Even if silver accessories are all the rage this summer, there’s one silver sparkle that I do NOT like to see on a patient: amalgam dental fillings. I often hear patients asking to change them because they’re ugly, visible when they laugh, or not tooth colored, but more and more people are taking them out for serious reasons. A recent inspection at the office inspired me to share with you some thoughts about those sadly common old mercury amalgam fillings.
Our yearly EPA inspection visit went smoothly as usual, the inspector noting the large collection traps in the basement of Contemporary Dentistry that hold the amalgam after it’s been whisked away from your mouth with our strong suction system. He checked our operatory traps and quizzed my assistant to make sure she knew where to dispose of the traps (a separate Mercury Waste bucket that is not the same as our Biohazardous Waste bin or our Sharp items, it’s a completely different recptacle) that might contain amalgam particles. Usually when a tooth is pulled, it is placed in a Biohazardous Waste receptacle for proper disposal. Do you know where you put a tooth with a mercury filling? In that Mercury Waste bucket. The EPA does not want that mercury anywhere near the water supply or out in the environment. Yet each year, millions of Americans receive a brand new, shiny amalgam filling stuffed directly INTO THEIR MOUTHS. You probably have one or two in your mouth right now too! There are dentists, bloggers, and doctors who mock the biological dental movement and scoff at patients who are concerned about mercury toxicity, but I want to share with you a few facts about amalgam and the reasons why I hate amalgam fillings, haven’t placed them in over 20 years, and would never have one placed in MY mouth:
- Amalgam fillings were described as far back as the Tang Dynasty in China.
- Amalgam fillings made it to the United States around 1830.
- Some other fun medical practices happening in this country around the time of amalgam introduction were: tobacco enemas, giving children opium for a cough, and diagnosing women with “hysteria” and treating it with pelvic massages (eek!). Putting mercury in your mouth probably did seem like a good idea at the time.
- “Amalgam consists of approximately 50% mercury by weight. Mercury vapor release is of particular concern as a potential health risk. An estimated 75% to 80% of inhaled mercury vapor, which reaches pulmonary alveoli, will be absorbed into the blood. ” “Make personnel aware of the potential sources of mercury vapor in the operatory.” – from the ADA mercury hygiene recommendation. 1
- The World Health Organization believes that there are no safe levels of mercury for the human body. 2
- In Norway, Sweden, Denmark, they have banned amalgam fillings. In Germany and Austria, amalgam fillings are banned for children and pregnant women.
- Aside from dangers presented to patients, dental personnel are endangered by constant exposure to toxic mercury.
- Patients with mercury fillings are constantly taking in mercury vapor as it is released from the mouth. “the average filling has 1 gram of mercury and leaks mercury vapor continuously due to mercury’s low vapor pressure along with loss due to galvanic action of mercury with dissimilar metals in the mouth. ” 3
- I belong to the International Academy of Oral Medicine and Toxicology, who has made a clear statement about their postion on mercury, which is to end the use of amalgam entirely. 4, 5
- My own personal experience! Every day I remove amalgam restorations. Even if you are unconvinced of the dangers of mercury exposure, there are other reasons why I hate amalgam fillings.
- To place an amalgam filling, you remove decay and create a little cave-like hole in the tooth, then stuff the crumbly filling material in until it’s hard packed and then polished. The process is kind of like filling a pothole.
- Amalgam expands over time, pushing outward agains thte thin enamel walls containing the filling. Combine this with the constant pounding of bite forces and I see cracked teeth, cusps broken off, and crumbled tooth structure every day. Often times the amalgam filling is still stuck in the tooth and the tooth breaks all around it.
- I frequently see something we call “ditched” amalgam fillngs, where the very edges of the filing are not sealed and are clearly leaking and letting bacteria pour underneath to create decay (see photo)
- After removing a huge amalgam filling, I routinely find decay forming underneath and also observe fracture lines snaking along the inside of the tooth.
- There are superior filling materials available to us THAT ARE NOT FROM THE 1800’s! You may have been told in the past that “white fillings” are not strong enoug for back teeth, but this is simply not true. When placed using the proper and strict technique, composite fillings are durable and aesthetically pleasing. 6
- For larger areas, I prefer a lab fabricated restoration for strength, beauty, protection, and biocompatibility.
I would like to look into a patient’s mouth and see only beautiful, healthy tooth structure with not a single filling. Unfortunately, most of us have experienced decay at least once in our lives and the dentist we saw had to remove the decay by drilling/removing the damaged tooth structure. A filling is used to restore the missing part of your tooth that was corrupted, seal out bacteria, and hopefully to hold the structure of the tooth together. Now take a look at the picture above, not only are those “silver” fillings ugly, they are NOT DOING THEIR JOB. The edges are open and leaking, letting bacteria sneak in/underneath the filling. Note that the enamel that should be strong and thick, is instead transparent and thin with chipped and fractured areas. In the x-ray you can see that there is a huge and lumpy overhang on the filling, causing bacteria and food to become lodged underneath, leading to gum inflammation and decay. Given the controversy around mercury amalgam fillings and the fact that we have structurally superior alternatives, it seems that the most logical choice is to save the silver sparkes for the jewelry box and eliminate amalgam fillings forever.