Removing amalgam (silver) fillings, with protective steps
Some patients ask us to replace their old silver fillings. If you choose removal after talking it through with your dentist, the filling is taken out with steps that reduce the mercury vapor and particles released, and the tooth is restored with a tooth-colored material. Kitcha Dental Clinic does not place amalgam.
- Open every day, 09:00–20:00
- Opposite Chiang Mai Gate
- Coordinators in English and Thai
Is this you?
- You have old silver fillings and want to know whether they should be replaced.
- An amalgam filling is cracked, worn or has decay around it.
- You would prefer tooth-colored fillings for how they look.
- You have decided to replace your amalgam fillings and want the removal done carefully, step by step.
Replacing fillings that are still intact is a choice you make with your dentist. We explain what the evidence says, including the downsides of removal, before any treatment.
What the evidence says about amalgam
Dental amalgam is a mix of mercury with silver, tin and copper, and has been used for fillings for many decades. It releases small amounts of mercury vapor, more when it is chewed on, ground or drilled.
The US Food and Drug Administration (FDA) states that studies do not show conclusive evidence that amalgam causes harmful health effects in the general population. The American Dental Association considers it a safe and durable filling material.
In 2020 the FDA recommended that certain higher-risk groups receive non-mercury fillings when possible and appropriate: people who are pregnant, planning a pregnancy or breastfeeding, young children, people with kidney problems or certain neurological diseases, and people allergic to mercury.
Countries are phasing out amalgam under the Minamata Convention on Mercury, mainly to reduce mercury pollution in the environment. This does not mean that fillings already in your mouth need to be removed.
Removing amalgam fillings is not a treatment for any illness, and we do not promise that removal will change how you feel.
Should you have your fillings removed?
When replacement is needed
The filling is broken or leaking, there is decay under it, or the tooth is cracked. Replacing it is then part of normal treatment.
When it is your choice
The filling is intact and you want it replaced, for appearance or peace of mind. Your dentist explains the benefits and the downsides so you can decide.
When waiting may be better
The FDA does not recommend removing intact amalgam fillings unless it is medically necessary. Removal briefly increases mercury vapor exposure and also removes some healthy tooth structure.
If you are pregnant or breastfeeding, have kidney disease, or are asking for a young child, read the next section before booking.
Pregnancy, breastfeeding, kidney disease and children
Following the FDA's recommendations, removing intact amalgam fillings is generally not advised during pregnancy or while breastfeeding, because removal itself briefly increases mercury vapor. Replacing a filling by choice can usually wait.
The same caution applies to people with kidney disease and to young children. If a filling is broken or decayed, your dentist discusses how to treat the tooth and which material to use.
Please tell us when you book if any of these apply to you.
Not sure whether to replace your fillings?
Book a check-up. Your dentist examines each filling, takes X-rays if needed, and explains whether replacement is needed, what it involves and the fee, so you can decide.
Why protective steps matter during removal
Drilling out an amalgam filling releases mercury vapor and fine particles for a short time. Studies have found that water spray, high-volume suction and a rubber dam reduce this exposure for the patient and the dental team.
When we remove amalgam fillings, we use the protective steps below. Your dentist goes through them with you before treatment.
Our protective steps
Rubber dam
A thin rubber sheet placed around the tooth every time, so water and particles do not go into your mouth or throat.
High-volume suction near the tooth
A wide suction tip held next to the filling removes vapor, water and particles as they are produced.
Plenty of water spray
Water keeps the filling cool while it is cut, because heat increases the mercury vapor released.
Removing the filling in chunks
The filling is cut into a few pieces and lifted out, rather than ground down to dust, to reduce vapor and particles.
Charcoal rinse
You rinse your mouth with a charcoal rinse as one of the steps of the procedure.
Separate air supply
Air or oxygen through a small nose mask, so you breathe less of the air around your mouth during removal.
Covering your eyes and skin
Protective eyewear and a cover over your face and clothing.
Extra suction or air filtration
A suction unit near your mouth or an air filter in the room captures vapor that escapes.
What happens at your visits
Consultation and examination
Your dentist checks each filling, takes X-rays if needed, asks about your health, including pregnancy and kidney disease, and explains whether removal is needed or optional.
