If you have old silver fillings and you are wondering whether to leave them alone or have them replaced, you are asking a question that comes up in dental practices across the UK every day. Interest in replacing amalgam fillings with composite has grown considerably, driven by aesthetic preferences, concerns about mercury content, and the UK’s ongoing phase-out of amalgam use. At Fitzroy Dental Practice in Fitzrovia, we help patients think through this decision carefully, without pressure. This guide sets out when removal makes clinical sense, what the procedure involves, and what it typically costs.
What exactly is an amalgam filling, and why are patients reconsidering them?
Dental amalgam is an alloy composed of approximately 50% elemental mercury bound with silver, tin, and copper. It has been used in dentistry for over 150 years, and for much of that time, it was the default material for filling back teeth because of its durability and ease of placement. Today, however, its use is being progressively reduced. The UK committed to phasing out amalgam under the Minamata Convention on Mercury, and from 2025 its use has been restricted for most patient groups, including children, pregnant women, and patients with kidney conditions.
Many patients with existing amalgam fillings are now asking whether to have them removed proactively. The honest answer is that it depends on the clinical condition of the filling and the patient’s individual priorities, not a blanket rule in either direction.
Is amalgam still considered safe by UK dental regulators?
The current position of the MHRA and the GDC is that existing amalgam fillings in stable condition do not need to be removed on health grounds alone. The mercury in a set amalgam filling is chemically bound and released only in very small amounts during normal use. That said, the phase-out reflects a precautionary approach consistent with wider environmental policy, and many patients entirely reasonably prefer not to have mercury-containing materials in their mouths going forward.
Why is the UK phasing out the use of amalgam in dentistry?
The phase-out is primarily an environmental measure. Dental amalgam is a significant source of mercury pollution through clinical waste, wastewater, and cremation, and the Minamata Convention commits signatory countries to reducing mercury use across industries. The UK restriction is not a safety recall of existing restorations; it is a forward-looking policy that prevents new amalgam from being placed, particularly in vulnerable patient groups.
What are the signs that an amalgam filling may need to be replaced?
Not all old amalgam fillings need replacing, but many do develop problems over time that make replacement clinically advisable. The most common signs include:
- Visible cracks or fractures in the filling or the surrounding tooth
- A dark stain spreading from the filling margins into the surrounding tooth structure
- Sensitivity to temperature, pressure, or sweetness around the filled tooth
- A loose or ‘rocking’ feeling in the filling when you bite
- Recurrent decay detected beneath or around the filling on an X-ray
An amalgam filling that is dark but otherwise intact, well-sealed, and symptom-free may not require immediate replacement. Your dentist at Fitzroy will assess the condition of each restoration at examination using X-rays where appropriate and give you an honest recommendation.
How do I know if my amalgam filling is failing rather than just old?
Age alone is not a reliable indicator of failure. Some amalgam fillings placed decades ago remain well-sealed and functional; others develop marginal breakdown within a shorter timeframe. The key signs of a failing restoration are those listed above, particularly sensitivity, visible cracking, or decay detected on X-ray beneath the margin. If you have noticed any of these, it is worth booking an examination rather than waiting for your next routine check-up.
Can a cracked tooth caused by an old amalgam filling be repaired with composite?
In many cases, yes. Amalgam fillings exert significant expansion forces on the surrounding tooth structure over time, and cracking of the enamel around an old silver filling is common. The appropriate repair depends on the extent of the crack. A small crack in otherwise healthy tooth tissue can often be managed with a composite replacement; a more extensive crack may require a ceramic onlay or crown to provide adequate structural support. Your dentist will assess this at your consultation.
Should I remove an amalgam filling that is not causing problems purely for aesthetic reasons?
This is a personal decision and one your dentist should respect either way. If the primary motivation is cosmetic, your dentist will discuss the pros and cons honestly: removing a stable amalgam does involve a small risk of disturbing the underlying tooth, and any replacement filling, however well placed, is a new restoration with its own lifespan. Many patients decide the aesthetic and peace-of-mind benefits outweigh this consideration. Others choose to replace only when the existing filling fails. Both are reasonable positions.
