mercury fillings? is it really safe?

[okiamhot]

i once got a filling (is that correct word, anyway) filled by a dentist with some white materials, but it got loose like a few weeks later. then another dentist filled me with those mercury look like material, and i had to sign a paper to acknowledge that it might be dangerous, etc or something like that, i don't remember.

so i am just wondering if it is really safe? and how come the white material is not as good as the mercury one?

thanks.

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[xc1999]

Amalgam (the silver/mercury filling) is still in debate as to whether or not it's really dangerous. I have heard from some ppl who did a research paper on this that even though amalgam does release some mercury, the amount that it releases per day is actually very miniscule compared to the amount that could kill you (actually, I learned this bit of info from some of my instructors as well). Because the safety of amalgam is still in debate, I think the ADA (correct me anybody if I'm wrong) has required all dentists to give the patient some sort of information about the materials they are using that could be potentially toxic.

The composite that you got the first time around (the white filling) may have fallen off b/c the dentist may not have isolated the area to be filled very well. With composite, you pretty much have to make sure the area you're working in is very dry, and this can be difficult with posterior restorations (fillings for the back teeth) because of saliva. Was the white fillling in your molars or premolars, or was it more so in the front (ie, canine, incisors?)? Amalgam, on the other hand, works just fine in a wet environment.

There are different situations in which a dentist much choose b/t a composite or amalgam; what the situation is depends on what tooth the filling is to be made and WHERE on the tooth the filling is to be made as well.

anyhow, hope this helps. I'm sure there'll be more ppl adding to this later

xc1999

 

[trypmo]

I was under the impression that it was the mercury vapors, which flow from the material while it's being put in, rather than leakage from the material after it has set, that was the problematic part of amalgam fillings. A dentist once told me that the studies which proved mercury in amalgams was harmful was actually proven wrong by later studies. On the other hand, the dentist I shadow doesn't do any amalgams at all. I have amalgams in my mouth, which I actually hope to replace someday with gold ones (for the properties of the material, not the fact that they'd triple my net worth). At this early stage in my pre-career, I'd say I'd be inclined not to use them by default until I could get my hands on the research papers which purport to prove whatever they say they do. But that's just me.

 

[dientesfuertes]

I'd just like to point out that no one has "proven" that composite is 100% safe, either. It's only been used as a restorative material for a small fraction of the time amalgam has been around.
Who knows...50 years from now, somebody could come up with some research that shows Bis-GMA (a component of composite) or any other part of resins to be toxic. Everyone assumes that since they are non-metallic and tooth-colored, they must be inert. However, one should keep in mind that anything a dentist can do to fix or replace a tooth will never be as good as the original structure.

 

[trypmo]

I do agree that nothing can be considered 100% safe no matter what, but I do think that materials can be shown to be unreactive enough that the probability of their somehow becoming reactive and causing harm can be considered negligible. JMHO

 

[aphistis]

I do agree that nothing can be considered 100% safe no matter what, but I do think that materials can be shown to be unreactive enough that the probability of their somehow becoming reactive and causing harm can be considered negligible. JMHO

True, but:

The first rule of composite restorations is that you NEVER get 100% polymerization, and the component molecules are all necessarily quite reactive. What happens if they get into your system? Nobody knows about that, either. There's no conclusive evidence answering either question, and just because someone can present their speculation persuasively doesn't mean they're any less speculating.

 

[dientesfuertes]

Exactly my point, Bill. Thank you for elaborating.

 

[drPheta]

Yup, you guys are all pretty much on the ball. From what I remember reading in the literature, seafood has higher mercury content than any amalgam (well condensed or poorly condensed) will leech off. So, if anyone is worried about mercury toxicity, they should be checking out that of their fish and crustaceans.

Just a side note: most dentists who don't do amalgams don't want to bother with having the patient say "but those are ugly" or something similar. My dentist has often presented amalgams in his tx plan, but he hasn't had to do one since 10 years ago. Everyone is all about the tooth colored composites, even if they cost more, present with possible leakage, break more readily, and have that nasty tasting resin pre curing compared to amalgam.

 

[Energon]

One of the worlds best amalgam expert (has his PhD in dental biomaterials and has been doing studies on amalgam since the late 60's is a professor at my school), he has two papers coming out in JADA later this year where he has disproved all the "amalgam danger" reports. He also authored an article on the same topic I believe in the Nov 2003 JADA issue. I am with him on this one. The mercury toxicity of amalgam is so low that it is a non issue.

 

[trypmo]

One of the worlds best amalgam expert (has his PhD in dental biomaterials and has been doing studies on amalgam since the late 60's is a professor at my school), he has two papers coming out in JADA later this year where he has disproved all the "amalgam danger" reports. He also authored an article on the same topic I believe in the Nov 2003 JADA issue. I am with him on this one. The mercury toxicity of amalgam is so low that it is a non issue.

Aha -- there's the kind of thing I was looking for. Thanks!

 

[booshwa]

This brings me to an interesting point (not my observation btw), about the internet. Overall it has done amazing things to the increased knowledge base of patients.

However, with this increased ability to look up dental procedures/materials,etc... comes the exposure to a myriad of websites put forth by anti-amalgamists-who base their information on partial truths, observation, poor interpretation of the data, etc....so now the public believes something that is completely untrue.

