Many of us still have a few of the old fashioned “silver” fillings left from a cavity that was filled in childhood. These were once the standard of dentistry. Composed primarily of the metals silver, copper, tin, and mercury, they were the best options of their time period. It offered a durable and relatively inexpensive restoration that remained the standard until patients began to be interested in the more aesthetic option of white composite fillings. It is only in the last 20 years that the risks of these amalgam fillings have been proven to outweigh the benefits. There is credible evidence to suggest that some people are too susceptible to the presence of the metals, in particular the mercury, in their mouth. Additionally, over time the metal in these fillings expands and contracts with temperature variations that can produce microscopic cracks in the enamel of the teeth. Finally, silver amalgam restorations do not bond to the tooth structure, and over time leakage occurs on the margins. This allows plaque to migrate under the restoration, and to do greater damage to the tooth. During a routine dental exam it is a good time to assess the condition of these silver amalgam fillings. First, are they still silver? If your silver filling is actually black it is a good indication it is very old and it is probably leaking. If it has fractures in the amalgam filling or in the surrounding tooth structure it makes the tooth vulnerable to being broken. The final consideration should be if you have been given medical advice that you are susceptible to the components that are known to be in amalgam. If so you should consider having them replaced. Any concerns about any amalgam restorations remaining in your mouth should be discussed with the dentist.