Mercury dental fillings (dental amalgam) are safe for most healthy adults, but a major federal policy shift is accelerating their phase-out across the U.S. Here’s what the science actually says, who should pay closest attention, and what your options look like today.
- In 2026, the Trump administration issued guidance encouraging states to end the use of mercury-containing dental amalgam fillings, building on a 2023 FDA rule that already restricted their use for high-risk groups.
- For most healthy adults with existing amalgam fillings, the current evidence does not support removing them solely out of concern, as removal itself releases more mercury vapor than leaving them in place.
- High-risk groups, including pregnant women, children under six, people with kidney disease, and those with certain neurological conditions, should discuss alternatives with their dentist before getting new amalgam.
- Composite resin (tooth-colored) and ceramic restorations are the main mercury-free alternatives, and they’ve improved dramatically in durability over the past decade.
- If you have questions about your existing fillings or want to discuss alternatives, our team at Vaksman Dental Group in South San Francisco can walk you through your specific situation.
What exactly is dental amalgam, and why does it contain mercury?
Dental amalgam has been used for over 150 years. It’s a mixture of metals: roughly 50% elemental mercury, combined with an alloy of silver, tin, and copper. The mercury binds everything together and gives amalgam its durability and workability.
The reason it became so popular is straightforward: amalgam is tough, relatively inexpensive, and can be placed even in a slightly wet environment, which matters in the back of your mouth where keeping a tooth perfectly dry is genuinely difficult. For decades, it was the standard choice for molars.
The concern is that mercury, as an element, is a known neurotoxin at high doses. Amalgam fillings do release tiny amounts of mercury vapor, especially when you chew, grind your teeth, or drink something hot. The key question has always been: is that amount significant enough to cause harm in a typical patient?
What did the FDA and federal government actually say?
This is where it gets a little complicated, because there have been two distinct federal actions.
In 2023, the FDA issued a final rule restricting dental amalgam use for specific high-risk groups. The rule said that people in those groups should avoid amalgam unless no alternative is available. That was a regulatory rule with legal weight.
In 2026, the Trump administration’s Department of Health and Human Services went further, issuing guidance encouraging states to phase out mercury-containing dental amalgam more broadly. This is guidance, not a federal ban, meaning the administration is signaling policy direction and encouraging action at the state level rather than mandating it everywhere overnight.
The European Union already agreed to a full phase-out by 2025 as part of environmental agreements around mercury pollution. The U.S. is now moving, however gradually, in a similar direction.
Who is in the high-risk group that should avoid new amalgam fillings?
According to the FDA’s guidance on dental amalgam, the groups for whom the risks warrant extra caution include:
- Pregnant women and those planning to become pregnant
- Women who are breastfeeding
- Children under six years old
- People with kidney impairment (kidneys filter mercury, so reduced kidney function means slower elimination)
- People with certain neurological conditions
- People with known sensitivity or allergy to mercury or other amalgam components
If you’re in one of these groups, the conversation with your dentist should happen before any new filling is placed, not after. Alternatives exist and are covered below.
I already have silver fillings. Should I get them removed?
This is probably the most common question we hear when this topic comes up in our office. The answer for most people is: no, not solely because of mercury concern.
Here’s why. Intact amalgam fillings that are bonded to your tooth release a very small amount of mercury vapor during normal use. When a dentist drills out an amalgam filling, however, that process generates much higher levels of mercury vapor and particles, at least temporarily. So unless a filling is cracked, failing, or causing another problem that requires replacement, the act of removing it can expose you to more mercury than leaving it alone would.
The American Dental Association has consistently held this position: for patients without specific risk factors, routine removal of functioning amalgam fillings is not recommended based on current evidence.
That said, if a filling is old, worn, cracked, or needs to be replaced for any clinical reason, that’s a perfectly reasonable moment to choose a mercury-free restoration. Over time, your silver fillings will naturally be replaced as they wear out, and increasingly, modern alternatives will fill that gap.
What are the mercury-free alternatives, and how do they hold up?
The two main alternatives have genuinely improved in the last decade, which is a big part of why the amalgam conversation has shifted. They’re no longer a clear compromise in durability.
