When do you need a dental filling?
A filling is needed when tooth decay has created a cavity, when a small part of the tooth has broken off, or when an old filling is damaged. Treatment starts with a diagnosis, with X-rays as needed, to assess the damage and choose the right type of filling.
When treating a cavity, as much healthy tooth as possible is preserved, and only the decayed parts are removed precisely. When deep decay comes close to the pulp, the pulp can sometimes be protected (pulp capping) to avoid root canal treatment.
White fillings (tooth-colored fillings)
White fillings have become the preferred option for most patients in recent years because of their clear aesthetic advantages. They are made of composite material matched precisely to the shade of the natural tooth, so once treatment is finished the filling is almost invisible. This is a major advantage over traditional amalgam fillings, whose silver-gray color stands out in the mouth.
Bonding also supports the structure of the tooth, whereas large amalgam fillings may be associated with cracks and fractures over time.
The cost of a white filling varies with the size of the filling, the position of the tooth, the complexity of the treatment and the materials used. An accurate written estimate is given at the personal consultation, after a full examination.
For patients who come in with badly decayed teeth, white fillings are generally preferred, especially on front teeth that show when smiling. The final choice of filling still depends on the size of the damage, the position of the tooth and the patient's preferences.
Amalgam fillings
The amalgam filling is a long-established treatment that has been used in dentistry for more than 150 years. Amalgam is a mixture of metals, including silver, copper, tin and mercury, that forms a strong, durable material. Its use is now shrinking (see below: are amalgam fillings safe?).
The main advantages of amalgam fillings are their durability and their relatively low cost. According to a 2021 Cochrane review, composite fillings fail about twice as often as amalgam fillings (low-certainty evidence), with no clinically important difference in safety demonstrated (Worthington HV et al., Cochrane, 2021).
1–3%
annual failure rate of composite fillings on back teeth (Demarco FF et al., 2017)
Composite resin fillings
Composite fillings, also called white fillings, are made of a composite material that combines resin with tiny glass particles. Modern composite combines a good appearance with strength and durability, and it is the filling material used at the clinic in most clinical situations. Its big advantage is that it bonds chemically to the tooth, which preserves more of the natural tooth during treatment.
Placing a composite filling is more demanding than placing an amalgam filling and requires a high level of technical skill.
01
Removing the decay
Treatment starts with precise removal of the decay and cleaning of the cavity.
02
Layering the composite
The tooth is then acid-etched, a bonding agent is applied and the composite is placed in successive layers. Each layer is hardened with a special blue curing light.
03
Shaping and polishing
Finally, the filling is shaped and polished to match the natural tooth and restore its original anatomy.
Recurrent decay at the edge of a filling (secondary caries) is one of the main reasons fillings fail, so good oral hygiene and regular check-ups remain important after treatment.
Composite fillings combine a natural look, good durability and preservation of natural tooth structure. Their failure rate on back teeth is about 1% to 3% per year, depending mainly on the individual risk of decay and the size of the filling (Demarco FF et al., Brazilian Oral Research, 2017).
Composite filling vs amalgam: the differences
Both types provide a sound dental restoration; the table below compares them point by point.
| Criterion | White filling (composite) | Gray filling (amalgam) |
|---|---|---|
| Material | Resin with glass or quartz particles | Silver, tin, copper and mercury |
| Appearance | Precise color match with the natural tooth | Visible silver-gray color |
| Attachment | Bonds chemically | Mechanically retentive cavity |
| Healthy tooth structure | More is preserved | More is removed |
| Durability | About twice the failure rate (Cochrane) | Longer-lasting |
| Restrictions | No specific restriction | Contains mercury; restricted in children and in pregnant and nursing women |
| Relative cost | Higher | Lower |
Are amalgam fillings safe?
Amalgam fillings contain mercury. Since 2020, the US FDA has recommended avoiding them whenever possible in high-risk groups (pregnant or nursing women, children under 6, people with a neurological disease, impaired kidney function or a mercury sensitivity). The European Union has banned their use since 2025, except in specific cases, and in Israel the Ministry of Health has restricted amalgam in children and in pregnant and nursing women. There is no need to replace an amalgam filling that is in good condition unless there is a medical reason.
For tooth decay in children, especially in baby teeth, mercury-free filling materials are chosen, in line with the restrictions on amalgam in children. The choice of restoration is made together with the parents, based on medical considerations.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Should you replace amalgam fillings with white fillings?
There is no need to replace an amalgam filling that is in good condition unless there is a medical reason: this is also the FDA's recommendation, because removing the filling means losing healthy tooth structure.
However, old amalgam fillings can develop cracks and marginal leakage, which increases the risk of recurrent decay.
Replacement can be considered when the filling is damaged, when it is in a visible area, or when there is a sensitivity to one of the components of amalgam.
Tooth sensitivity or cracks in an existing filling are signs that replacement is worth discussing.
