The Safety of Amalgam Fillings

[iversondental]

As a dentist, what is your professional opinion on the use of amalgam fillings, do you feel that the constant release of mercury, though trace amounts, throughout the patients life could have no detrimental effects. Although it hasn't been proven that these fillings create health problems, its a well known fact that mercury is a poisonous element and knowing that your filling is essentially leaking trace amounts of it, do you feel that it is 100% safe?

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[browncrack]

Yes. It is 100% safe. I am however, worried about how a person can start a thread like this as their first and only post.

 

[Mohab]

Haha, definitely curious...
www.iversondental-labs.com
All dental schools teach amalgam (and its proven safety)... Not using amalgam because it just seems like it would be bad is not exactly evidence-based...

 

[Doc Smile]

As a dentist, what is your professional opinion on the use of amalgam fillings, do you feel that the constant release of mercury, though trace amounts, throughout the patients life could have no detrimental effects. Although it hasn't been proven that these fillings create health problems, its a well known fact that mercury is a poisonous element and knowing that your filling is essentially leaking trace amounts of it, do you feel that it is 100% safe?

What are you going to put on a posterior tooth with a heavy occlusal load? an amalgam that has proven the test of time (not to mention countless peer-reviewed, scientific community approve, research studies) or a resin that will last 1/2 the the amalgam's life?

Just pack it with mud and see how much 'trace' elements that are proven to be detrimental to health are in that.

Amalgam is 100% safe. Stop trolling. urgh, these people who get amalgam crazy are non well attuned with the scientific process or evidence based dentistry. . . drives me bonkers.

:troll:

 

[Doc Smile]

From that Iverson Dental website:

"A: Over the years there has been some concern as to the safety of amalgam (silver) fillings. An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury. Dentists have used this blended metal to fill teeth for more than 100 years. The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth. The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe. Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective. The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling. The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed at high, unsafe levels. For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them. However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings. We encourage you to discuss these options with your dentist so you can determine which is the best option for you."

High, unsafe levels . . . not found in amalgams brah, they are tied to the crystal structure. . .

 

[senpai]

What are you going to put on a posterior tooth with a heavy occlusal load? an amalgam that has proven the test of time (not to mention countless peer-reviewed, scientific community approve, research studies) or a resin that will last 1/2 the the amalgam's life?

Just pack it with mud and see how much 'trace' elements that are proven to be detrimental to health are in that.

Amalgam is 100% safe. Stop trolling. urgh, these people who get amalgam crazy are non well attuned with the scientific process or evidence based dentistry. . . drives me bonkers.

:troll:

Completely agree. However, I personally prefer composite in my own mouth even if I have to replace it 2-3 times for the time an amalgam would last just for esthetic reasons. Different topic, I know, but I think it's funny sometimes how loyal restorative dentistry is to amalgam. Yes it is a superior material, but what does most of the public care about (including me )?: 1. Esthetics, THEN 2. Function/durability, etc., etc. The same goes with Gold. I won't put it in my mouth for the same reason. Now if we're talking people with low income, then yes, I think it is a little more appropriate to push amalgam on them to save 'em some money in the long run and give them something that'll last. Middle/upper income America on the other hand? Don't fight it

 

[Tooth]

As a dentist, what is your professional opinion on the use of amalgam fillings, do you feel that the constant release of mercury, though trace amounts, throughout the patients life could have no detrimental effects. Although it hasn't been proven that these fillings create health problems, its a well known fact that mercury is a poisonous element and knowing that your filling is essentially leaking trace amounts of it, do you feel that it is 100% safe?

I place amalgams practically every day I work. I also place composites, gold, and porcelain restorations. My favorite amalgam quote is as follows.

"I don't feel comfortable using a substance designated by the EPA to be a waste disposal hazard. I can't throw it in the trash, bury it in the ground or put it in a landfill, but they say it's okay to put it in people's mouths. That doesn't make sense."

I believe this quote captures the essence of the dilemma that many dentists face when placing amalgams. For some this uncomfortable feeling causes them to not place amalgams, while for others it just makes them feel uncomfortable.

I am aware that amalgams release mercury vapors and that mercury is a known toxin and yet I still place them routinely. Why?

The only other practical alternative is composite. Do you think composites are safer? Ever heard of BPA? I don't think Bis-GMA is much different. In my mind it's truly a case of pick your poison.

On one hand you have a known neurotoxin and on the other a hormone disrupter which can lead to reproductive harm among other problems.

Gold and Porcelain don't have these problems but they just aren't practical. Additionally, you could probably just as easily find biochemical arguments against the cements we use to hold them in place.

There will be an endless argument over which restoration is the best or the safest. There is no perfect material. As professionals, we are prepared to discuss the pros and cons of each material and help our patients make an informed decision.

Lastly, there is the matter of the standard of care. Right now the standard of care for amalgams is generally accepted. Amalgam restorations are on their way out the door (for cosmetic reasons) but for now they stand. When the day arrives that the majority of dentists are no longer placing amalgams (and that day will come) then it will become more of a liability to continue to place amalgams. For now though, it is still acceptable.

 

[armorshell]

When the day arrives that the majority of dentists are no longer placing amalgams (and that day will come) then it will become more of a liability to continue to place amalgams. For now though, it is still acceptable.

Has that day not come already? I've done 2 amalgams on patients in my life, and one of those was on boards.

 

[The Dawgfather]

Has that day not come already? I've done 2 amalgams on patients in my life, and one of those was on boards.

I have placed over 100 surfaces of Amalgam during dental school. As senpai said, it makes the most sense when treating a lower income patient who wants the filling to last as long as possible. Posterior composites still have a slew of problems, especially the ones that are sub G (leakage, less predictable proximal contacts, lack of strength, isolation issues, "self etching" composites, etc). I expect amalgam to be around for a long while still yet. Ironically, the only direct restorative material that is longer lasting, is the one that is even more bio compatible... Gold Foil, which is now nothing more than a dental hobby.

 

[sarah_bellum]

Has that day not come already? I've done 2 amalgams on patients in my life, and one of those was on boards.

I'm guessing it depends on your training. I'd say that half of the restorations I've placed have been amalgam.

 

[Streetwolf]

My school pushes amalgam for most larger posterior (molar) restorations and pretty much every class 2 restoration out there (except maybe 1st PM mesial if esthetics is an issue).

In 2nd/3rd year for the most part we were blindly following that, and the faculty were pushing for it as well. I'm not saying I disagree with it, but I don't think everyone needs it. The right patient will do fine with a class 2 composite.

In 4th year we had more of a say if we wanted to place composite in any of those areas.

I've still done a ton of amalgams throughout d-school though.

 

[HCHS]

Having practiced for 27+ yrs, I have found that well placed amalgams last the longest and will continue to use this material. When a patient asks for only tooth color I always inform them that it won't last as long, it's their decision.
ALWAYS be aware there are people who use scare tactics and false info for only personal gain.

 

[Aleman]

http://www.foxnews.com/politics/2011/10/27/us-weighs-support-for-un-treaty-that-could-force-dentists-to-change-materials/

There is a big push for a UN mandated ban on amalgam as a dental restorative material. Unfortunately the decision of whether or not to use amalgam will be taken from the dentist and patient and decided by biased policy makers.

 

[youngmc27]

Amalgam is a good material and I see no reason to change old amalgams to composite if they are still functional, that said however, I went to school in an area where most people are concerned with esthetics so amalgam and even PFM crowns were less desirable. I have still placed a fair amount of amalgams but I prefer composite but only time will tell if they will last.

 

[jacksonkelly]

As a dentist, what is your professional opinion on the use of amalgam fillings, do you feel that the constant release of mercury, though trace amounts, throughout the patients life could have no detrimental effects. Although it hasn't been proven that these fillings create health problems, its a well known fact that mercury is a poisonous element and knowing that your filling is essentially leaking trace amounts of it, do you feel that it is 100% safe?

Amalgam is 100% safe, yes amalgam has mercury, silver,zinc, but the mercury causing your concern before being placed in the patient's mouth, has already reacted and formed silver mercury which is a new different chemical.

Its like you're saying H2O isnt safe because it has hydrogen which is not a safe material!

Another point you mentioned is "constant release of mercury" I dont believe that mercury is released after the amalgam is set, at least thats what I was taught in dental school.
Please correct me if Im wrong....Depending on the speed of the setting reaction amalgam is used, the initial set of amalgam used today is about 5 mins, reaching a complete set within 1 to 24hrs, again depending on the amalgam used. That means the patient leaves the dental chair with a SET amalgam, and no mercury released what so ever.

