Dental Amalgam, Mercury is Controversial
Dental Amalgam is Rarely Untilized Now
Dental amalgam, often called a “silver filling,” is an alloy or mixture of metals used historically to successfully restore literally billions of cavities in teeth. The alloy is comprised of approximately 50% mercury, with the balance being primarily silver, plus a little tin, copper and zinc. Amalgam has been the material of choice for over 100 years due to its ease of usage, its strength, its efficacy in a wet environment, and its low cost.
However, its popularity in the last thirty years or so has dwindled due to concerns over mercury, esthetics, and environmental problems. The World Health Organization (WHO) states that “mercury levels in biomarkers such as urine, blood, and hair do not do not represent levels in critical organs and tissues.” Gattineri, et al, concluded that “there was not enough evidence to support or refute many of the other claims such as increased risk of autoimmune disorders, but stated that the broad and nonspecific illness attributed to dental amalgam is not supported by the data.”
The American Dental Association (ADA) states that “the removal of amalgam dental restorations from the non allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical.” The ADA “forbids its dentists from suggesting mercury removal under threat of license suspension.” The Center for Disease Control (CDC) states that amalgam is a “safe, sound, and effective treatment for tooth decay.”
However, tooth colored composites are now used instead of amalgams in the greatest majority of dental offices. Additional and successful alternatives are glass ionomers, gold, and porcelain. In some cases, veneers may be utilized if the decay is confined to the facial side of the tooth. It must also be realized that due to the tremendous success of preventive dentistry, all cavity rates are declining significantly. That fact alone, plus the use of alternatives will lessen the use of amalgam.
The advantages of the composite resin fillings are that they are tooth colored and esthetic, they require less tooth reduction, and they are easily placed (but must be in a dry environment). Disadvantages are that they are slightly more expensive, are less durable than amalgams, and sometimes require replacement. These products are consistently improving in all aspects and their longevity continually increases.
American Dental Association-Life Member, American Academy of General Dentistry- Emeritus Fellow, American Academy of Implant Dentistry