After your filling
For the first few days after a filling, the tooth may be sensitive to cold or pressure; this usually settles on its own (see tooth sensitivity). Sensitivity that does not go away, pain on biting or worsening pain should be checked by your dentist.
What affects the cost of a white filling?
Size and location of the cavity
Larger fillings, or fillings on back teeth that are harder to reach, usually cost more. The complexity of the treatment is one of the main factors: fillings on several surfaces of the same tooth require more precise work and therefore cost more.
Material
The material used for the filling plays an important role in the cost. Composite materials differ in price and properties, and the time needed for treatment also affects the cost.
Additional treatment
Sometimes additional treatment is needed, such as a root canal or an inlay or onlay instead of a filling, which affects the total cost. The consultation includes an accurate assessment of your needs and an individual written estimate.
Prices vary between clinics. At the clinic, the options and expected costs are presented in a written estimate after the examination and before treatment starts, and itemized receipts are provided so you can submit them to your insurer (coverage depends on your policy).
White fillings vs silver fillings: why the cost differs
Comparing the cost of a white filling with that of an amalgam filling shows a difference: amalgam fillings generally cost less than composite (white) fillings. The difference comes mainly from the fact that a white filling takes more time, a precise technique and a demanding layering process, while an amalgam filling is quicker to place and needs less chair time.
The raw materials for white fillings also cost more: composite fillings require etching acid, bonding agents and several layers of composite, while amalgam fillings require mainly the amalgam itself. The difference in cost also reflects the advantages of white fillings: better appearance, better preservation of tooth structure and no metal.
For most cavities in back teeth, a filling is the recommended solution, but the choice between materials should be individual. Amalgam can be an option for adults outside the risk groups, on a limited budget, on teeth that do not show. For visible front teeth, or when you want to avoid metal, a white filling is the preferred option despite the higher cost.
How to choose between amalgam and a white filling
Each type has its own advantages, and the decision should be based on clinical and aesthetic factors adapted to each patient's needs. With deep decay, the dentist first assesses how close it is to the nerve, because deep decay can lead to the need for root canal treatment if it is not treated in time.
Amalgam fillings, made of silver, tin, copper and mercury, resist wear well and withstand high chewing forces, for example on back teeth or in patients with bruxism (teeth grinding); but they contain mercury, and their use is restricted in risk groups. Composite (white) fillings match the natural tooth color precisely, but require a more demanding technique and careful isolation of the area from saliva. The choice requires a careful assessment of the location and size of the decay, the patient's chewing habits and aesthetic needs.
For sudden toothache caused by deep decay or a broken filling, contact an emergency dentist for prompt care.
At the dental clinic in Jerusalem, the decay is assessed with a clinical examination and X-rays as needed, and the right type of filling is chosen with a conservative approach that preserves as much healthy tooth as possible. After the examination, you receive a treatment plan and a written estimate. Consultations with Dr Haim Aseriel are held in English, at 12 HaTnufa Street in Talpiot, south Jerusalem.
Dental fillings: frequently asked questions
A white filling (composite) is made of a resin with tiny glass or quartz particles, while a gray or silver filling is made of amalgam, an alloy of silver, tin, copper and mercury. A white filling bonds chemically to the tooth, so more healthy tooth structure can be kept when preparing the cavity. An amalgam filling needs a mechanically retentive cavity, which means removing more healthy tooth structure.
If a filling falls out or breaks, see your dentist soon, even if it does not hurt, because the exposed tooth is more vulnerable to decay and fracture. Until then, brush the area gently and avoid chewing hard food on that side. Severe pain, swelling or fever call for a faster visit.
There is no need to replace an amalgam filling that is in good condition unless there is a medical reason, because replacing it means removing more tooth structure. Replacement can be considered when the filling is cracked or leaking, when there is recurrent decay or a mercury sensitivity, or for aesthetic reasons when the filling is visible.
The cost of a white filling depends mainly on the size and location of the cavity, the number of tooth surfaces it covers and the complexity of the treatment: large fillings, fillings on back teeth and fillings on several surfaces take more time and more precise work. Additional treatment, such as a root canal, also affects the total cost.
How long a filling lasts depends mainly on your individual risk of decay and on the size of the filling. Composite fillings on back teeth fail at a rate of about 1% to 3% per year, and according to a Cochrane review, composite fillings fail about twice as often as amalgam fillings (low-certainty evidence). Good oral hygiene and regular check-ups help fillings last longer.
Sources
- U.S. Food and Drug Administration, Dental Amalgam Recommendations, 2020 – Link to source
- European Union, Regulation (EU) 2024/1849 – Link to source
- Schwartz D et al., Israel Journal of Health Policy Research, 2026 – Link to study
- Worthington HV et al., Cochrane Database of Systematic Reviews, 2021 – Link to study
- Demarco FF et al., Brazilian Oral Research, 2017 – Link to study
