While the majority of dentists now use mercury-free composite fillings, some continue to use dental amalgam, also known as "silver fillings". Over the years, concerns have been raised about the use of amalgam because it contains mercury. Here are answers to some common patient questions about dental fillings.
What is in a mercury-metal filling?
Metal Fillings are composed of mercury, tin, silver (not much), and copper. The actual mercury content is between 43 and 54% mercury when placed. They are not chemically bonded to the tooth as tooth colored, or composite, filling material is. It is the consistency of wet sand when it is placed in a tooth and is only held in by undercutting the tooth structure so it is wedged into place. As time goes by, the filling breaks down in three ways:
The release of mercury vapor in the mouth lessens the strength, longevity, and resilience of the filling.
Corrosion of the surface of the filling due to the persistently wet environment. This process is similar to rusting iron.
Attrition of the surface and edges of the filling from eating, clinching, and grinding cause the edges to be tattered and irregular, causing food traps.
How do mercury-metal fillings work?
When a tooth is prepared mercury-metal filling, healthy portions of the tooth are undercut in order for the filling to stay in the tooth. Essentially, it relies on mechanical retention (it is wedged into place), rather than having a chemical bond and seal to the tooth such as with a tooth colored, or composite) filling.
What you can't see: decay often occurs underneath amalgam fillings, and it doesn't always present on x-rays. By removing "silver fillings" and replacing with white composite resin, your dentist will accurately assess any future damage and treat with tiny fillings versus more indepth restorations like crowns, root canals, and/or dental implants.
How do these metals affect the tooth?
Metal mercury fillings, without exception, microscopically expand and contract over time (just as mercury does in a thermometer). This causes the enamel of the tooth to fracture over time. Enamel fracture leads to tooth fracture. The more damaged a tooth is, the more expensive it is to repair. The expansion and contraction compromises the seal between the filling and the tooth, allowing cavity causing bacteria to colonize the area below the surface of the filling between the filling and the tooth, eventually causing new cavities.
Cavities beside metal fillings likely grow more slowly than some others because the metals in the filling kill bacteria through exposure. But eventually, the bacteria grow in number enough to overpower the effects of the metals. These new cavities are often difficult to recognize on routine dental x-rays because the metal distorts the view immediately around the filling. But if the margin of the filling is not smooth and perfect, then the cavity forming process has already begun. The new cavities develop over time, possibly causing the tooth the break or facilitating the need for a Root Canal Procedure or an Extraction.
How do metal filings affect your body and overall health?
It has been demonstrated through extensive studies that the amount of mercury released from fillings each day is considerably lower than the amount normally absorbed from the rest of our environmental sources including air, water, and foods. Other studies have demonstrated safety for patients and dental professionals in the removal of amalgam fillings.
Amalgam v/s Composite Fillngs
What do we believe?
We do not believe profound evidence exists showing the mercury is affecting the overall health of most of the individuals who have them. We also find it compelling that if you could actually suffer through reading all of the metal filling related regulations, according to the FDA, EPA, ADA, state governments, and local municipalities, there are only two places where it is acceptable for metal-mercury filling material to exist; Hazardous Waste Disposal, and your mouth. Think about that.
However, we do know with certainty that the amalgams are incredibly detrimental to the health of the tooth. So generally, we believe that if metal fillings are present, they should be removed and replaced with a restoration, porcelain or composite, which will restore the strength of the tooth to last in the long term.
BOTTOM LINE: we remove amalgam fillings because we know (with 99% accuracy) that if the margins are not sealed and they are of a certain age, there is decay destroying the tooth structure below the filling.
Conservative Cavity Care: Small, tooth-colored fillings that remove as little enamel as possible so your teeth last longer.
Inlays & Onlays First: Bonded inlays/onlays as our go-to over crowns, preserving far more natural tooth structure.
Enamel-Sparing Crowns: When crowns are truly needed, we design them to leave up to 50% more natural enamel than typical approaches.
Save-Your-Teeth Reconstruction: In severe wear or erosion, we rebuild and stabilize teeth that many offices would extract for full-arch implants, often avoiding full-mouth removal.
Full-Arch Implants When Needed: All-on-X-style implant solutions for cases that genuinely require extractions-never a one-size-fits-all default.
Bite-Tuned, Long-Lasting Results: Every restoration is calibrated to your bite to reduce fractures and the cycle of redoing dentistry every few years.
Early Growth & Airway Evaluation — Age-appropriate screening for nasal breathing, tongue posture, crowding, and sleep-related issues.
Myofunctional Support (Early Intervention) — Train healthy habits (nasal breathing, tongue posture, lip seal, chewing/swallow) to guide growth and reduce future problems.
Guided Orthodontics — When needed, we time orthodontic treatment to growth to expand space, correct crowding, and help them catch up if development is behind.
One Team, Clear Roadmap — We coordinate with parents on what to do now, what to watch, and when to act next.
Prepless, conservative veneers: Transform your smile while preserving your natural enamel whenever possible.
Facially driven smile design & previews: Plan your smile around your face, lips, and profile-and use digital mockups/temporaries to try out your new look before anything is permanent.
Non-surgical "dental facelift": Improve facial support, fullness, and symmetry through thoughtful changes in bite and tooth position.
Additive cosmetic bonding: Repair chips and reshape worn edges without aggressive drilling.
Whitening & color harmony: Professional whitening and shade-matching that works with your natural teeth and restorations.
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Grateful to have landed at Downtown Dental, they’ve taken excellent care of me! Katy was very knowledgeable and helpful getting my oral health journey kick started. Bailey is also very gentle & kind if you are you looking to get your teeth cleaned.
Grant Arnold
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I have been using downtown dental for several years now and Bailey has always taken good care of my teeth. She is knowledgeable and thorough in her work.
Diane Wheeler
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The staff at Downtown Dental was very professional and efficient! My hygienist, Katy, did a great job on my cleaning and also explaining everything to me as a new patient. Their equipment was state-of the-art!
Laura S
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This is the first dental office that’s actually been so thorough in my dental work and has taken time to really explain things to me about dental care—which says a lot! Katy has been a wonderful and this dental office has changed my outlook on dentist appointments as I know I am in good hands at this office!
bobbie swann
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Parking behind bldg. For those hesitate about going dwntwn to Dentist. I had a very thorough consultation and various approaches to heal TMJ. I had prior TMJ treatment that was very costly, which did not resolve the pain/discomfort or flare ups. Very detailed and informative. Personable in explaining why I still had ongoing problems.
John Keefe
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I am not the type of person that writes a bunch of Google reviews. However, I have to pass along a very well-earned 'atta boy to Downtown Dental. I trust these people, and genuinely feel like they are looking out for my dental health. I take care of my teeth, but I am grinding them down to nothing by clenching my teeth while I sleep. I have been working with Katy, who is awesome, and we're getting it all figured out. I'm happy I chose this place. If you're looking for a good dentist in Nashville, this is the spot.
Sherry Lloyd
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I recently had my first experience with Dr. Clark, Katy, and the girls at the front desk. Everyone was so friendly and helpful and genuinely cares about how they can support each person‘s personal needs. Katy, the dental hygienist called me the day before and we had a wonderful chat as to what my needs would be, and really set the tone to to help me feel comfortable on my first visit the following day. Dr. Clark is so knowledgeable and has acquired special skills and technology to help with various needs that we might have to improve our well-being. I actually had fun and left feeling I was in extremely capable hands for the well-being of my teeth and dental needs.
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