Can you actually replace amalgam fillings with composite, and is composite suitable for back teeth?
Yes, and this is one of the most common procedures carried out at private dental practices in London. Modern composite resins are a significant advance on the materials available even ten to fifteen years ago. They bond directly to tooth structure, require less removal of healthy tooth tissue than amalgam, and perform well under normal biting forces in the majority of posterior restorations.
For straightforward to medium-sized amalgam replacements in back teeth, composite is an entirely appropriate and clinically sound choice. For very large restorations where the cavity occupies the majority of the tooth’s chewing surface, your dentist may recommend a ceramic inlay instead, which offers greater structural strength and longevity in high-load situations.
How long does a composite replacement filling last in a back tooth?
With good oral hygiene and regular dental reviews, composite fillings in back teeth typically last between seven and twelve years, with many lasting considerably longer. Longevity is influenced by the size of the restoration, the position of the tooth, and the patient’s bite. Patients who grind their teeth, for example, may experience earlier wear. Your dentist will advise you on maintenance and recall intervals tailored to your situation.
Is a ceramic inlay a better option than composite for a large amalgam replacement?
For larger cavities in heavily loaded back teeth, a ceramic inlay or onlay is frequently the more durable long-term option. Fabricated in a dental laboratory and bonded to the tooth at a second appointment, a ceramic inlay provides exceptional strength and aesthetics. It does cost more than a direct composite filling and requires two visits rather than one, but for the right clinical situation, the additional investment can pay dividends in longevity.
What does the amalgam removal and composite replacement procedure actually involve?
Amalgam removal is carried out under local anaesthetic, so you should feel no pain during the procedure, though you will be aware of vibration and pressure. At Fitzroy, we use safe removal protocols including rubber dam isolation, sectioning of the amalgam into chunks rather than grinding it, and high-volume evacuation to minimise the release of mercury vapour during removal. These precautions protect both the patient and the clinical team.
Once the old amalgam and any underlying decay have been removed, the cavity is cleaned, conditioned, and filled with composite resin in thin layers, each hardened with a curing light before the next is placed. The final restoration is shaped and polished to match your bite and the appearance of the surrounding teeth. Most single-tooth appointments take between 45 minutes and one hour.
Is amalgam removal safe, and does it release mercury vapour?
A small amount of mercury vapour is released during amalgam removal, as it is during normal chewing on an amalgam filling. The safe removal techniques used at Fitzroy rubber dam, sectioning, and high-volume suction reduce this exposure to a minimum. The overall mercury exposure from careful removal is considered by most clinical authorities to be low and time-limited. If you have specific health concerns, discuss them with your dentist before treatment. They can advise based on your individual circumstances.
Will I need more than one appointment to replace multiple amalgam fillings?
This depends on how many fillings are being replaced and your preference. Some patients choose to have all replacements completed across two or three appointments to limit the time spent under anaesthetic at any one visit; others prefer to spread treatment over a longer period. Your dentist will plan a schedule that is clinically sensible and suits your diary.
Does having an amalgam filling removed hurt?
With an effective local anaesthetic, most patients experience no pain during amalgam removal. The injection itself may cause a brief sharp sensation, and some patients find the vibration of the drill uncomfortable even without pain, but most find the procedure far more straightforward than they anticipated. Post-procedure, mild tenderness in the gum around the treated tooth for a day or two is normal and typically resolves quickly.
How much does it cost to replace amalgam fillings with composite in the UK?
The cost of replacing amalgam fillings with composite in the UK depends on whether you are treated under the NHS or privately, and on the size and number of fillings involved. Under the NHS, replacement on clinical grounds where the amalgam is failing, or the tooth is symptomatic, typically falls within Band 2 treatment at a fixed patient charge of £76.60. Replacement for purely aesthetic reasons is not available on the NHS.
For private patients in London, composite amalgam replacement typically ranges from £90 to £300 or more per tooth, depending on the size of the restoration and the complexity of placement. Larger restorations or those requiring ceramic inlays are priced separately. At Fitzroy Dental Practice, we provide a written treatment plan with a clear fee breakdown before any work begins.
