Saturday, March 6, 2010

Information About Silver Amalgam Fillings

What are amalgam fillings?
Amalgam fillings, also called silver fillings because of their silver color and content, have been used for a very long time (over 150 years) and for a long time they were considered the material of choice for fillings done in the molar areas, where the chewing forces were very strong and the material used needed to be able to withstand them.

Dental amalgam contains approximately 50% elemental mercury, which when mixed with other metals like silver, tin, and copper, the resulting alloy will harden into a “silver filling”. Once hard, the mercury in the filling does not come out. It has been shown that there are very low levels of mercury vapor that are released, but these levels are so low that are well below the levels shown to cause any adverse effects. High levels of mercury vapor exposure are associated with adverse effects in the brain and the kidneys.

Should I be worried about silver fillings?
Based on investigations published for more than 100 years till the present date, there is no evidence that dental amalgam fillings are harmful to patients. The following excerpt from an article published by the Food And Drug Administration and updated in August of 2009 describes their findings:

“The FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages 6 and above. The amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects. Even in adults and children ages 6 and above who have fifteen or more amalgam surfaces, mercury exposure due to dental amalgam fillings has been found to be far below the lowest levels associated with harm. Clinical studies in adults and children ages 6 and above have also found no link between dental amalgam fillings and health problems.”

The ADA has a similar position paper published summarized in this quote:
“Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.”

The only definite contraindication to silver amalgam fillings is if the individuals have an allergy or sensitivity to mercury or the other components of dental amalgam (such as silver, copper, or tin).
Recent environmental concerns about the content of mercury in fish may make you wonder if all this mercury used in fillings and other industries have some thing to do with the mercury levels in fish, and I do not know of any studies linking these levels to dental amalgam. Personally, I tend to think that the use of mercury in other industries is more likely the cause, since elemental mercury in dental amalgam produces mercury vapor, and the mercury found in fish is methyl mercury, more likely to be an industrial byproduct.

The next question that comes up is: Should I have my silver fillings replaced?
The FDA has this recommendation: “ If your fillings are in good condition and there is no decay beneath the filling, FDA does not recommend that you have your amalgam fillings removed or replaced. Removing sound amalgam fillings results in unnecessary loss of healthy tooth structure, and exposes you to additional mercury vapor released during the removal process.” The guidelines that I follow in my practice are these:

1.If the silver filling is in a non-cosmetic area and is visibly and functionally good, I do not recommend replacing it.
2.If the filling is in a cosmetic area, or shows signs of deterioration, open margins or other signs of problems, I recommend replacing them.
3.If the filling is older than 10 or 15 years old, I may recommend selectively replacing a couple of the oldest ones to determine if the rest should be replaced.
Strategic replacement of selected silver fillings allows me to catch areas of decay that are not evident in radiographs and at the same time, keep the size of the tooth preparation as small as possible and the tooth stronger as a result. This Minimally Invasive Dentistry is something that I believe in and the way I would like my family and myself to be treated when we need these services. Having said that, let me make it clear that if a patient requests having all the silver fillings replaced, we will gladly comply with that request.

Do you place silver Fillings or tooth colored fillings?
No. Our office presently utilizes porcelain and a material called composite instead of silver amalgam in our fillings, because these materials, in conjunction with the bonding techniques that are currently utilized allows us to create better restorations for our patients.

If you would like to read the actual articles quoted in this writing, they will be listed below.

For the FDA article on silver amalgam fillings, see the following webpage:

The final rule for dental amalgam (long paper) is here:

For the ADA position paper on Dental Amalgam see this webpage:

For any additional information or any questions that we may help you answer please visit our website at: