Pregnant, nursing or planning a pregnancy with old silver fillings: should you replace them now?

The short answer: usually no, and the FDA explains why

If your silver (amalgam) fillings are intact, sealed and free of decay, the FDA's advice is not to have them removed during pregnancy or nursing. That may sound backwards, because the same agency lists pregnant and nursing people among the groups it says should avoid getting new amalgam where possible. The two recommendations fit together once you see the reasoning: drilling out an amalgam filling briefly raises the mercury vapor you are exposed to, and it removes some healthy tooth structure along with the filling. A sound filling that is simply left alone does neither. So the FDA treats "do not place new amalgam in this group" and "do not remove intact amalgam in this group" as two sides of the same caution.

What this guide cannot do is tell you whether your fillings are intact. That is what an examination determines, and it is the reason the decision belongs in a dental chair with your obstetric provider in the loop, not in a search result.

What the FDA actually says

Who the FDA lists as higher-risk

In 2020 the FDA issued recommendations for groups it considers potentially more susceptible to the effects of mercury vapor from amalgam. The list includes pregnant people and their developing fetuses, people planning a pregnancy, nursing people and their infants, children (especially under six), people with pre-existing neurological disease, people with impaired kidney function, and people with a known sensitivity or allergy to mercury or other amalgam components. For these groups the FDA recommends avoiding new amalgam fillings whenever possible and appropriate, and using a non-mercury alternative such as composite resin or glass ionomer instead. The FDA notes that placing a new amalgam filling during pregnancy may produce brief spikes in mercury exposure for the mother and fetus.

For everyone else, the FDA's position is that the majority of evidence does not show that mercury exposure from amalgam harms the general population, while little is known about its effects in the higher-risk groups, which is why it urges caution for them. The NIDCR says the same: amalgam releases low levels of mercury vapor, mainly when it is placed or removed and during chewing, and current evidence has not shown that exposure from fillings harms health. The FDA's 2020 recommendation is the source for the pregnancy advice: for people who are pregnant or planning pregnancy, it recommends mercury-free alternatives such as composite resins or glass ionomer cements when appropriate.

Two recommendations that are easy to confuse

The FDA says it does not recommend that anyone, including people in the higher-risk groups, remove or replace amalgam fillings that are in good condition unless it is medically necessary. Its stated reasons are the temporary rise in mercury vapor during removal and the loss of healthy tooth structure. For a sound filling, waiting until after pregnancy and nursing is consistent with federal guidance, not a compromise of it. For a broader discussion of that guidance, see Should a sound silver filling be removed? Start with the FDA's guidance.

Nursing worries many new parents. The FDA states that the amount of mercury in breast milk is typically very low, and that the few, limited studies of breast-fed infants did not identify any definite associations with harmful health effects. That is not a reason to place new amalgam while nursing, which the FDA still advises against where possible, but it is a reason not to rush removal of existing fillings either.

What changes the answer

A filling that is cracked, leaking or decayed

"Medically necessary" is the hinge of the whole decision. A filling with a fracture, an open margin, decay underneath it or a chunk missing is no longer a sound restoration; it is an active dental problem that usually gets worse with time. The ADA's position is that oral health care, including fillings, extractions and root canal treatment, can be performed during pregnancy, and that delaying needed care can lead to more complex problems. In that situation the question is no longer "should I remove amalgam while pregnant" but "which material replaces a failing filling," and the FDA's advice for your group is to choose a non-amalgam material where possible and appropriate. The signs that a filling may be failing are described in Cracked amalgam or decay underneath: when replacing a filling may be necessary.

Pain, swelling or infection

Toothache, a tooth that hurts when you bite, gum swelling near a filled tooth, or a bad taste from one area are reasons to be examined promptly, pregnant or not. These symptoms are assessed in the same way as for any other patient, and treatment is usually planned around your pregnancy rather than postponed because of it. Spreading swelling, fever with facial swelling, or trouble breathing or swallowing are emergencies: call 911 or go to the nearest emergency department first.