I would agree with you about the mercury concern with "conventional amalgam" where dentists had to condense it with lots of pressure until the excess mercury moves to the surface of the amalgam and to be removed. Or the conventional amalgam where dentists had to place amalgam powder and mercury and mix it in pestle and mortar...yes thats not safe to everyone in the dental office including the patient.

But again my question to the people concerned about mercury effect on health, how mercury will get in the blood through a class 1 or 2 cavity?

 

[Mackchops]

Mercury is volatile and the argument is that amalgam fillings release mercury vapors... however, the "exposure" and resultant physiological effects of these vapors is debated. It's like how x-ray radiation is bad so people refuse to get x-rays. Or the amount of arcenic in tap water. Or even oxygen!! Ever heard of free radicals? Oxygen is toxic toxic toxic stuff!!

But you have to appreciate the body's ability to filter. It's all dose-dependant.

Also, please note that there is not a piece of literature or a scientific study ANYWHERE that will state that amalgam is "100% safe". The literature has consistently found "no evidence of harm", which is not the same. Arguements for both sides of the debate are based on assumptions, anecdotes, and testimonials -- NOT on scientific fact.

My personal opinion is that the number of clinical scenarios for which amalgam is the superior restoration is shrinking. Modern composites are strong, require more conservative preps, and are lasting longer and longer. My patients more than likely will get a composite.

All that said, I personally think it borders on malpractice to remove an acceptable amalgam restoration for anything other than esthetic reasons...

 

[MonchichiMan]

Haha, definitely curious...
www.iversondental-labs.com
All dental schools teach amalgam (and its proven safety)... Not using amalgam because it just seems like it would be bad is not exactly evidence-based...

Nor is it Ethical, patients should be given all options and treated accordingly. People who profess to have an office "Amalgam Free" for health reasons are not quite ethical.

 

[Aleman]

What are you going to put on a posterior tooth with a heavy occlusal load? an amalgam that has proven the test of time (not to mention countless peer-reviewed, scientific community approve, research studies) or a resin that will last 1/2 the the amalgam's life?

Just pack it with mud and see how much 'trace' elements that are proven to be detrimental to health are in that.

Amalgam is 100% safe. Stop trolling. urgh, these people who get amalgam crazy are non well attuned with the scientific process or evidence based dentistry. . . drives me bonkers.

:troll:

We went through all the research in dental school that proves amalgam last longer, etc. but it always seemed to me that these studies were of dentist who were trained in and used amalgam all of their lives and then of course, had higher failure rates using resin composite, a material they weren't well trained or had alot of familiarity in.
I've talked to a number of more contemporary dentist who were trained well with composite and use it everyday and claim to have similar success rates.
Sometimes I wonder if it is only a materials question, or if it depends entirely upon the operator...

 

[BrandonCW]

I came across this statement online: "Temperature changes in the mouth cause the silver fillings to expand and contract over a period of time; this damages the integrity of the tooth."
This is the first I've heard of this. Is it true? I can't find a study to back this up. The ADA didn't say anything I could find. They only talked about debunking the falsehoods about mercury poisoning.

 

[vellnueve]

I came across this statement online: "Temperature changes in the mouth cause the silver fillings to expand and contract over a period of time; this damages the integrity of the tooth."
This is the first I've heard of this. Is it true? I can't find a study to back this up. The ADA didn't say anything I could find. They only talked about debunking the falsehoods about mercury poisoning.

Thanks for bringing back a thread six years dead.

The statement is technically correct but very misleading. All materials expand and contract to some degree with temperature. All fillings do so differently than natural teeth. Gold is the closest to natural teeth. Amalgam is typically closer than resin composites.

 

[avangusva]

Amalgam has a property knows as "creep" which, yes, does expand over time (partly related to absorption of water and degradation of the alloys). Any and all restorations (amalgam, composite, gold) will negatively affect the mechanical properties of teeth and leave them more prone for fracture. Amalgam creep is one of the properties of this material which actually leads to a good marginal seal and less "leakage".

On the flip side, composite shrinks (at a rate of up to 3% if I remember correctly) at the time of light curing and can cause micro-fractures in the tooth at the time of placement.

