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Dental amalgam used to be the material used predominantly to restore decayed teeth. As a young child and young adult, I myself had a number of silver fillings placed in my own teeth. I thought nothing of it, and just trusted my dentist to do his job. Nowadays, however, it has gotten a rather bad name. Is there any reason for the hype? In this article, I will discuss my personal experience and opinions regarding dental amalgam.
Dental amalgam first emerged in the early-mid 1800s. These silver fillings were less expensive and far easier to place than gold. Because mercury is a component of these materials, there were concerns early on about the health consequences of using them. In the early 1900s, more serious concerns began to be raised. Some providers outside of the United States began to recommend the removal of any dental alloy that patients had in their mouths.
Chemist Alfred Stock did research on the mercury gases that are released from dental amalgams around this time, as well. Around 1980, there was actual research showing that dental alloy released measurable mercury vapor. This release was even increased with chewing and tooth-brushing. Furthermore, around 1990, studies began to show that dentists and dental staff had much higher levels of mercury in their various hormonal glands than non-dental workers. Since then, mercury toxicity from dental amalgams has been linked to MS, SIDS, clinical depression, and a host of auto-immune disorders. Many of these research studies were autopsy studies. They linked dental amalgams with high mercury levels in fetuses and infants.
Sweden and Germany were among the first countries to actively move to curb the use of dental amalgam. Canada followed suit. Sadly, the United States has been quite slow to address the validity of this research. In fact, the American Dental Association tried to squash such talk early on. With the marked upswing of medical diagnoses such as lyme disease, autism, and many others, our country is finally being forced to take a closer look at this subject. The FDA has taken the stance that dental amalgam is safe for those over 6 years of age.
About 50% of a dental alloy is elemental mercury, which acts as a binder for the copper, tin, and silver it also includes. These silver fillings last a long time, which may be either a good or bad thing. They are less expensive, or have historically been less expensive, than other options such as porcelain or gold. Elemental mercury releases vapor. The other forms of mercury, such as those in tuna and other fish, do not.
When I was in dental school, we learned how to place and remove alloy fillings. White, or composite, fillings were not recommended at that time for back teeth. It was explained to us that the white filling materials were not strong enough to stand up to the forces the posterior teeth take with chewing and grinding. In dental school we also learned how to place cast gold restorations, and gold foil restorations. Gold foil is extremely technique sensitive, is also quite expensive, and is really not done so much anymore. With the better white filling materials, we are able to place white fillings nowadays on back teeth and enjoy the comparably long life span they have.
In my practice, I do not necessarily advocate the immediate removal of all silver fillings. I also do not recommend the initial placement of silver fillings. I do not personally place amalgam fillings anymore.
There are many considerations to be made prior to replacing silver fillings. One is whether or not the patient has any sort of autoimmune issue or other underlying health issue that points to mercury toxicity. Another would be if there is anything wrong with the filling, or its margins. Each time we drill into a tooth for any reason, we endanger the tiny nerve inside that tooth. We cannot do this lightly. The nerves in our teeth are fragile, and can actually die as a response to trauma, drilling, decay, or even sometimes for no apparent reason at all. Of course, if there is dental decay, some sort of fracture, or structural defect, then replacing silver fillings with non-mercury options is strongly recommended.
In the presence of an underlying mercury toxicity issue, or if the patient simply wishes to rule out mercury toxicity, I personally am happy to discuss options of silver filling removal. Part of this discussion is always the risks involved in again disturbing the tooth.
In summary, if you have questions or concerns about the silver fillings in your mouth, I would strongly recommend you research the subject thoroughly before making a decision for your own health. I would recommend not only reading what the ADA and FDA have to say about it, but also look at naturopathic physicians’ opinions and studies. As always, it’s best to find sources that have nothing to gain monetarily for their opinion. There are valid, compelling reasons to replace silver fillings with white fillings. There are also valid, compelling reasons to leave them in place if they exist.
