Issue 38.15
Sometimes my patients ask me, “What is the most durable and safe option?” or “I’m not in pain and I don’t mind the color, but my dentist has told me that I must replace all of my fillings. What should I do?” Here are some facts about dental amalgam to chew on*:
- Dental Amalgam is not mercury.
It’s important to separate fear from facts. People who might be concerned about dental amalgam because it contains mercury can be reassured that credible scientific studies show no cause for alarm. Study after study shows amalgam is safe and effective for filling cavities. Mercury exists in set amalgam as inter-metallic chemical compounds, for example with silver and copper, not as elemental mercury. This is similar to the sodium in table salt; both sodium and chloride can be toxic alone but not when combined. Our average diets (fruits, vegetables, and breads) expose us to five to ten times the measured levels of dental amalgam-derived mercury and fish provide even more in the most toxic form. Even children with amalgam fillings that consume fish at every meal have shown no mercury-related neurodevelopmental outcomes at 9 months, 30 months and 5 years.
- Dental amalgam is safe.
Authoritative medical organizations (outside of dentistry) have independently reviewed the scientific literature related to neurological, degenerative, autoimmune and psychological syndromes looking at dental amalgam as a causative agent – and found nothing: Alzheimer’s Association, National Multiple Sclerosis Society, Institute of Neurotoxicology and Neurological Disorders (Autism), and The American Academy of Pediatrics. Furthermore, many organizations outside of dentistry have also reviewed the scientific literature looking for any credible link between dental amalgam fillings and general health problems – and have found none: U.S. Food and Drug Administration, National Institutes of Health, U.S. Public Health Service, U.S.P.H.S. Centers for Disease Control and Prevention, World Health Organization, and The European Commission. Recently, two prospective clinical trials (7 years) compared the neurobehavioral, neuropsychological and renal effects in children receiving dental amalgam versus resin-based composites. No adverse effects were found in either study, other than a higher re-treatment rate for children with resin-based composite fillings.
- Dental amalgam is effective – no true direct filling “substitute” yet exists.
Although the color is not a good match, amalgam fillings are considered less expensive to place and generally last much longer than any other material directly placed as a filling. While plastic fillings (composite) provide satisfactory service for approximately five years, multiple independent studies have shown that they are replaced at higher rates and repaired at twice the rate of amalgam.
- Dental amalgam is not a major source of environmental mercury.
Less than one percent of mercury released to the environment from man-made sources comes from dentistry, according to the Environmental Protection Agency. First, the vast majority of mercury in surface water is from coal-fired utility plant exhaust that travels through the air then falls back to the earth. Second, very little amalgam enters surface water, because standard dental equipment and wastewater treatment facilities capture approximately 95 percent of waste amalgam. The American Dental Association and dentists across the country are committed to recovering and recycling amalgam. No state that has examined the issue has banned or limited dental amalgam.
States where either legislative or regulatory actions were taken and terminated include: Washington, Alabama, Illinois, New Hampshire, Oregon, Georgia, Minnesota, New York, California, Ohio, Connecticut, Pennsylvania, Arizona, Maine, Massachusetts, Hawaii, Colorado, Virginia, Iowa, and Vermont.
*Excerpts taken from the position statements of the American College of Prosthodontists.
Dr Rodney Andrus is Southern Utah’s only ADA recognized board certified specialist for missing and damaged teeth issues—a prosthodontist. He can be contacted at 435-674-3100.