing their silver fillings to cure their health problems is violating ethical standards. Where do I stand on this? In the middle. If a patient believes that removing their silver fillings will improve their health I will help them but I will but not promise them a cure for their systemic illness. I still have silver fillings in my mouth. Also recent studies have suggested that the chemicals used with the newer porcelain fillings may have issues of their own. So then what do you do? Just leave the holes unfilled?
How do you know a filling needs to be replaced?
So when does a filling need to be replaced? If it breaks, decays around the edges or becomes difficult to clean. So if you feel a sudden edge develop,a piece fall out, a space develop between your teeth, feel something move when you floss, or develop a sensitive tooth, you should have your dentist check it out. Many of these same symptoms indicate the need to replace a porcelain filling as well. The difficulty with porcelain fillings is that they can stay bonded and sealed in one area not showing any defects and de-bond and leak rapidly in another . Silver fillings never have looked pretty but their ability to stay sealed and decay free in spite of their appearance is well documented.
How does the dentist know a filling needs to be replaced?
The dentist will check the edges of the filling and use radiographs to evaluate for decay. Sometimes its as simple as just smoothing the rough edge. This is not rocket science. The dentist should be able to show you in a mirror or with an intra-oral camera his concerns. Ask him to point it out. With the advent of digital x-rays decay is much easier to see for the dentist and patient, its like watching a big screen TV. Reading x-rays does take some training but the dentist should be able to explain and point out to you what he is looking at. Usually darkness means decay. A dentist should be able to address your concerns and questions. It is your job to ask and be your own advocate. If you don’t feel comfortable get a second opinion.