White Fillings or Amalgam: Materials Compared
For anyone choosing between a white (composite) and a silver (amalgam) filling, this page compares how each works, how long each lasts, tooth removal, safety evidence, UK rules and cost. In trials in children, amalgam failed less often (low-certainty evidence); composite bonds, so less tooth is removed. There is no general reason to replace sound amalgam fillings for health reasons alone, except a diagnosed allergy to a component.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist at Deepcar Dental Care, reviewed this page. He is a General Dental Practitioner, GDC 301711.
How do white fillings and amalgam compare?
Neither material wins on every measure: composite matches the tooth and keeps more of it; amalgam failed less often in children's trials (low-certainty evidence). Sources: NHS guidance; Bristol Dental School's guides; SCENIHR, the European Commission's scientific committee on health risks (2015 review); Cochrane 2021; and Opdam 2010.
| In general | White (composite) filling | Amalgam (silver) filling |
|---|---|---|
| What it is | Tooth-coloured resin containing a ceramic filler (SCENIHR, Bristol) | A mixture of mercury, silver, tin and copper (NHS) |
| How it stays in | Bonds to the tooth (Bristol) | Held by the cavity's shape, such as undercuts (SCENIHR) |
| Tooth removed | Less, because it bonds (Bristol) | Larger cavities, often with excessive tooth removal, because it does not bond (SCENIHR) |
| Appearance | Can be matched to the tooth's colour (Bristol) | Silver; does not match the tooth (Bristol) |
| Longevity studies | Failed more often in trials in children (Cochrane 2021, low certainty); in large fillings in one practice, outlasted amalgam overall and in low-risk patients (Opdam 2010) | Failed less often in those trials (low certainty); in that practice, outlasted composite in three-surface fillings in high-risk patients |
How does each material work?
A white filling is bonded to the tooth, while amalgam is placed in a cavity shaped to hold it in place.
Bristol Dental School's guides say composite is applied over a thin bonding layer and set with a blue light, as our page on white fillings explains. The same guides say amalgam is placed in the prepared cavity, shaped to the bite and polished, and ideally not bitten on for 24 hours, as it can take that long to harden fully.
Which lasts longer, composite or amalgam?
In trials, composite fillings in back teeth failed more often than amalgam, but the evidence is low certainty and the main analysis was in children.
A 2021 Cochrane review pooled two trials of 1,645 composite and 1,365 amalgam fillings in the adult back teeth of 921 children. It found low-certainty evidence that composite had almost double the risk of failure and a much higher risk of new decay beside the filling (secondary caries), but was not more likely to fracture. All the trials were at high risk of bias, and composites have improved since, the authors note.
In one practice's records, results also depended on the patient's risk of decay. Among 1,949 large back-tooth fillings in that general practice (Opdam and colleagues, 2010), 293 of 1,202 amalgam and 114 of 747 composite fillings failed within 12 years. Composite survived better overall and in patients at low risk of decay; amalgam survived better for three-surface fillings in high-risk patients.
Which material keeps more of the tooth?
Composite usually keeps more of the tooth, because it bonds instead of relying on the cavity's shape to hold it.
Bristol Dental School's guide says bonding means less tooth needs removing for a composite filling to stay in place. The European Commission's SCENIHR committee notes that because amalgam does not bond, larger cavities have to be prepared, often with excessive removal of tooth, and says this and appearance, not overall longevity, are driving the move to alternatives.
Composite has limits: Bristol's guide says it is not appropriate when it is difficult to keep the tooth dry, the cavity extends near or under the gums, or the cavity is very large.
Which material may suit which situation?
The better choice depends on the tooth, the cavity and the patient. In general, composite may suit a filling that will show, or a cavity of the right shape in a tooth that can be kept dry, while amalgam may be more suitable for a tooth that is hard to keep dry or a patient at high risk of decay (Bristol Dental School's guides). The European Commission's SCENIHR committee found that the longevity of alternative materials in back teeth had improved but, in situations such as large cavities and high decay rates, was still inferior to amalgam.
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Are amalgam fillings safe?
