Should an old amalgam filling be replaced?

Dental amalgam was widely used to restore back teeth. Its mercury content can raise concerns, but an amalgam that is stable, functional and well tolerated should not be removed routinely.

Why not remove every amalgam?

The French Ministry of Health states that exposure from amalgams in place is far below toxic thresholds and that available evidence does not rigorously establish general health harm from sound restorations. Removal is also when mercury exposure may be highest, and it removes additional tooth tissue.

When might replacement be appropriate?

A dentist may advise replacement if there is decay around or beneath the filling, a fracture, leakage, symptoms with an identified cause, or a wider restorative need. The replacement may be composite, ceramic or another option depending on the tooth and mechanical constraints.

Since 1 January 2025, EU rules generally prohibit the use of new dental amalgam except where a practitioner considers it strictly necessary for specific medical needs. This environmental measure does not mean that all existing fillings should be removed.

If a filling causes no problem, monitoring may be sufficient. The decision should follow an examination and a discussion of benefits, risks and alternatives.

Official sources: French Ministry of Health; Regulation (EU) 2024/1849.