If you're a parent researching mercury fillings — either because your child has some, or because you want to understand your options before a filling is placed — this guide is written for you. No jargon, no advocacy spin, just the practical information you need.
What the FDA says about children specifically
In 2020, the FDA updated its guidance on dental amalgam and issued a specific recommendation: whenever possible, avoid amalgam use in children under 6. This is not a fringe position — it is the stated guidance of the United States' top public health regulator.
The FDA also recommends against amalgam for pregnant women, women planning to become pregnant, nursing mothers, and people with kidney impairment. The 2020 update represented a significant shift from previous guidance, which had treated amalgam as safe for the general population without these carve-outs.
The European Union went further — banning amalgam for children under 15, pregnant women, and nursing mothers in 2018, with a full phase-out announced by 2030.
My child already has amalgam fillings — what now?
This is the most common question parents ask, and the answer is genuinely nuanced.
Stable, intact amalgam fillings in children are not an emergency. The FDA guidance recommends against placing new amalgam, but does not recommend rushing to remove existing fillings that are in good condition. Removal itself temporarily increases mercury exposure — and in a child, that short-term spike may be more significant than the ongoing low-level exposure from a stable filling.
What matters most is the condition of the filling:
- Cracked, leaking, or corroded fillings release more mercury and may need replacement for purely clinical reasons — this is a good time to switch to composite
- Fillings with recurrent decay underneath need to come out regardless
- Stable, intact fillings in an otherwise healthy child are generally monitored rather than immediately removed
Have a direct conversation with your dentist about each filling individually — ask about its condition, estimated remaining life, and what the replacement would be when it eventually needs to come out.
Pregnancy, breastfeeding, and amalgam
Mercury crosses the placenta. It is also present in breast milk. This is why the FDA specifically flags pregnant and nursing women as a group for whom amalgam should be avoided.
If you are pregnant and have existing amalgam fillings: the general guidance is to leave stable fillings alone during pregnancy and schedule any necessary dental work for the second trimester when possible. Elective amalgam removal during pregnancy is not recommended by most clinical guidelines — the short-term exposure spike during removal is considered riskier than the ongoing low-level exposure from a stable filling.
If you are planning pregnancy and want to remove amalgam, the recommended approach is to complete removal before conception, with adequate recovery time before becoming pregnant. Discuss timing with both your dentist and your OB/GYN.
What to ask for instead
For any new filling in a child, ask for composite resin. It is tooth-colored, bonds directly to the tooth structure (requiring less drilling), and contains no mercury. Modern composite materials are durable and appropriate for the vast majority of pediatric restorations including back teeth.
Some dentists may suggest that composite is less durable in back teeth under heavy chewing pressure. While this was a more significant concern with older composite formulations, modern materials perform well in most pediatric cases. Ask your dentist specifically which composite material they use and what their clinical experience is with it in children.
Insurance plans often cover composite restorations at the same rate as amalgam for children — check your specific coverage before assuming you'll pay more.
Talking to your family dentist
Most general dentists are comfortable with composite alternatives — many have already stopped using amalgam entirely. If your dentist recommends amalgam for your child, a simple and direct response is:
"I've read the FDA's 2020 guidance recommending against amalgam for children under 6. Can we use composite instead?"
A dentist who is resistant to this conversation or dismissive of your concern without substantive clinical reasoning is a signal to seek a second opinion. Most will simply say yes and proceed with composite.
If you want to find a dentist who already practices mercury-free by default, use our provider directory to search for mercury-free family dentists in your area.