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Amalgam or composite filling: advantages and disadvantages

  1. With a hole in a tooth, the dentist will first drill out the damaged part of the tooth. After this, this area is made free of bacteria, after which it is filled with a filling. The dentist can choose from many materials for the filling. Gold, porcelain, amalgam and composite are the most commonly used materials. A 'typical' filling, as most people will imagine, is gray / silver in color. In this case amalgam was used. However, white fillings are increasingly common. In this case, the dentist opted for composite. What are the pros and cons of these two different filling materials?

Amalgam or composite filling?

  1. The choice between an amalgam or composite filling is generally translated into the choice between a gray (or silver) or a white (or tooth-colored) filling. Usually, simply by looking in the mirror it is easy to see what type of filling has been used. If you still have doubts, the dental bill can be used to find out what type of material has been used. That's because the codes for amalgam fillings start with V7, while the codes for composite fillings start with V9.

Advantages of amalgam filling ('gray filling')

  1. Amalgam has been used by dentists for over a hundred years. This material has three important advantages.


  1. Amalgam fillings last a long time, usually 10-15 years, but it also happens that amalgam fillings last even longer. This applies not only to small fillings, but also to fillings that cover several surfaces of a tooth or molar. For example, research shows that about half of all large amalgam fillings last more than 11.5 years.


  1. Amalgam fillings are strong, so that they are also suitable for molars that are heavily loaded during chewing.


  1. Amalgam fillings are the cheapest fillings.

Disadvantages of amalgam filling ('gray filling')

  1. Amalgam fillings are, however, less and less used, because this filling material also has some significant drawbacks.

Health risks of mercury: allergies

  1. Although very rare, there have been some reports of people allergic to mercury (one of the materials used in amalgam fillings). It is estimated that about 1% of the population suffers from a mercury allergy. Amalgam is not a suitable filling material for them.

Disputed health risks: cancer, Alzheimer's, MS, etc.

  1. Amalgam fillings, in particular the mercury in these fillings, have been linked to diseases and conditions ranging from Alzheimer's, multiple sclerosis (MS) and cancer to mental illness since the nineteenth century. However, there is no evidence that amalgam fillings are actually linked to any of these diseases. Although some mercury is released from amalgam fillings, this is a minimal amount for which no health risks have been proven.

Aesthetically unattractive

  1. Amalgam fillings are gray in color so they are clearly visible in a tooth. This is generally considered unsightly. Composite fillings, on the other hand, have the color of the tooth in which they are placed, so that in the most favorable case they are hardly visible at all. In the longer term, amalgam fillings can also cause a gray tint to the surrounding dental material.

Requires grinding of healthy teeth

  1. In order for an amalgam filling to remain in place, it is often necessary to drill into healthy dental material in order to create sufficient space and grip for the gray filling.

Cracks and (bone) fractures

  1. Amalgam often reacts more to temperature differences than other filling material does. As a result, cracks or fractures may occur due to the amalgam expanding or contracting a lot.

Advantages of composite filling ('white filling')

  1. The advantages of a composite filling are often the mirror image of the disadvantages of an amalgam filling.

No health risks

  1. There are no known significant health risks for composite fillings. Allergies to composite materials are common, but relatively rare.

More aesthetically pleasing

  1. Composite fillings look better because they are the same color as the tooth in which they are placed. For this reason, white fillings are chosen almost as standard, especially for holes in the front teeth. It may be the case that white fillings discolour over time, so that the aesthetic benefits are (partly) lost.

Saves dental material

  1. Unlike amalgam fillings, composite fillings do not require grinding into healthy dental material. The white filling is namely 'glued' to the tooth or molars, so that no extra space has to be made for grip for the filling. This 'sticking' to the tooth or molar also provides extra adhesion so that the tooth or molar regains more strength (which will be necessary, especially when chewing).

Disadvantages of composite fill ('white fill')

  1. In addition to advantages, white fillings also have some important disadvantages.

Less sustainable

  1. White fillings do not last as long as gray fillings. The typical life of a composite filling is three to ten years. Especially large fillings and fillings in molars that are important for chewing last very short.

More expensive

  1. Composite fillings are more expensive than amalgam fillings.

Placing filling takes longer

  1. Placing a composite filling requires more actions by a dentist than with an amalgam filling. As a result, placing a white refill also takes considerably more time, up to an extra twenty minutes per refill. Multiple dental visits may even be required when composite fillings are used for inlays or onlays.

Risk of abort

  1. Composite fillings have the risk of breaking off as they are less strong than amalgam fillings. For this reason, white fillings are generally not used for large fillings in molars.

Conclusion: white or gray filling?

  1. The above discussion shows that the choice between a composite or an amalgam filling consists of a trade-off between, in particular, durability, strength and price on the one hand and aesthetics and saving of healthy dental material on the other. When choosing, strength will usually be more important, while aesthetic considerations will weigh more heavily with front teeth. On the other hand, the 1% of the population with a mercury allergy makes the choice quickly: they should not take amalgam filling. On the other hand, there is no evidence for other health risks of amalgam fillings, so that health is not a relevant factor in the choice between a gray or a white filling.

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