Timing and your obstetric provider's input

The ADA states that oral health care, including dental X-rays and local anesthesia, is safe at any point during pregnancy, and the ADA, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics all encourage dental visits while you are expecting. Within that, the timing of elective work is a coordination question. Some patients and obstetric providers prefer to schedule non-urgent treatment after the first trimester or defer it until after delivery; others want it handled before the baby arrives, when reclining in a dental chair is more comfortable. Tell both offices what the other has said. Your obstetric provider knows your pregnancy; your dentist knows the condition of the tooth. The decision uses both.

Three situations, one way to think about them

Pregnant now, fillings intact

Keep them. Keep your check-ups, mention every filling you have questions about, and ask the dentist to note the condition of each one so you have a baseline. Pregnancy can make gums more inflamed, so the exam will usually pay attention to gum health as well. Revisit the question of replacement, if you still want to, after you have finished nursing.

Pregnant now, a filling is broken or hurting

Have it examined. If the filling needs to come out, the FDA's advice for your group is a non-mercury replacement, and ask the dentist how the tooth will be isolated during removal. Which restoration the tooth then needs depends on how much sound structure remains: a small defect may take a bonded filling, while a larger one may need an onlay or crown. The steps of that visit are described in What does an amalgam replacement appointment involve?.

Planning a pregnancy or nursing, choosing a new filling material

If you are planning a pregnancy and a tooth needs a filling now, you are in the FDA's higher-risk group already, so a non-amalgam material is the recommended choice. The main options are composite resin (tooth-colored, bonded to the tooth), glass ionomer and resin-modified glass ionomer (which release fluoride but wear faster, so they are often used in low-stress areas or as a base), and ceramic restorations for larger defects. None of these is free of trade-offs. Composites depend on careful isolation during placement and suit small to mid-size fillings under moderate chewing pressure; glass ionomers are less durable under chewing load; ceramic restorations are made outside the mouth and usually reserved for larger defects. The ADA and MouthHealthy both describe material choice as depending on the location of the tooth, the size of the defect, the chewing forces on it and your preferences, which is exactly the conversation to have at the consultation. The questions worth asking are collected in Tooth-colored filling materials: the questions worth asking before you choose.

What to expect from the office

• Tell the office before you arrive. Say that you are pregnant, nursing or planning a pregnancy when you request the visit, and again on the health history, so the examination and any imaging are planned with that in mind. The health history also asks about medications and supplements, including prenatal vitamins and anything prescribed for nausea or reflux; Why your dentist asks about medications before looking at your teeth explains why.
• Ask how the office coordinates with your obstetric provider. Ask whether the dentist will send a short note or call your obstetric office before non-urgent treatment, and bring your provider's contact information.
• X-rays only when they change the decision. Deciding whether a filling is failing sometimes needs an X-ray, and sometimes does not. Current ADA radiation-safety recommendations rely on digital equipment, restricting the beam to the area being imaged and reviewing earlier X-rays before taking new ones; the ADA no longer recommends lead aprons or thyroid collars for patients. State radiation-safety rules may still require a protective apron; ask what the office uses. If you have recent X-rays elsewhere, ask that office to send them.
• Comfort options. The ADA advises that pregnant patients avoid exposure to nitrous oxide, so if you are anxious, ask about other listed comfort options such as a longer appointment.
• If a filling must be replaced. Ask what steps are used while the old filling is removed, such as isolating the tooth with a rubber dam and high-volume suction, and which material is planned for the replacement.

When to seek emergency care instead

Facial or neck swelling that is spreading, fever together with facial swelling, difficulty breathing or swallowing, uncontrolled bleeding or a serious injury to the face or jaw are medical emergencies. Call 911 or go to the nearest emergency department first; do not wait for a dental appointment request to be answered.

The next step

If you have old silver fillings and are pregnant, nursing or planning a pregnancy, you do not need to decide anything on your own. Request a check-up through the appointment request page (a request is not a confirmed appointment; the team follows up) or call during office hours, state your situation when you do, and ask for each filling to be assessed and recorded. If every filling is sound, the plan is usually to leave them alone until after nursing and reassess. If one is failing, the plan is a non-amalgam replacement arranged with your obstetric provider's input. Either way, the examination, not the calendar, drives the decision.