The short answer
Dental amalgam — the grey metal filling — may no longer be placed in the European Union since 2025, apart from narrowly defined medical exceptions. Tooth-coloured composite (Komposit) is now standard care (Regelversorgung) in every tooth, front and back, and statutory health insurance covers it with nothing to pay at the desk. The ban was driven above all by mercury in the environment, not by a finding that patients were being harmed. Amalgam fillings that are already in your mouth do not have to come out: German dental associations take the view that an intact, well-sealing amalgam filling is not in itself a reason for removal. Grey fillings are replaced for the same reasons as any other filling — decay underneath, a fracture, a leaking margin, or a documented allergy.
Two materials, two completely different ideas
Amalgam is an alloy. Liquid mercury is mixed with a powder of silver, tin and copper, and the resulting paste is packed firmly into a cavity that has been shaped with undercuts so the metal locks in as it hardens. Nothing glues it. The filling stays put because of the shape of the hole it sits in.
Composite works the other way round. Finely ground glass and ceramic particles suspended in a resin are bonded to the tooth with an adhesive and cured in layers under a blue light. The filling is glued to the tooth substance itself.
That one difference explains most of what follows. Because composite sticks, the cavity can stay as small as the decay; healthy walls are left standing rather than sacrificed to create a mechanical grip. Because amalgam did not stick, the hole always had to be cut wider than the problem. How that bonding actually happens in the chair is a subject of its own: White fillings: what they are made of and how they are placed (EN).
Amalgam served for well over a century, and it served well
It is easy to be dismissive about a material that has just been retired, so it is worth being fair to it. Amalgam was forgiving in exactly the situations where dentistry is hardest: a lower molar at the back of a child’s mouth, saliva everywhere, a patient who cannot hold still. It tolerated damp conditions that would ruin an adhesive bond. It was quick to place, inexpensive, and its corrosion products tended to seal the margin over time rather than open it up. Many amalgam fillings placed decades ago are still doing their job today.
None of that is an argument for bringing it back. It is a reason not to feel let down by the dentistry you had in the past.
Why it went anyway
The decisive argument was environmental. Mercury is a persistent pollutant, and dental practices were one of its routes into wastewater and waste streams. Under the international Minamata Convention on Mercury, the EU first phased amalgam down and then stopped it: from 2018 it could no longer be used in children under 15 or in pregnant and breastfeeding women — a precaution rather than a verdict — and from 2025 it may not be placed at all, other than in narrow cases where a dentist judges it strictly necessary for a particular patient. Germany implemented the rules, and the statutory funds adjusted what they cover accordingly.
What that changed about the money
For decades the arrangement in Germany was uncomfortable but clear: amalgam was the covered standard in back teeth, and a white filling in a molar meant paying the difference. That is over. A tooth-coloured filling is now standard care everywhere in the mouth, provided as a benefit in kind (Sachleistung) — you hand over your health insurance card (Gesundheitskarte/eGK) and pay nothing for a standard filling. Costs only appear if you choose something above that standard, such as a laboratory-made ceramic inlay, and then only under a written extra-cost agreement (Mehrkostenvereinbarung) signed before treatment, with the fund’s share still counting towards the bill. The full money picture: What does a dental filling cost in Germany? (EN).
"Is the amalgam already in my mouth dangerous?"
This is the question people actually come in with, so here is a straight answer rather than a reassuring one.
Amalgam releases very small quantities of mercury vapour, and slightly more of it during hard chewing, grinding or when the filling is drilled. The health authorities and dental associations that have reviewed the evidence have not concluded that these quantities harm the general population, and that assessment is why the EU restricted amalgam by category — children, pregnancy — before restricting it for everyone, and why the general ban is framed around the environment rather than around patient safety.
A true allergy to a component of amalgam exists, but it is uncommon. It is established by proper allergy testing, not from a symptom list found online — and where it is documented, replacing the fillings becomes a medical indication and is treated as one.
The point that surprises most people: taking an intact filling out is not the risk-free option. Drilling releases more vapour in half an hour than the filling would release over years of sitting quietly, and every removal costs healthy tooth substance that does not grow back. “Leave it alone” is an active clinical decision, not laziness.
So should you have your old amalgam replaced?
Disliking the appearance is a perfectly legitimate wish, and nobody has to justify it. It is then your decision rather than a medical necessity, which also decides who pays: statutory insurance covers treatment that is needed, so an exchange made purely for appearance is a private matter. What matters is that you get it in writing beforehand and know exactly what you are agreeing to. When a filling really has reached the end of its life is set out here: When does a filling need replacing? (EN).
