Understanding Dental Amalgam Fillings

by Sara Alvarado

Updated March 21, 2024
If you've ever visited the dentist, for a cavity chances are you've come across amalgam fillings. These fillings, often referred to as " fillings" due to their appearance actually contain mercury.

During this procedure dentists use amalgam to fill cavities caused by tooth decay. This method has been a practice for over 150 years. Is still used on millions of patients worldwide. Let’s explore the world of amalgam fillings together.
Dental Amalgam Fillings

1. Safety Controversies Surrounding Dental Amalgam

Curious about the controversy surrounding amalgam? It revolves around the use of Mercury alloy, in these fillings. Dental amalgam is composed of a blend of metals– Mercury alloy. You see, this dental amalgam contains a mixture of different metals together. These Metals are made up of liquid mercury and a powdered alloy made of silver, tin, and copper. Dental amalgam has about 50% of mecury by weight. Why so much mercury? Well, Mercury is used to effectively combine the alloy particles, which gives it its robust, long-lasting, solid filling attributes. In your elementary school, I'm sure you know that Mercury has the ability to remain in a liquid state at room temperature and its strong bonding capabilities with alloy powder. These characteristics make it a very important "secret weapon" in dental amalgam's arsenal.

Overview of Controversy

Having said that, some people supports the notion that amalgam is safe, effective, and long-lasting, while others have concerns and argue about its safety due to potential mercury poisoning and other toxicity. Proponents of amalgam fillings argue that they are safe, lasting, affordable and easy to use. Compared to resin composites amalgam fillings have a lifespan. Are more resilient.

It is also quicker to place and can handle saliva or blood contamination during placement, but sadly, we cannot say the same thing about composites. And as we have stated earlier, amalgam seems to be cheaper to be more cost-effective. Yea, let's say 20-30% cheaper.

The mercury used in all these procedures is quite different from the ones you already know. The Dental amalgam used is elemental mercury, which can release mercury vapour. When this vapor is inhaled the lungs absorb it in a process known as bioaccumulation. Bioaccumulation involves the accumulation of substances in the bodys tissues or organs. In this case the substance is the mercury present in amalgam fillings.

While the mercury is different from the one found in fish, the process of bioaccumulation can still occur when one eats seafood that has mercury in it. According to the FDA, it is possible that you have mercury vapour build-up in specific tissues in your system, like the kidneys and the brain. However, no evidence is out yet on the gathering of mercury overtime, leads to organ damage.

Consumer Reports has it that there are some individuals who are preachers against the use of mental amalgam are trying to mislead patients into going for a more expensive treatment alternatives for their gain.

Regulatory Perspectives (e.g., FDA, European Commission)

Some individuals who are against the use of amalgam argue that modern composites are continuously improving in terms of their strength. Critics of amalgam fillings not express concerns, about potential health and ethical issues but also argue that these fillings may contribute to mercury pollution in the environment.

The World Health Organization (WHO) notes that healthcare facilities, including clinics account for up to 5% of mercury emissions in wastewater. In addition, the health agency, WHO highlights the importance of amalgam separators, which are commonly installed in dental offices' wastewater lines. These separators help reduce the amount of mercury that is released into the public sewer system.

Amalgam waste disposal down the drain is not allowed in the majority of dental practices in the United States. Some critics argue that the cremation of dental fillings is an added factor in air pollution, accounting for approximately 1% of global emissions.
Dental Amalgam Fillings

Image by  Caroline LM on Unsplash

2. Comparison with Alternative Restorative Materials

If you go straight up to your dentist to treat a cavity, he will first remove the decayed part of the tooth and then "fill" the portion of the tooth where the decayed material was uprooted.

As time went by, many dentists neglected the use of dental amalgam and replaced it with materials like "white fillings" (Known as "porcelain", "glass ionomers" or "resin"), resin-based composites, amongst others. Although not as strong as dental amalgam fillings, these alternatives have been given quite an improvement lately, especially when it comes down to areas with greater biting force or stress from chewing, like the molars (back of the teeth). Dental amalgam has merits over resin-based materials in some clinical situations, for example:
  • where moisture can pose a challenge for certain placements, such as near the gumline.
  • when a patient is tagged as being at greater risk for decay of the tooth;
  • when there is a need for a lot of fillings in the back teeth (molar) with more biting forces.
Resin-based materials may take a bit longer to place, but they generally involve removing less healthy tooth structure compared to dental amalgam. However like any material resin based compounds come with their set of risks.One of the concerns revolves around the risks associated with exposure and sensitivity, to certain chemicals like methacrylate. Another important aspect to consider is the durability of these materials and their lifespan.

When deciding on a filling it's crucial to engage in a conversation with your dentist or dental provider. They can offer insights into treatment choices outlining the benefits and possible drawbacks of using amalgam and other restorative materials. This will enable you to make a decision that aligns with your needs. If you have worries about mercury exposure from amalgam it is advisable to explore resin based materials as a substitute.

3. Official Stances on Dental Amalgam Fillings

Despite conflicting research outcomes regarding the safety of mercury in amalgams the American Dental Association maintains that the procedure poses risks for most patients.

The ADA reaffirmed its stance in 2009. Reiterated it in 2016 stating, "Studies consistently support the assertion that dental amalgam remains an option for restoration, in both children and adults. When addressing safety apprehensions it's vital to differentiate between established risks and theoretical possibilities.”If your dental fillings made of a blend of metals are in shape and there's no decay underneath them the FDA recommends keeping them in place without the need for replacement or removal. Removing amalgam fillings can expose you to mercury vapor during the extraction process.

However if you suspect you have a sensitivity or allergy to mercury or any metals in amalgam it's advisable to discuss treatment options with your dentist. The SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks) reported to the EU Commission that using amalgam doesn't present risks of systemic effects or systemic disease.

4. In conclusion

Various factors influence the durability of fillings and teeth beyond the materials used. To maintain teeth and fillings, for lasting results it's essential to follow a balanced diet, practice good oral hygiene and attend regular dental checkups.

5. References

Article by
Sara Alvarado
Greetings, I'm Sara, a dedicated nurse and a proud contributor to the AutoInfu blog. With my firsthand experience in the world of infusion pumps, I'm here to provide you with the latest insights, expert advice, and essential updates to ensure you stay informed about the infusion pump industry.

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