Silver (amalgam) fillings: still a good choice in 2008
For many years, the dental profession has been moving away from gold and silver restorations to composite (plastic) and porcelain/ceramic restorations. However, they are not always the smartest options for certain circumstances. While there is a lot of misinformation out there about the alleged dangers of (mercury) silver fillings, here’s the simple truth: Silver fillings are perfectly safe, and there is not ANY reputable research by any reputable organization that has shown that the mercury from the fillings causes ANY harm. PERIOD. All that misinformation is simply that – misinformation. ‘Nuff said.
When do I recommend silver fillings? There are just a couple circumstances in which I actually recommend silver fillings instead of a tooth-colored restoration (composite or porcelain):
1) Patients who have high rates of decay; IOW – anyone who seems to get cavities frequently no matter how hard they try to care for their teeth. These include patients with acid reflux, who drink a lot of sodas, who are on medications that dry up their saliva, who have recently been through radiation treatment of the head/neck, or similar conditions. In my experience, while there are steps that can be taken to reduce that risk, silver fillings last longer with fewer problems.
2) Patients who grind their teeth and who do not wear a nightguard. Again, in my experience and in a fair amount of current research, composite fillings do not last as long. While the ability of composite fillings to withstand significant wearing forces is definitely improving, in the teeth of patients who really grind, they’re just not there yet.
3) Patients who need a lot of work and need to stage it over time: in our practice, silver fillings are still less expensive because the material is less expensive. We still take just as much time as necessary to restore the tooth as with a composite filling, but we believe it is fair to pass on the savings in cost to our patients, because that helps make dentistry more affordable.
And the thing is, while old silver fillings can look pretty ugly and flat, properly-placed new silver fillings can look extremely natural, just not tooth-colored.
Here’s an example of a silver filling that’s probably been in place 20+ years:
Here’s what 2 shiny new amalgams can look like:
So while most patients still prefer tooth-colored restorations, there really isn’t anything wrong with silver fillings, and under some circumstances, they can be a better solution for some patients.
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Chip, that’s a very nice, concise explanation of the benefits that dental amalgam can offer. I’d like to print it out for our patients if you don’t mind. Very nice post and the photos look great, too.
Linda
Linda, of course you may print that off for your patients; in fact, I’d be honored.
Mercury is UNIVERSALLY recognized as a POISON. In fish, in florescent lamps, in hats, in thermometers, in all uses in industry there are standards for exposure to mercury. There are at least (3) different US Government standards for exposure to mercury. The toxic effects of mercury have been known about for hundreds of years. It is generally regarded as the 3rd most toxic element on the periodic chart. The only place mercury amalgam is not regarded as TOXIC WASTE is in a living human mouth.
An amalgam is not a chemical compound, it is a MIXTURE. The mercury retains it’s elemental form and gives off poisonous mercury vapor for the entire time the the filling is in the tooth.
At one point in history, when the United States was much less affluent and technologically advanced mercury amalgam fillings might have made some sense. It was the risk of low level mercury poisoning versus the more rapid effects of severe dental deterioration. Back in the 1850’s when this use really got started, people did not live as long anyway, and other toxic exposures to add to mercury’s toxic load were less available in the environment and the economy. Nowadays, it is unconscionable to expose people to any level of mercury deliberately placed in their bodies. It is simply not necessary in this day and age. Thousands of people have already benefited in remarkable ways from removal of mercury amalgam fillings. Do we really need to wait for narrowly focused “scientific” double blind studies to take action to prevent poisoning ourselves? Are our old belief systems really so ossified and self-serving as to be blind to this?
Mylo, I don’t suppose that you are aware that – in extremely small amounts – mercury is actually essential to the correct functioning of human DNA? Or that virtually every vitamin, mineral, or medication known to science can be harmful in excess? By that measure, perhaps we should ban everything, as it’s all poisonous. But I don’t think that you’re likely open to an actual open discussion. Nor am I, really, as both common sense and science have disproven your claims for decades.
On the common sense side: given that BILLIONS of amalgams have been placed in billions of humans over many decades, it sure seems like it would be pretty easy to prove if there is any serious medical issue…….but NOPE, somehow the “evidence” is just ridiculously sketchy.
Secondly, it would seem pretty obvious that, IF mercury were such a problem, then dentists, dental assistants, hygienists, etc. would naturally be the most affected……but again, NO ONE has been able to prove it consistently.
As for science, it seems you realy know very little about mercury or amalgam fillings, so I’ll just leave it at that.
In closing…..would I feel perfectly safe in putting a silver filling in the mouth of my 3.5 year old daughter? ABSOLUTELY!