One of the most interesting things I've learned about amalgams comes from their ban (or non-usage) in Sweden. This isn't based on their safety to the patients, but is based on the high incidence of cremation in their dead. With this cremation comes amalgam and the associated mercury fumes. But I bet the general public doesn't know this.

Anyways, my point is that it is important for us to know the facts about the materials and be able to explain that to patients. Clearly, amalgams often remain an ideal material because of their strength, durability, cost, ease in placement and their ability to seal off. It will be interesting to see what further advancements will be made in alternative materials (or even within the amalgams) during the duration of our careers.

 

[marshall]

If you read newsgroups the dental newsgroups were completely inundated with this topic last fall (may still be, I stopped reading because this is all they talked about). I got some laughs because people think the ADA is involved in a large conspiracy to cover up amalgam toxicity because if it were ever proven, we'd all be in hot water. Take that one to the bank.

 

[booshwa]

If you read newsgroups the dental newsgroups were completely inundated with this topic last fall (may still be, I stopped reading because this is all they talked about). I got some laughs because people think the ADA is involved in a large conspiracy to cover up amalgam toxicity because if it were ever proven, we'd all be in hot water. Take that one to the bank.

The ADA actually sued a lawyer in Van Nuys, CA for defammation and libel/slander (whichever it is) because he was spreading information about the dangers of amalgams-as well as suggesting this conspiracy that the ADA had such an investment/interest in amalgam-that they were willing to cover up its dangers in order to protect their image.

Personally, this makes me feel good to know that we have such a strong organization backing us up....and another reason why everybody should be members of ADA when they are practicing.

 

[okiamhot]

so how many dentists are still using amalgam instead of the composite?

yea, my fillings was in the inside. if later on, i want to do some veneer, can they cover it or do something?

 

[xc1999]

It seems to me that there are more dentists who use amalgam and composite than those whose offices are amalgam free. There are dentists out there who use no amalgam whatsoever, but I think there are plenty more who do use it because it's cheap and in a lot cases has a smaller chance of failing than composite fillings. Plus, it's great for posterior teeth cause amalgam is easier to carve with than composite.

But this is only my speculation. Anyone else have more accurate info on this?

 

[UBTom]

Yup... For repairing teeth where good isolation is difficult (such as if you are trying to repair class-V caries on molars where you expect gingival bleeding), Amalgam is still the best material to use. You can shove it into a bloody hole that is an excavated-and-prepped Class V lesion and it will hold, whereas if you use composite it will be guaranteed to fail and leak in a few months if not weeks.

Amalgam is also the fastest core-buildup material one can use... I find using resin core-buildup materials slow-going because you have to apply it incrementally to minimize shrinkage, whereas with amalgam you just shove it in and condense it, and that's that. And it will be covered by a crown in any case..

 

[drPheta]

The whole notion that the amalgam is a conspiracy always baffles me. Why the hell would we keep promoting something that doesn't net us as much money as composites? I don't even find it that much easier to work with compared to the composites I've worked on in the typodont (taking aside the isolation part of the equation). So, really, if we were all about some consipiracy, wouldn't it make more sense to claim that amalgam was bad and force insurance and patients to fork out the dough for composites? Also, since composites are apt to fail sooner than amalgams, that means more procedures we get to do which = more money. Never understood anti-amalgamites. *shrug*

 

[3rdMolarRoller]

You guys are so out of wack. The Communist introduced Amalgam with 50% mercury to destroy our society just as they have put Fluroide in our water. Please wake up to reality folks.

 

[UBTom]

Nah... It's the aliens who are doing this!

I'm surprised there hasn't been an X-Files episode on this popular conspiracy theory..

 

[3rdMolarRoller]

Anyway, have you guys seen this new DDS device being made that helps people lose weight by reducing the size of the oral cavityor thier bite? Ah...with over 50% of our population overweight I see this as a $$$. Hey, if people want it and it doesn't screw them up, I will gladly offer it. Who knows, they may come in for that and become a patient for good.

http://www.sfgate.com/cgi-bin/artic...004/05/18/national1731EDT0718.DTL&type=health

 

[ShawnOne]

I saw that on Yahoo news, but the article was basically criticizing it, and I agree. It said the procedure is as effective as using a baby spoon.

Do we really need a physical barrier to stop ourselves from eating? how bizarre!

 

[3rdMolarRoller]

Do we really need a physical barrier to stop ourselves from eating? how bizarre!

If you do not have self control, then yes you need a physical barrier. And these people are overweight for a reason...no self control!

 

[KDBuff]

I had a patient who wouldn't allow me to use topical flouride on her child because it's a "government conspiracy, and a by-product of aluminum." Eh, that's what I get for living in Boulder.

 

[ShawnOne]

If you do not have self control, then yes you need a physical barrier. And these people are overweight for a reason...no self control!

When what is to stop the person from removing the device and stuffing their face?

 

[3rdMolarRoller]

When what is to stop the person from removing the device and stuffing their face?

Laziness bec they are so lazy. Another reason they are over weight is because they are lazy

 

[trypmo]

Laziness bec they are so lazy. Another reason they are over weight is because they are lazy

That was a joke, right?

 

[ShawnOne]

Laziness bec they are so lazy. Another reason they are over weight is because they are lazy

Still laughing from yesturday