Is replacing amalgam with composite available on the NHS, or only privately?
NHS composite replacement is available where there is a clinical justification, a failing filling, a symptomatic tooth, or evidence of decay. Purely cosmetic amalgam removal is not covered under NHS provision. If aesthetics are your primary motivation, private treatment at a practice such as Fitzroy gives you full control over material choice, timing, and the number of teeth treated at each appointment.
How many fillings can be replaced per appointment, and how does that affect the total cost?
Practically speaking, most dentists recommend replacing no more than two to three fillings per appointment, both to limit the time under local anaesthetic and to manage any post-procedure sensitivity comfortably. For private treatment, each filling is priced individually, so the total cost scales with the number of restorations. We are happy to discuss a phased treatment plan that spreads the clinical work and cost over a timeline that suits you.
Does Fitzroy offer 0% finance for amalgam replacement treatment?
Yes. We offer 0% interest-free finance over 12 months with no deposit required, making it possible to replace multiple fillings without a significant upfront payment. Ask our team for full details when you book your consultation.
What should I expect after having amalgam fillings replaced with composite?
Most patients recover quickly and comfortably after amalgam replacement. The local anaesthetic wears off within two to three hours of the appointment, and mild sensitivity to cold or pressure on the treated tooth for a few days to two weeks is normal as the composite settles. This sensitivity typically resolves on its own; if it persists beyond two weeks or worsens, contact your dental practice.
How long will my new composite fillings last, and how do I look after them?
Composite fillings respond well to the same care routine as natural teeth: brushing twice daily with fluoride toothpaste, daily interdental cleaning, and regular dental check-ups. Avoiding extremely hard foods, ice, hard sweets, and crusty bread in quantity reduces the risk of chipping. With consistent care, most composite restorations in back teeth last at least seven to ten years, and often considerably longer.
Should I see the hygienist after having amalgam fillings replaced?
A hygiene appointment following amalgam replacement is always a good idea. Professional cleaning removes plaque and calculus from around the margins of new fillings, giving them the best possible environment to bond and bed in. Your hygienist can also advise on any areas of the mouth that need particular attention during home care and ensure the gum tissue around treated teeth is healthy.
If you would like to discuss amalgam replacement or to have your existing fillings assessed, the team at Fitzroy Dental Practice would be glad to help. We are at 14 Fitzroy Square, Fitzrovia, London W1T 6AH. Call us on 020 7387 3317 or book online.
Frequently Asked Questions
Should I have my amalgam fillings removed?
Not necessarily, if an amalgam filling is clinically stable, well-sealed, and symptom-free, there is no urgent clinical reason to remove it. Replacement is most advisable when a filling is failing, cracked, or showing signs of recurrent decay. If aesthetics or peace of mind are your motivation, your dentist can discuss the pros, cons, and cost at a consultation.
Can amalgam fillings be replaced with composite?
Yes. Modern composite resin is suitable for replacing amalgam in most situations, including back teeth. For very large restorations, a ceramic inlay may offer better long-term durability. Your dentist will assess each tooth individually and recommend the most appropriate material.
How much does it cost to replace amalgam fillings with composite in the UK?
Under the NHS, clinically justified replacement falls within Band 2 at £76.60. Private composite replacement in London typically ranges from £90 to £300+ per tooth. Fitzroy Dental Practice offers 0% interest-free finance with no deposit required.
Is amalgam removal dangerous?
Safe amalgam removal techniques, including rubber dam, sectioning, and high-volume evacuation, minimise mercury vapour exposure during the procedure. The exposure is considered low and time-limited. If you have specific health concerns, discuss them with your dentist before treatment.
How long do composite fillings last compared with amalgam?
In back teeth, composite fillings typically last seven to twelve years or longer with good care. Amalgam historically showed slightly longer average longevity in large restorations, but modern composites have narrowed this gap considerably and offer significant advantages in terms of aesthetics and conservation of healthy tooth structure.