 

[KillaCam]

There is a dentist that works in the same practice as me out here that went to Columbia and thinks that Amalgam is the anti-christ. She tells patients to remove them and replace them for composites on a daily basis. Perfectly good fillings being taken out and teeth subjected to undue trauma and work that has resulted in many pulp exposures and problems for the patients. I am the lucky one who gets to take all these teeth out eventually and I feel bad because this lady is a complete *****. She also believes fluoride is poisonous and tells patients to not brush with fluoride toothpaste, she won't put in GI, and tells patients with dry sockets that they need more Vitamin C to cure the dry socket. All that education, and for what

 

[avangusva]

There is a dentist that works in the same practice as me out here that went to Columbia and thinks that Amalgam is the anti-christ. She tells patients to remove them and replace them for composites on a daily basis. Perfectly good fillings being taken out and teeth subjected to undue trauma and work that has resulted in many pulp exposures and problems for the patients. I am the lucky one who gets to take all these teeth out eventually and I feel bad because this lady is a complete *****. She also believes fluoride is poisonous and tells patients to not brush with fluoride toothpaste, she won't put in GI, and tells patients with dry sockets that they need more Vitamin C to cure the dry socket. All that education, and for what

When do you get back in town? Also that lady sounds terrible.

 

[Kareful]

High, unsafe levels . . . not found in amalgams brah, they are tied to the crystal structure. . .

Is silver amalgam even crystalline? Seems more amorphous to me due to the lack of long-range order within the amalgam.

 

[KillaCam]

When do you get back in town? Also that lady sounds terrible.

First week of August, starting that 5 months of anesthesia with you animals over at Parkland. So ready to be done with med school

 

[vellnueve]

First week of August, starting that 5 months of anesthesia with you animals over at Parkland.

It's fun


As for the topic. Pretty sure I've done more amalgam than a majority of the posters on this board. I'm pretty sure the vast majority of my patients are still walking around with those amalgams in good shape.

 

[avangusva]

First week of August, starting that 5 months of anesthesia with you animals over at Parkland. So ready to be done with med school

Get your golf game up and brush up on the cigar palate. I can't tell you how much I hate medical school right now.

 

[schmoob]

There is a dentist that works in the same practice as me out here that went to Columbia and thinks that Amalgam is the anti-christ. She tells patients to remove them and replace them for composites on a daily basis. Perfectly good fillings being taken out and teeth subjected to undue trauma and work that has resulted in many pulp exposures and problems for the patients. I am the lucky one who gets to take all these teeth out eventually and I feel bad because this lady is a complete *****. She also believes fluoride is poisonous and tells patients to not brush with fluoride toothpaste, she won't put in GI, and tells patients with dry sockets that they need more Vitamin C to cure the dry socket. All that education, and for what

The definition of malpractice.

 

[TanMan]

I'm pretty upfront with my patients. I tell them if its not broken, don't replace them. However, I don't think an amalgam free practice is necessarily unethical. I place no amalgams in my office and when a patient asks why, I'm pretty upfront in saying that I don't want chronic exposure to the material since a lot of the Hg is released at the time of placement. It's safe to have your teeth filled with them, but I sure as heck don't want to be exposed thousands of times during my lifetime.

 

[vellnueve]

I'm pretty upfront with my patients. I tell them if its not broken, don't replace them. However, I don't think an amalgam free practice is necessarily unethical. I place no amalgams in my office and when a patient asks why, I'm pretty upfront in saying that I don't want chronic exposure to the material since a lot of the Hg is released at the time of placement. It's safe to have your teeth filled with them, but I sure as heck don't want to be exposed thousands of times during my lifetime.

So basically you're perpetuating the myth by stating that it's safe, but you don't want exposure.

 

[Kareful]

So basically you're perpetuating the myth by stating that it's safe, but you don't want exposure.

Vellnueve, so no Hg is released at all? Or is some? Is that Released Hg comparable to a few lake fish eaten in a year? I'm just curious... as such low levels would be negligible in the grand scheme of thhings

 

[vellnueve]

There's more mercury exposure eating a barracuda.

 

[TanMan]

So basically you're perpetuating the myth by stating that it's safe, but you don't want exposure.

I'm not sure what you're saying, but essentially, I'm telling the patient that its safe and there's no reason to replace it unless there's caries or fracture. However, I also inform them that I do not place any amalgams since I am concerned about being exposed to it everyday of my working career. I don't think there's any studies done on workplace exposure to amalgams, but I choose not to take the risk as a personal choice. They have the option to go to a dentist that places amalgams and I have referred one patient one time, but that was because they were too cheap to pay for composites (few dollar difference), since the insurance was downcoding composite to amalgam. You cannot make me place something that I am not comfortable placing, as you cannot make me do braces if I don't want to. However, I do not misrepresent the material either. There are pros and cons to each material; amalgam nor composite is a miracle material.