For the general population, the European Commission's SCENIHR committee (2015) called amalgam an effective filling material with low risk of adverse health effects.
It concluded that current evidence does not preclude using either amalgam or the alternatives, but that the choice should rest on patient characteristics. It said amalgam is not indicated in baby teeth, in people with a mercury allergy, or in chronic kidney disease with reduced kidney clearance, and that caution applies to placing any filling material in pregnancy.
A 2021 Cochrane review found three trials that looked for harms. Two, in children, reported higher urinary mercury levels in those with amalgam fillings, though lower than levels known to be toxic. Some differences between the groups appeared on certain measures, but no consistent or clinically important harms were found, and the authors judged false positives likely given the many comparisons. On very low-certainty evidence, the authors concluded there may be no clinically important difference in safety between the two materials.
Is amalgam banned in the UK?
Not outright: NHS guidance in England still names amalgam as an option for back teeth, though its use in some groups was restricted from 2018.
From 1 July 2018, EU mercury rules, then applied across the UK, ended amalgam use in baby teeth, children under 15 and pregnant or breastfeeding women, except where the dentist deems it necessary based on the individual patient's medical requirements. The Scottish Government said this was not because of safety concerns but part of a wider environmental drive; Northern Ireland's Chief Dental Officer called amalgam still an effective filling material for particular situations (2019).
Internationally, parties to the Minamata Convention on Mercury decided in November 2025 that after 2034 the manufacture, import or export of dental amalgam would not be allowed, except when the dentist considers its use necessary based on the patient's needs, an exception due for review at their twelfth meeting.
Should you replace your amalgam fillings?
There is no general reason to replace a sound amalgam filling for health reasons alone, except a diagnosed allergy to one of its components.
The European Commission's SCENIHR committee found no general justification for unnecessarily removing clinically satisfactory amalgam fillings, except in people diagnosed as having an allergic reaction to one of amalgam's constituents.
A failing filling of either material is a different question, covered on our page about signs an old filling is failing. Show any change in a filling to a dentist.
How do white fillings and amalgam compare on cost?
On the NHS in England, Band 2 treatment (£76.60 in October 2026) may include fillings, and white fillings are available when clinically necessary.
For a back tooth, NHS guidance says amalgam may be a more effective option; if you would prefer a white filling, your dentist can advise about private costs, risks and benefits.
What other restorative choices are compared?
Other restorative decisions are compared among the options in this section. Fillings belong to repairing and rebuilding damaged teeth, which aims to save natural teeth rather than replace them with implants, and our guide to making restorations last covers aftercare. Our page on restorative treatment costs explains restorative fees.
Frequently asked questions
Do white fillings contain mercury?
No. Amalgam is the mercury filling; composite is a resin containing a ceramic filler, one of what the European Commission's SCENIHR committee calls non-mercury alternatives. It adds that these are not free from concerns about adverse effects, allergies to some of their substances have been reported, and data on their possible adverse effects is very limited.
Can amalgam fillings cause an allergic reaction?
Occasionally. The European Commission's SCENIHR committee (2015) said local reactions, including allergic reactions, are occasionally seen with amalgam, but the incidence is low (under 0.3% for all dental materials in general) and usually readily managed. Show any change in your mouth beside a filling to a dentist.
Are there filling materials other than composite and amalgam?
Yes. Bristol Dental School's guides name glass ionomer cement as another type of filling that may be an option. The composite guide says it is often used as an intermediate filling, and the amalgam guide says it is used in areas where there are low biting forces. Your dentist can explain which is most appropriate for your tooth.
Does a white filling take longer to place than amalgam?
It can. Bristol Dental School's guide says composite fillings can take longer to place than amalgam because there are more stages. The guide adds that, as moisture can affect how well composite sticks, the tooth may be covered with a rubber dam, a rubber sheet that protects it from moisture.
Who decides which filling material is used?
You and your dentist, within your clinical needs and local protocols. NHS guidance says your dentist will offer the most appropriate type of filling for your clinical needs, and the European Commission's SCENIHR committee says each material's risks and benefits should be explained. A 2021 Cochrane review says the choice depends on shared decision-making and local directives and protocols.
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