When a silver filling can stay

If the edges are sealed, the X-ray shows no decay underneath, and the tooth around it is not cracking, there is no clinical reason to drill it out. Replacing a healthy filling removes more tooth each time, and every replacement is a little larger than the last.

Cosmetic preference is a fair reason to want a change, and I will tell you honestly what that involves. It is just not a reason I will invent for you.

When I recommend replacing one

Silver fillings expand and contract slightly with hot and cold over the years. On large ones, that can stress the surrounding enamel until it cracks. That is the most common reason I replace them, and it is a structural call, not a material preference.

• A visible crack in the filling or the tooth around it
• A dark shadow under the filling on the X-ray, which means decay has slipped in at the edge
• The filling has pulled away from the tooth and food or floss catches there
• The tooth has started to fracture because the old filling is large and the remaining walls are thin

What replaces it

Tooth-colored composite bonds to the tooth and needs less drilling than silver. For a small or medium area, that is the usual choice. If the old filling was large and the remaining walls are thin, a composite may not hold up. In that case I talk about an onlay, which covers the weak part while keeping the rest of your tooth, or a crown when the tooth needs full coverage.

You see the X-ray and the scan before we decide, and you get a written estimate. Most PPO plans cover a portion of fillings and crowns. We verify benefits first.

What to watch for between visits

Sensitivity to cold that lingers, a rough edge your tongue keeps finding, or a crack you can feel with floss are reasons to come in sooner. None of them mean an emergency. All of them mean the filling deserves a look before a small fix becomes a larger one.