 

[vellnueve]

I understand your rationale, but you have to realize that to the patient, all they hear is "fine for me but not for you."

Therefore, however unintentionally, you perpetuate the myth.

I'll place amalgam any day of the week and twice on Sunday. I have seen poor placements of both amalgam and composite. But I have seen far more poor composites than amalgams. Thus, I would do what I feel is in the best interest of the patient.

Remember that the oldest dentists and the older faculty around today worked in an era where they did almost exclusively amalgam, without masks and gloves, all the way into the 80s.

 

[TanMan]

I understand your rationale, but you have to realize that to the patient, all they hear is "fine for me but not for you."

Therefore, however unintentionally, you perpetuate the myth.

I'll place amalgam any day of the week and twice on Sunday. I have seen poor placements of both amalgam and composite. But I have seen far more poor composites than amalgams. Thus, I would do what I feel is in the best interest of the patient.

Remember that the oldest dentists and the older faculty around today worked in an era where they did almost exclusively amalgam, without masks and gloves, all the way into the 80s.

I suppose you're right, but I still wouldn't place it due to concerns of chronic exposure. It's easier to do an amalgam under non-ideal circumstances/poor moisture control and they last a lot longer when done conservatively.

 

[schmoob]

Just playing devils advocate here. But with proper PPE, I would think amalgam is significantly less of a worry than the daily exposure to all sorts of aerosolized material created during patient care.

 

[TanMan]

Just playing devils advocate here. But with proper PPE, I would think amalgam is significantly less of a worry than the daily exposure to all sorts of aerosolized material created during patient care.

Just one less thing to worry about

 

[schmoob]

Just one less thing to worry about

I'll even go as far as saying the exposure to potential harm is higher using a curing light.

Not calling you out. Just a friendly debate.

 

[TanMan]

I'll even go as far as saying the exposure to potential harm is higher using a curing light.

Not calling you out. Just a friendly debate.

That's good, its a matter of personal preferences. Looking at the light directly will definitely harm your eyes. Kinda like how you can't make a dentist do something they aren't comfortable with, I think its important to be honest with the patient about pros and cons of everything. Sometimes its hard as a GP, since we're seen as the go to for a lot of procedures, but gets easier as time progresses as you usually don't see those patients again. It's hard to tell the patient that I'm referring them out for partials because I don't do partials/dentures/combination cases.

 

[sadandsick]

I understand your rationale, but you have to realize that to the patient, all they hear is "fine for me but not for you."

Therefore, however unintentionally, you perpetuate the myth.

I'll place amalgam any day of the week and twice on Sunday. I have seen poor placements of both amalgam and composite. But I have seen far more poor composites than amalgams. Thus, I would do what I feel is in the best interest of the patient.

Remember that the oldest dentists and the older faculty around today worked in an era where they did almost exclusively amalgam, without masks and gloves, all the way into the 80s.

Sorry to but in . As a biological chemist and having a doctorate in organic chemistry, the gov gets away with the most criminal unethical scams including fraud at every level. That includes the lies that are told by the medical schools , FDA, and CDC, and pretty much the rest of the alphabet gang! Do yourself a service and save the pain of going through the biggest long over due class action suit in the history of the modern age. They allow whom ever wants to poison the pubic to do so, to continue to do so. Shameful study real science not one molecule of Hg is safe for human consumption that is fact! And one has to move on to Plutonium to have more toxicity. Check this out for starts then tell me how you feel about using Hg.

 

[lemoncurry]

You're a chemist, but don't wonder how mercury vapor, which is heavier than air, would rise from the scratched tooth instead of sink? I find it curious that a PhD would resort to a junk science documentary to try to prove a point (I've seen the video).

 

[Eli Manning]

Welcome to the internet, where everyone has a PhD in organic chemistry.

 

[nealofgrafton]

huh... you join today. make ridiculous statements backed by "doctorate in organic chemistry". here's a brief though experiment... if mercury is so toxic how are there any old dentists? Shouldn't we all have died because we are definitely around it more than the patients are especially during the dangerous cutting of it.
when you go use your SMART amalgam removal technique kick it up one notch and just put a plastic bag over your head to protect yourself
thanks, from a dentist that got a masters in chemistry first

 

[2TH MVR]

There's probably more toxins in a Big Mac than an amalgam filling.