Can I have a new amalgam filling replaced with composite?!


Question: I just had an amalgam (silver) filling placed in a molar about two days ago. My dentist asked if I would rather have a composite (tooth colored) filling but I figured since it's close to the back I would save some money and just go with silver. However, I did not realize it would be so noticable. It is on two surfaces. The top and outer part.

My question is can I have it replaced with composite even if it's a new filling? I realize that my insurance will not cover this as it is for cosmetic reasons. I also want to know what the risks may be. I go back to the dentist in a couple weeks to have wisdom teeth removed and I will definitely ask him. Just wanted to find out if anyone knows about this and if there is no use in worrying until then. Would love to hear from a DDS if one happens across this question : ) Thanks so much!


Answers: I just had an amalgam (silver) filling placed in a molar about two days ago. My dentist asked if I would rather have a composite (tooth colored) filling but I figured since it's close to the back I would save some money and just go with silver. However, I did not realize it would be so noticable. It is on two surfaces. The top and outer part.

My question is can I have it replaced with composite even if it's a new filling? I realize that my insurance will not cover this as it is for cosmetic reasons. I also want to know what the risks may be. I go back to the dentist in a couple weeks to have wisdom teeth removed and I will definitely ask him. Just wanted to find out if anyone knows about this and if there is no use in worrying until then. Would love to hear from a DDS if one happens across this question : ) Thanks so much!

If for cosmetic reasons you want to replace the filling, then by all means get it replaced. You are correct...unfortunately insurance typically won't pay. The main risk has to do with the design of the prep...silver fillings don't stick to the tooth...therefor the dentist puts undercut in the prep design. For resins you don't want too much undercut. All this means is that the filling may get a tad bit bigger. Other than that there is minimal risk. It's perfectly understandable to get it replaced if you don't like the look...so talk to your dentist.

There are those who will answer your question touting risks associated with mercury in the filling...don't listen to them...there is no evidence to back it up. I would reccommend a rubber dam though to remove the alloy and place the resin. Reason is that the alloy can be swallowed and can be sharp and that resin (white filling) is easily contaminated by saliva and is much harder for the dentist to place and thusly more expensive. Good Luck

You always have a choice when it come to "elective" dental care. If a dentist does not feel ethically right doing a procedure for whatever reason, he/she may decline to perform it, but I don't think it would be difficult to find a dentist who would be willing to remove a new amalgam to place a composite in its place.

However, I would advise that you at least wear the amalgam for a little longer before you make the final decision. Anything that is new in the mouth - from a full denture to a new crown to a bleaching job to the filling you just got - requires some adjustment time for the patient. Even if it doesn't feel any different, you will likely notice it a huge amount since silver/gray is such a different color that what you're used to seeing in the mirror.

You may also want to try asking people, since it is of course the public's observation that you are concerned about. Ask some friends whether or not, in the course of a normal conversation with them, they can see which tooth just got an amalgam in it. Then maybe smile as you would for a picture, but don't open and have them look inside, since that wouldn't be a normal action and of course they'd be likely to see it then.

I recommend thinking more about it because there are indeed several risks associated with replacing it. If it was a good restoration, it is ALWAYS better to keep it than replace it, especially for purely aesthetic reasons.

The dentist wouldn't just be taking out the amalgam in one piece; it needs to be removed with a bur in a handpiece (dental drill.) In order to ensure that all amalgam is removed, the dentist will remove slightly more tooth structure than just the walls of the preparation (hole that receives the filling) now. So you'll be losing healthy tooth structure. Also, there are some benefits of amalgam over composite in posterior teeth because amalgam gradually forms a tighter seal over the years (from micro-corrosion) whereas composite tends to lose seal if it changes shape at all. Amalgam is usually stronger to resist biting forces and tends to last longer than composite (though there is still a lot of discussion about that idea.) You would also need to go through another round of injections, rubber dam placement, drilling and recovery, all unecessarily. And as with any dental procedure, there are other minor and less likely risks such as infection, occlusion problems, etc.

So as long as you fully understand the risks, feel free to ask the dentist. I personally wouldn't touch it. You'll get used to the occasional notice of it soon, and I swear I can't see it fom here. ;)





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