Amalgam is dangerous??

To take the official stance of the American Dental Association, Amalgam is not dangerous. When it is set, the Mercury in the restoration is completely bound and inert. Dramatized claims of amalgam removals from a patient's mouth and a sudden cure of any and all disease processes they may have no scientific merit/explanation for them, just anecdotal claims.

What I tell my patients when they ask me is that the greatest risk for mercury problems with amalgam restorations is for myself and my assistant who are around the unbound, unset amalgam with great frequency. I also will open my mouth and let my patients see that I have a couple of amalgam restorations in my mouth, and I tell them that they have been there since 1985. I end this discussion with telling them that part of my job involves keeping current with all the latest research on these topics, and that if I thought there was any health issues related to amalgam restorations, why would I have them in my own mouth?? <img border="0" title="" alt="[Wink]" src="wink.gif" />

Frankly, the literature that tries to make amalgam out to be the pending doom of civilization as we know it today, is junk science if you evaluate it critically. Look, the legislature in California just denied a bill that would eliminate the placement if amalgam restoration by 2006, because the scientific proof behind the anti amalgamists claims was determined to be junk science. <img border="0" title="" alt="[Eek!]" src="eek.gif" />

The major issue with amalgam in dentistry may end up being more with waste water disposal levels of mercury than with amalgam placement issues. Many communities are imposing/finally enforcing water mercury concentration limits. This could really dramtically effect how we dispose of this waste water when amalgam removal is done, since the purifiers to eliminate the amalgam down to the allowable levels can have price tags/maintenance fees rapidly appproaching 6 figures, and the potential fines for non-compliance could be much greater than that!

Amalgam though is still a great restorative material! For those in school now/residency now that believe that all you need is some bonding agent and composite, just wait until your composite restorations placed with sub gingival margins, mandibular posterior lingual surfaces, the disto-buccals of maxillary 2nd molars, many squirming, fidgety pedo patients, have been i the mouth for a couple of years, and you see the recurrent decay on the bite-wings(this will happen commonly even with rubber dam isolation in those questionable circumstances). The flip side of this is as long as its been atleast 2 years since you placed the original composite, the patient's insurance company will pay for its replacement(at the amalgam reimbursement fees of course!), this way, after a few years you'll be giving yourself a future supply of restorative work, and potentially some endo and crown and bridge too! <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" /> Don't get me wrong, I love composite, you just need to be very carefull in selecting appropriate places to place them(atleast until they come up with an composite that can be placed in less than a dry field, and perform as well long term as amalgam does)

 

i am a pedodontist and from my experience i tell u that sometime u need to use amalgame cause it's very difficult to isolate the cervical margin.so u must decide in the clinic case. .

 

I read the article too and I thought the article was 'self explanatory'---&gt; not harmful.
And, as Dr. Jeff said ( by the way, I've been reading your responses and must commend you on the insights you provide), Amalgam poses a greater harm to the dentist than to the patient.
Also, I would like to know more about guidelines for disposal of waste amalgam in a dental setup.

 

Amalgam disposal guidelines vary greatly from state to state, and in some cases, county by county. Some states (I know Michigan and California for certain) have pending legislation that would mandate that the maximum allowable amalgam concentration present in water released into the sewer system (where the vast majority of all dental waste water goes) is in the neighborhood of 1 part per BILLION <img border="0" title="" alt="[Eek!]" src="eek.gif" /> (current federally mandated safe levels are in the range of 3 to 5 parts per MILLION). The estimated costs associated with the scrubbers needed to reach these levels would literally costs dental offices well over 100,000 to set up and in the neighborhood of 10,000 per year to operate. The ADA is currently working on legislation opposing the 1 part per Billion, or atleast trying to get it modified to have dental offices excluded from this <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />

For my office (in Connecticut), what we do with our amalgam waste is as follows. The suction system obviously has traps which catch large debris particles. The particles that are small enough to pass through the traps is released with the waste water in the office into the towns sewer system. Any pieces large enough to be caught in the trap, or scraps left over in the amalgam well after placing a new amalgam restoration, are placed in our "amalgam jar" which is supplied to us by our hazardous waste disposal company, who removes the jar every 2 or so months and disposes it in the proper manor. The scary thing about this is that the my office's liabilty with the scrap amalgam doesn't end when they pick it up. If they dispose of it improperly and it gets traced back to my office, me and my partner are responsible for all the environmental clean-up charges and any legal imposed fines associated with this <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" />
Fortunatelty 99% of all hazardous waste disposal firms are ethical and proper, so you don't have to worry about this

 

Costly amalgam scrubbers? I can see it now. Gold inlays and onlays make a big comeback in school curriculums and the licensing boards.

 

Any body say anything, from my experience , amalgamam is one of the best material gifted to dentistry <img border="0" alt="[Pissy]" title="" src="graemlins/pissy.gif" />

 

the best point that DrJeff brought up is that dental amalgam is an ALLOY. just because mercury is present does not mean that it is harmful. it is chemically bound to the other metals in the amalgam and prevented from "leaking" into the oral cavity.

 

I decided to try defending the other side since everyone here seems to be pro-amalgam ...