If it does have to come out
Careful removal is standard practice and not something you need to request as a favour. The filling is sectioned into pieces rather than ground into dust, cooled with plenty of water, and drawn away with high-volume suction; where the tooth allows it, the working field is isolated with a rubber dam (Kofferdam), and the mouth is rinsed thoroughly afterwards. Working under a microscope also helps, because the margins and any decay underneath are visible rather than guessed at. Removal that is not urgent is generally postponed during pregnancy and breastfeeding.
What replaces it today
Composite is the everyday answer: one appointment, tooth-coloured, covered as standard care, repairable rather than replaceable, and it preserves more of the tooth than the material it succeeded. It is the workhorse of ordinary tooth preservation: Tooth preservation and fillings – service page (EN).
Glass ionomer and compomer are softer materials with their own niches — children’s teeth, root surfaces near the gum, situations where the area is hard to keep dry.
Ceramic inlays, partial crowns and crowns take over once the defect is too large for a filling at all. A thin or missing cusp is not a filling problem; covering it protects against the fracture that turns a restorable tooth into an extraction. Which option suits which tooth: Which dental filling is best for your tooth? (EN).
When to have an old filling looked at — and when to leave it in peace
Decay hiding under an existing filling is the reason this list exists. It causes no pain for a long time, and small bitewing X-rays plus a look under the microscope find it while the repair is still small.
Special situations
Pregnancy and breastfeeding. Amalgam is no longer placed in these groups anywhere in the EU, and elective removal of existing fillings is normally deferred until afterwards. Treatment of active decay, on the other hand, should not wait — untreated infection is the greater risk, and the second trimester is usually the most comfortable window for planned work.
Children and teenagers. They will not receive amalgam at all. For young permanent molars, tooth-coloured materials and fissure sealants are the usual approach, and prevention does more than any material choice.
A diagnosed metal allergy. Bring the allergy passport (Allergiepass) or the test report to your appointment. That single document changes the case from a wish into an indication.
You arrived in Germany with grey fillings. Amalgam is still in use in many countries outside the EU, so people move here with a mouth full of perfectly serviceable metal fillings. A dentist here will not remove them by default. What we do is check whether they are still sealing, X-ray what the eye cannot see, and treat what needs treating — nothing more.
Your German is limited. Material discussions are exactly the kind of conversation where you need to understand every word, because you are being asked to make a choice. We treat and explain in English here, and you can read how examinations, insurance and appointments work for newcomers in English-Speaking Dentist in NRW.
It is banned. Since 2025 dental amalgam may not be placed in the EU, with only narrowly defined medical exceptions, and Germany applies the rule. If you need a filling here today, it will be a tooth-coloured material — and for statutory patients that is the covered standard in back teeth as well as front teeth.
No. German dental associations do not recommend removing intact, well-sealing amalgam fillings, and the 2025 rule applies to new fillings, not to old ones. They are replaced when there is a reason: decay underneath, a fracture, a failing margin, or a documented allergy.
If there is a medical reason — decay under the filling, a fracture, a leaking margin — the replacement is ordinary covered treatment, like any other filling. If the filling is sound and you simply want it gone for cosmetic reasons, that is a private choice, and you should have the cost in writing before anything is drilled.
The authorities that have assessed the evidence have not found harm to the general population from the amounts released by fillings. A genuine allergy to one of the components does occur, and it is diagnosed by testing. If you suspect one, ask for an allergy referral rather than starting with the drill.
Not in itself. Many countries outside the EU still use it, often for good practical reasons. We will assess it exactly as we would assess any filling: is it sealing, is the tooth sound underneath, is the margin intact.
Usually you cannot, and that is precisely the difficulty — it rarely hurts until it is deep. Small bitewing X-rays show what sits between and beneath fillings, and a check under the microscope reveals leaking margins and hairline cracks that are invisible to the naked eye.
The amalgam debate has largely resolved itself. New fillings in Germany are tooth-coloured, statutory insurance covers them in every tooth, and the old back-teeth surcharge for a white filling disappeared with the ban. What remains is the practical question of the metal you are already carrying — and the honest answer is that a sound amalgam filling is not an emergency, not a health scandal, and not something to drill out on principle. Have it checked, keep the check-ups, and replace it when the tooth gives a reason.
Zahnarztpraxis Tsypin · Wuppertal. This article was medically reviewed and is provided for information; it does not replace an examination. Updated August 2026.