Composite resin (tooth-colored fillings): Made from a mixture of plastic and glass particles, composite is bonded directly to the tooth. It looks natural, requires slightly less removal of healthy tooth structure, and has become much more durable for back teeth than it was 15 to 20 years ago. It’s now the default choice for most small-to-medium cavities at most modern dental offices.
Ceramic restorations: For larger areas of decay, a ceramic inlay, onlay, or crown can restore the tooth with excellent durability and a completely natural appearance. At our office in South San Francisco, we offer same-visit ceramic restorations through our CEREC CAD/CAM system, which mills a custom ceramic piece right here while you wait, so there’s no temporary filling and no second appointment.
Glass ionomer: A lesser-known option sometimes used for small cavities or root surface decay, glass ionomer releases fluoride into the surrounding tooth and contains no mercury. It’s less durable than composite for biting surfaces, but useful in specific situations.
Does this mean amalgam fillings are “dangerous”?
The honest answer is: not for most healthy adults in the way that word usually implies. The policy shift is real, and it’s driven by a combination of factors: environmental concerns (amalgam contributes to mercury in wastewater and cremation), precautionary reasoning for vulnerable populations, and the fact that better alternatives now exist at comparable cost. It’s not primarily driven by a wave of new evidence showing that existing fillings are harming otherwise healthy people.
That distinction matters for anyone tempted to panic about their existing restorations. If you have amalgam fillings and you’re a healthy adult, the most useful thing you can do is keep them clean, keep an eye on them at your regular checkups, and have a real conversation with your dental team about timing if and when they eventually need replacing.
How do I talk to my dentist about this?
A few practical questions to bring to your next appointment:
- “Are any of my existing fillings worn, cracked, or close to the end of their life?” If so, now is a good time to choose what replaces them.
- “Am I in a high-risk group for mercury exposure?” Pregnancy, kidney health, and young children all change the calculation.
- “What filling material would you recommend for a new cavity in my molar?” Most modern practices now default to composite or ceramic for most situations.
At Vaksman Dental Group, our dentists take a practical, evidence-based approach. We don’t push unnecessary treatment, and we don’t traffic in fear. If you’re curious about your existing fillings or want to understand your options for an upcoming procedure, we’re happy to look at your specific situation and give you a straight answer.
Frequently Asked Questions
Are my old silver fillings going to be recalled or forced out?
No. There is no federal recall of existing amalgam fillings, and no law requiring you to have them removed. The new federal guidance encourages states to phase out the use of new amalgam, particularly for vulnerable groups, but patients with functioning existing fillings are not being asked to take any action. Whether to replace them is a clinical decision to make with your dentist based on the condition of the filling and your individual health picture.
Is composite resin as strong as amalgam for back teeth?
For most cavities in adults, yes, modern composite resin is durable enough for back teeth. The materials have improved significantly since the 1990s and early 2000s, when composites were more prone to wear on chewing surfaces. Very large cavities in molars that experience heavy biting force may still be better served by a ceramic restoration like an inlay, onlay, or crown. Your dentist can assess which material makes the most sense based on the size and location of the area being restored.
Is removing amalgam fillings covered by dental insurance?
Coverage varies by plan. Many plans cover filling replacements when there’s a clinical reason, such as a cracked or failing filling, but may not cover elective replacement of a functioning amalgam filling for cosmetic or precautionary reasons. It’s worth checking with your insurance provider and asking your dental team to document any clinical findings that indicate replacement is needed. Our front desk team can help you understand your specific coverage.
What does this policy change mean for children getting fillings?
Children under six are already in the FDA’s high-risk group, which means amalgam should be avoided for them unless there truly is no alternative. In practice, most pediatric dentists and family dental offices have largely moved to tooth-colored composite or stainless-steel crowns for primary (baby) teeth, and composite for permanent teeth. If your child needs a filling, it’s completely reasonable to ask your dentist upfront to use a mercury-free material, and in most cases that’s already the default.
Have questions about your existing fillings, or need a new one placed? Our team at Vaksman Dental Group uses tooth-colored composite and ceramic restorations and can walk you through exactly what makes sense for your situation, with no pressure and no upselling.
Written by the Vaksman Dental Group team and medically reviewed by Dr. Irena Vaksman, DDS — South San Francisco. Last reviewed July 2026.