Thank you for your thoughtful response. Indeed the quantitative aspect of nutrition, poison, polluntants, etc. is critical. As you say most substances can be good or bad for us depending on the amount ingested. From what studying i have done, it has been shown to me that mercury amalgams are the greatest source of mercury exposure in humans. Generally 3 times more than fish or any other common exposure. The amount in fillings obviously does not cause acute poisioning. I suspect the amount that is needed for essential functioning of DNA is thousands of times less than the exposure from amalgams. I will check that out as i get time. The difficulty is that the effects are more subtle and are usually attributed to something else. There are many “diseases” of unknown causes. There are many symptoms people have which doctors are perpetually stumped to find a cause. Many people have found relief from many symptoms after having amalgams removed and doing subsequent heavy metal chelation detoxification for several months. I know this is vague, and i suppose we may not want to get too extensive on this website, since the discussion could of course become very detailed and specific, particulary with regard to parts per million and other units to specify mercury toxicity and in what chemical form of mercury, etc. Since mercury is clearly a poison, it seems to me the burden of proof should be to prove that it is safe, not to prove that it is dangerous. At any rate it is a difficult thing to prove scientifically anyway since the effects are subtle and easily attributed to other things. Some of my sources in recent weeks have included Andrew Cutlers book on amalgams. I also think this video is a good introduction to the topic. http://www.youtube.com/watch?v=9ylnQ-T7oiA&feature=player_embedded#
Mylo, I honestly have a great deal of difficulty understanding WHY that really stupid video (and yes, I’m being quite blunt about my opinion on it) is given any credence, because there are some MAJOR problems with it that apparently go completely unnoticed, but here’s the biggie:
The boiling point for mercury (the temperature at which it evaporates and becomes vapor) is 356.73 degrees Celsius!!!! Do you REALLY think that a mere rubber eraser could possibly heat up the mercury in that filling to the point it would evaporate? Do you realize that 356.73 degrees Celsius = 674.11 degrees Fahrenheit!!!!!
So let’s assume momentarily (in a total suspension of disbelief and reality) that you could generate 674 degrees Fahrenheit temperature just by rubbing an eraser on an amalgam filling. What do you think would happen to the tooth at that temperature? Don’t you think that such a high temperature would transmit through the tooth and into the person’s finger? What do you think would happen to fingers holding an object at 674 degrees Fahrenheit? Ummmmmmmmmmm………HELLOOOOOOOOOO!?!?!!?!?
C’mon, let’s get a little common sense going here. I’m tempted to delete the link because it is such bull, but for the sake of discussion I will leave it. What is really EMBARRASSING is that a supposedly science-based professional organization puts that junk out as real. 😦
As for the burden of proof as to it being safe? Well, the ENORMOUS preponderance of scientific literature does prove it, while only fringe elements have been able to “replicate” the findings that amalgams cause illness, but remarkably, they have (at least to my knowledge) EVER been able to prove their findings with a double-blind, calibrated, prospective study (the real gold-standard of scientific research).
I give Mylo’s statements an Excellent Rating
I would make a distinction–perhaps, in the mouth, with the normal wear and tear of chewing and the like, the amalgam fillings pose little risk. However, when they are drilled out to replace with a crown, the amount of vapor generated might be questionable.
The boiling point of water is 212 degrees, yet it evaporates at pretty much any temperature, even below freezing. There is a difference between boiling, evaporation, and sublimation. Even ice can evaporate. So it is not necessary to reach a materials boiling point to produce vapor.
Can you send me a link to a double blind calibrated prospective study which shows mercury amalgams are safe?
So in that video, exactly which of those 3 processes is it that you are claiming is supposedly taking place, and what measurements were taken, and where can I find them, to show EXACTLY what the “vapor” is? And what studies have shown that rubbing an eraser over an amalgam releases any measurable amount of mercury?
Mylo — while I think that you have displayed at least a reasonable ability to have a courteous discourse, for which I thank you — this topic is one on which the “evidence” is simply so weak, that it is not something I wish to spend further time on. All further posts will simply be deleted without comment. There are forums where you can discuss your views, but I do not wish anyone reading my blog to be exposed to views that I consider far outside the norm or unsubstantiated.
Mylo, I deleted your last post because it is simply irrelevant to the topic of amalgam dental fillings, or even of exposure of people working in dental offices to mercury.
For anyone reading this far:
Quite frankly, if you are anti-amalgam fillings, then I am not the dentist for you. I have little use for conspiracy theories and bad science, and if you really want to read that kind of thing, there are plenty of places around the Web to find it. But not here. As a conscientious professional who has to sleep comfortably at night, knowing I did the best I was able each day for each patient, I am 100% comfortable placing amalgam fillings in my family’s teeth, having them in my own mouth, leaving them in my parents’ mouths (some have been there longer than I’ve been alive – my Dad is a PhD in Organic Chem and my Mom is an accountant — no apparent brain damage there), whatever.
Unlike many amalgam opponents, Mylo has actually been courteous and writes well, which is why I have left his initial comments and the discussion. But no more discussion of this topic will be allowed, as I refuse to let my professional blog to become a place of misinformation that might unnecessarily alarm anyone.
Hi Chip, just came across your blog. I met you years ago when I hung around the Townie crowd. (Remember that limo ride to the Ghost Bar at The Palms?)
I understand your logic, but it’s a losing game to continue embracing amalgam. People don’t like the stuff.
I stopped using amalgam about 15 years ago. No regrets. For sure it’s harder to build good composites or Porcelain Inlays-Onlays. And those composites have to replaced or resurfaced more often.
I’m not going to try to convince you of anything Chip. Just wanted to share my perspective.
Joe 🙂
http://www.RoyalYorkDental.com