You say it's an alloy, but that's only if all the mercury reacts. Nothing is perfect, so there is probably an unknown number of unreacted mercury left in the prep.

Certainly composites are not non-toxic, but as we all know amalgam corrodes (that's how it makes a seal at the margins), so the corroded products can certainly leak into the oral cavity. While amalgam technology hasn't advanced for quite some time, the fast-paced research going on with all the tooth-colored alternatives will eventually produce something long-lasting and safe.

 

true, true.
however, with the advent of high copper amalgam, doesn't corrosion of the amalgam happen at a much lower rate? also, even if there is corrosion, how much amalgam is truly freed from the silver-mercury alloy? i've read somewhere that the amount of mercury that we ingest in seafood is significantly higher than the mercury that we ingest from our amalgam.

 

Your right on about the seafood(especially the ground-dwellers), and don't even think about a nice healthy serving of Broccoli, because that has more mercury in it than a "leaching" amalgam.

The intuitive thing that I'm really suprised that some of the legislature folks, as well as the non clinicians argueing for anti-amalgam laws, is that if they look at the group who would have the greatest financial gains from these laws(us restorative dentists) we're the same majority of folks that are argueing against this! For example, just for curiosity sake, my partner and I had our office manager recalculate what the office production would have been last year if we were an amalgam free office. Taking into account that what we charge for composite fillings vs the same surface amalgam restoration is roughly 50% more (this is a very, very common thing), we would have added an extra $75,000 to the practice's gross last year <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" /> We commonly tell our patients that question amalgam safety this figure (as well as all the other pro/con amalgam vs pro/con composite info) and then say that my partner and I actively support one of oyr state congressional representatives who opposes the anti amalgam bills. Patient's find it quite reassuring after hearing all this, and when they realize that I'm in favor of preventing legislation that would ultimately make me more money each year, it really sinks in that alot of the claims made by the anti amalgamists are nothing more than hot air.

BTW, since the article from time magazine that is in the link in the 1st post of this thread was published, I've had 4 of my patients/patients parents ask me about it. This is about average for anytime that there is an article in a magazine/paper, or a segment on TV about dentistry, so pay attention to your local papers/TV news/magazines, because you will be asked about it.

 

heh, I think our profs all went to the same amalgam convention, because I heard about that seafood thing too

DrJeff, you mention that composites will earn you more money, but don't they in general take more time to prepare because they are more technique-sensitive? So each case may be worth more but you end up doing fewer cases... Also, if indeed we are forced to go amalgam-free, I wonder if we have to replace fillings for no charge when we get failed composites in an area that should have been done with amalgam (i.e. high moisture-contamination risk)?

 

2 things here, on the added fees for composites vs the addded time issue. **Most** composite restoration placements vs amalgam restoration placements will take me an extra 5 minutes for the composites (I know it may be tough to believe, but with an ARC light with a 5 second cure time it doesn't take much longer than an amalgam) Plus, if your quite meticulous about shaping and contouring the composite before you cure it, it should then only take about a minute two to the final finishing and polishing after the final curing, which is about the same amount of time that it takes me to carve an amalgam. So when you factor in a roughly 50% increase in fees vs about for a roughly 5 minutes of extra chair time, composites can be quite a bit more profitable.

As for the replacement of a leaky composite, most Docs will base it on the insurance industry standards, which is that a restoration will be covered every 2 years (slight variance one way or the other from company to company) when placed in the same office(read as if your partner placed a composite a year ago, and it needs to be redone now and you do it, neither you or your partner will get paid for it <img border="0" title="" alt="[Eek!]" src="eek.gif" /> ) My personal theory on this is that without a doubt, if its within 2 years, its redone for free, sometimes depending on the situation (i.e. the patient's oral hygiene, the condition of the tooth {should it have really had a crown vs the composite}, did the secondary decay lead to the tooth needing endo, etc, etc, etc) sometimes I'll redo the composite for free for upto 3 or 4 years (or if the patient is now looking at a crown, or worse yet and endo, post and crown, then I may very well credit the original restortaion fee towards the new treatment. If the patient is a total oral hygiene disaster, then at 2 years and 1 second after orginal placement, if the composite fails, they're paying for the new one.

 

I'm still learning..
...when i observed during the pre-dental days..and i never remembered anyone using amalgam...even with posterior restorations (i even saw a ceramic inlay)..

however, nowadays my professors never miss a chance to remind us that amalgam is the "restorative material of chose"..

Dr. Jeff,
what is the reasoning behind some of the scandinavian countries banning amalgam a few years ago?

 

As my recolection goes about the banning of amalgam in Scandanavia a few years ago, it was part fear, part concerns over the manufacturing of the amalgam, and part not particularly good science. What we are now seeing in the country is that good science is winning out over sensationalization claims about amalgam. Look at the ADA right now and their suit against an "ambulance chaser" attorney in California, look at all the state anti amalgam legislation being voted down. Also, take a step back and think about it. Dental amalgam has been around in one form or another for about a century. Literally BILLIONS of amalgam restorations have been placed, and many of those older ones that are 20, 30, 40+ years old had alot higher mercury content than "modern amalgam". You're not seeing a huge population of folks dieing of mercury toxicity, are you...