Planning
If you decide to go ahead, your dentist plans which teeth to treat first, how many visits you need and which replacement material suits each tooth, and explains the fee.
Removal with protective steps
Most patients have the tooth numbed with local anesthesia. The protective steps are put in place, and the amalgam is removed. Any decay underneath is then cleaned out.
The new restoration
Smaller teeth are usually filled with tooth-colored composite at the same visit. Larger ones may need an inlay, an onlay or a crown, made after an impression or scan and fitted at a later visit.
The number of visits depends on how many fillings you have and how large they are. Your dentist plans them with you.
What replaces the amalgam
Composite resin filling
A tooth-colored filling, placed and hardened at the same visit. Suits small and medium fillings.
Ceramic inlay or onlay
A piece made to fit the tooth and bonded in place. Often suggested when the old filling was large.
Crown
For a tooth that is cracked or has very little of its own structure left after the filling is removed.
Your dentist recommends a material based on the size of the old filling and the condition of the tooth.
Cost of amalgam removal
There is no single price for amalgam removal. Each of these is charged as a separate item: the protective supplies used during removal, including the rubber dam, charged per visit; oxygen through the nose mask; local anesthesia; and the new restoration for each tooth, such as a composite filling or an inlay or onlay. The protective supplies and the restorations are listed on our prices page. Oxygen and local anesthesia are not listed there; your dentist explains these fees before treatment. X-rays are charged separately, only if you need them.
Prices on our prices page are shown as ranges. Your final fee depends on what the examination finds, and may include additional items — such as special materials — when your treatment needs them. Your dentist explains these before treatment.
Amalgam removal FAQs
Are amalgam fillings dangerous?
For most people, the evidence does not show that amalgam fillings in good condition cause health problems. The FDA and the American Dental Association consider amalgam safe for the general population. In 2020 the FDA recommended non-mercury fillings, when possible and appropriate, for some higher-risk groups such as pregnant women and young children.
Should I have my amalgam fillings removed?
Only if there is a reason you and your dentist agree on. Broken, leaking or decayed fillings need replacing anyway. The FDA does not recommend removing intact fillings unless medically necessary, because removal briefly increases mercury vapor and removes some healthy tooth. If you still prefer replacement, for example for appearance, your dentist explains the pros and cons first.
Does removing amalgam release mercury?
Yes, for a short time. Cutting the filling releases mercury vapor and fine particles. Water spray, high-volume suction and a rubber dam reduce the exposure, which is why protective steps are used during removal.
Will removing my fillings improve my health?
We cannot promise that. Removing amalgam is not a treatment for any illness, and there is no reliable evidence that it improves general health or symptoms. If you have health concerns, please also discuss them with your doctor.
Can I have amalgam removed while pregnant or breastfeeding?
Following the FDA's recommendations, removing intact amalgam fillings is generally not advised during pregnancy or breastfeeding, because removal briefly increases mercury vapor. If a filling is broken or decayed, your dentist discusses how to treat the tooth. Please tell us if you are pregnant or breastfeeding when you book.
How many visits will I need?
It depends on how many fillings you have and how large they are. A small filling replaced with composite is usually done in one visit. Inlays, onlays and crowns need a second visit. If you have several fillings, your dentist may suggest treating one area per visit.
What replaces the amalgam?
Usually tooth-colored composite resin for small and medium fillings, or a ceramic inlay, onlay or crown when the old filling was large or the tooth is cracked. Your dentist recommends a material for each tooth.
Do you use amalgam (silver) fillings?
No. Kitcha Dental Clinic does not use amalgam. Fillings are made with tooth-colored composite resin; for larger cavities your dentist may suggest an inlay, an onlay or a crown.
Ask about amalgam removal
Tell us how many silver fillings you have, whether any are causing problems, and about any health conditions such as pregnancy or kidney disease. A coordinator will reply in English or Thai and book a consultation. Open every day, 09:00–20:00 (Thailand time).
Or email us at [email protected]
Content reviewed by Dr. Pawak Tungthangthum — DDS, Chiang Mai University; Master's Degree in Esthetic Restorative and Implant Dentistry (International Program), Chulalongkorn University · Last reviewed