Are Amalgam Fillings Safe?
When it comes to repairing teeth, dentists have many material options for fillings, including a mixture of liquid mercury and powdered alloy composed of silver, tin and copper known as dental amalgam. Used for more than 150 years, this material is used to fill cavities caused by tooth decay. But if you have heard the somewhat recent controversy over the mercury component in these "silver fillings," you may also be wondering if you should replace any you already have in your mouth. However, according to many health organizations, including the Food and Drug Administration (FDA), dental amalgam is a safe, reliable and effective restorative material.
New materials for fillings have been developed over time, such as ceramics and polymer compounds, though these new options have not eradicated the use of older materials, such as amalgam. According to the American Dental Association, dental amalgam is the most thoroughly researched and tested restorative material among all those in use. It is durable, highly resistant to wear and relatively inexpensive.
The Truth About the Amalgam Controversy
If you type "amalgam" into your Web browser, you will likely see countless stories of patients linking their amalgam fillings with health problems due to the low levels of mercury vapor released inside the mouth. However, the FDA found that the amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects. The FDA also determined that even in adults and children ages 6 and above who have 15 or more amalgam surfaces, mercury exposure was far below the lowest levels associated with harm. Clinical studies in adults and children ages 6 and above have also failed to associate dental amalgam fillings and health problems.
According to Bradley A Dykstra, DDS, MBA, in Hudsonville, MI, there is no residual free mercury in fillings with appropriate handling and mixing. "It is similar to having anything resembling an egg in a cake after it has been mixed and baked. It is no longer an egg, but part of the cake. The cake is different than the sum of its parts, as is an amalgam restoration," says Dr. Dykstra.
Though amalgam has been deemed safe, it's still important to consider several different types of fillings, not just amalgam. "There is no one universal restorative material that is totally safe and appropriate for every tooth and individual on Planet Earth," says Dykstra. It is best to meet with your dentist to discuss which type of material is best for you.
Better Alternatives to Dental Amalgam
Although amalgam is safe, Gerald Middleton, DDS, of Riverside, CA, rarely places the fillings for other reasons. "Amalgam does not look particularly good. When amalgam ages and begins to corrode, it tends to take on a dark grey and sometime blackish color. Also because there is no bond to the tooth with amalgam fillings, the remaining tooth structure may become unsupported and fracture," says Dr. Middleton. In his opinion, there are better materials.
Composite resin is fast becoming, if not already, the most common filling material used. "It is tooth-colored, bonds to the teeth, is strong, relatively inexpensive and can be completed in a single appointment. Its biggest disadvantage is that it can wear in time if the filling is large, and it may be difficult to get a good contour on fillings that go between the teeth," says Middleton. He finds that composite resin is a great cost-effective alternative to amalgam fillings, but the cost will be slightly higher than amalgams due to the technique sensitivity of these types of fillings.
Washington, PA, dentist Barry Bartusiak, DMD, has also found that amalgam fillings are still used, but decreasingly so. "There are newer dentists coming out of school who are exposed to better materials. For a run-of-the-mill filling, bonding with composite is the top choice for a vast majority of dentists," says Dr. Bartusiak.
What Should You Do About Amalgam Fillings?
If you have amalgam fillings, it is important that you routinely see a dentist to evaluate the integrity and health of the fillings, teeth and entire mouth. "Since there is no evidence that amalgam fillings cause disease, there is no need to have well-fitting, good functioning amalgams removed for health reasons," says Middleton.
Dykstra agrees that for the vast majority of people, there is no reason to do anything until the restorations need replacing. "It is important to respect the desires of the patients. If they have done their own research and request that all amalgam restorations be replaced, it is important to have a discussion with them and replace the amalgams, if that is what the patient wants after the discussion," says Dykstra.
Dykstra has seen numerous patients over the years suffering from Multiple Sclerosis. "The link here to amalgam restorations is at best anecdotal, but for the patient, very real. In this case, again it is appropriate to remove all of the amalgam restorations at the request of the patient," says Dykstra.
In the end, is the cost greater than the benefit? "Many people have spent thousands of dollars removing amalgam fillings in the hopes that it will resolve many terrible diseases. Unfortunately they find themselves having gone through uncomfortable, unnecessary procedures with no improvement in their disease state," says Middleton.