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March 29th, 2012

Restoring the back teeth, especially the molars, may present you with a choice.  Silver or tooth colored (composite) filling?  Which is better and why?
From the point of view of safety and effectiveness, they are both excellent choices.  Despite some of the misplaced concerns over the mercury in silver amalgam fillings, the Center for Disease Control and the American Dental Association have both been very strong in their support of the safety record of this material.  Scientific studies have been unanimous in confirming the safety of silver amalgam.  Both of these options work well.
Esthetically, the composite materials look more like real teeth.  This may be a factor if you have a wide smile or a professional acting career.  However, the area may not show at all and this may not be a factor in your decision.
Some teeth are broken in a way that the tooth colored composite may be easier to place and more effective, while some hard to reach areas may be difficult to keep dry and therefore amalgam would be the better choice.  Cost may be a factor as well.  The silver amalgam is quicker to place and less sensitive to technique variation and is generally less expensive.  But composites can bond to tooth structure and may provide additional strength when wall of tooth is left thin.
Statistically, silver amalgam lasts longer but this may be misleading since more recent composites are more technologically advanced and stronger than the older types.  Tooth colored, bonded fillings may be more susceptible to leakage in a very acidic diet and may be more likely to allow recurrent decay in patients who are prone to tooth decay.  In those cases, amalgam may be a better choice.
As with many health issues, the final decision needs to be made on an individual case basis.  Speak with your dentist and the office staff to determine which is best for you. They will discuss the pros and cons for your case.
Another question that often arises is when do we stop thinking about a filling and start considering a crown?  This is often a decision based on both function and cost.  When more than ½ of a tooth is restored or missing, then it is a given that the tooth is weaker than original.  If you are one who chews a hard diet, a crown may be the answer.  The further towards the back of the mouth the tooth is, the more force is put on it when chewing, so a tooth towards the front may not be as severely impacted and may do fine with a filling.
Finally, cost can be an issue.  Some fillings can cost more than half the price of a crown and only last for 1/3 or less of the time a crown should last.  If you are healthy, the crown is a good long term decision.

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