Dental amalgam has been a widely used material for dental fillings for over 150 years. It is a combination of metals, primarily silver, mercury, tin, and copper, which, when mixed together, form a durable and reliable substance for filling cavities. Despite its longstanding use, dental amalgam has been the subject of much debate, particularly in recent years, regarding its safety due to the presence of mercury, a known toxic substance. This has raised concerns among patients and dental professionals alike.
In this article, we will explore the safety of dental amalgam, examine the research behind its use, address the concerns surrounding its mercury content, and look at both the pros and cons of using amalgam in modern dentistry. By the end of this article, you should have a clearer understanding of whether amalgam is a safe option for dental fillings and how it compares to alternative materials.
What Is Dental Amalgam?
Dental amalgam, often referred to as “silver fillings,” is a mixture of metals, including about 50% elemental mercury, along with silver, tin, and copper. The mercury serves as a binder that holds the other metals together, creating a material that is hard, durable, and able to withstand the pressure of chewing and grinding. This makes amalgam particularly useful for fillings in the back teeth, where the force of chewing is the greatest.
The process of placing an amalgam filling involves cleaning out the decayed portion of a tooth and then filling the cavity with a mixture of the metals. The material hardens within a few minutes, providing a stable and long-lasting restoration.
The Safety Concerns About Mercury in Amalgam
Mercury is a toxic heavy metal that has been linked to various health concerns. Its presence in dental amalgam fillings has raised questions about whether it can be safely used in the human body. Mercury vapor can be released from the fillings over time, especially as they wear down or are subjected to the heat from food and drink, leading some to worry that prolonged exposure could be harmful.
The concern primarily revolves around the potential for mercury exposure to cause neurological damage, kidney damage, or other serious health issues. In particular, there have been fears about the effect of mercury vapor on children, pregnant women, and individuals with pre-existing health conditions such as kidney disease.
What Do Experts Say About The Safety of Amalgam?
Over the years, many health organizations and government bodies have conducted studies to assess the safety of dental amalgam. The most prominent of these include the U.S. Food and Drug Administration (FDA), the World Health Organization (WHO), and the American Dental Association (ADA).
U.S. Food and Drug Administration (FDA)
In 2009, the FDA classified dental amalgam as a “Class II” medical device, which means it is considered safe for use in the general population, with certain exceptions. The agency’s ruling is based on extensive scientific research, which has consistently found that dental amalgam does not pose a significant health risk to most people. However, the FDA has cautioned that certain vulnerable populations, such as pregnant women, children, and individuals with kidney problems, should avoid unnecessary exposure to mercury. It is also recommended that those with a known sensitivity to mercury or other components of amalgam avoid its use.
World Health Organization (WHO)
The World Health Organization has similarly stated that dental amalgam is safe for use in the majority of individuals.
According to the WHO, the mercury released from amalgam fillings is minimal and does not pose a health risk for most people. The organization acknowledges the potential risks of mercury exposure, but it emphasizes that the risks are generally low compared to other sources of mercury in the environment, such as seafood and air pollution.
American Dental Association (ADA)
The American Dental Association has been a strong advocate for the continued use of dental amalgam. According to the ADA, dental amalgam has a long track record of safety and effectiveness. It has been used in millions of patients over the years with a very low incidence of complications. The ADA notes that while amalgam does release small amounts of mercury vapor, the exposure is well below the levels that would pose a risk to human health.
The Pros of Dental Amalgam
Despite the concerns about mercury, there are several advantages to using dental amalgam as a filling material:
Durability: Amalgam fillings are incredibly durable and can last for many years, often up to 10-15 years or more. This makes them an ideal choice for back teeth, which are subjected to heavy chewing forces.
Cost-Effective: Amalgam is generally less expensive than other filling materials like composite resins or gold. This makes it an accessible option for many patients, particularly those with limited insurance or financial resources.
Strength: Amalgam is strong enough to withstand the pressure of chewing and grinding, which is why it is often used for fillings in the molars and premolars.
Proven Track Record: Dental amalgam has been in use for over a century, and during this time, it has consistently demonstrated effectiveness and longevity in dental treatments.
Ease of Use: Amalgam fillings are relatively easy to place compared to other materials. The material hardens quickly, allowing the patient to return to normal activities sooner.
The Cons of Dental Amalgam
While dental amalgam offers several benefits, there are also drawbacks to its use:
Aesthetics: One of the biggest disadvantages of amalgam is its appearance. The silver-colored fillings are visible when patients smile or talk, making them less desirable for individuals who are concerned about the aesthetic appeal of their fillings. This is why many people opt for tooth-colored alternatives, such as composite fillings, for fillings in visible areas of the mouth.
Mercury Concerns: As mentioned earlier, mercury is a toxic substance, and its presence in dental amalgam has raised health concerns.
However, most research indicates that the mercury in amalgam fillings is not harmful to the majority of individuals, though some people may be more sensitive to it.
Potential for Expansion: Over time, dental amalgam can expand slightly, potentially leading to fractures in the tooth. This is particularly problematic if the filling is large, as it can weaken the structure of the tooth and increase the risk of further damage.
Not Suitable for All Patients: Certain individuals, particularly pregnant women, young children, and those with known mercury sensitivity, may not be good candidates for amalgam fillings. These groups are often advised to choose alternative materials.
Alternatives to Amalgam Fillings
Given the concerns about mercury, many patients seek alternatives to amalgam for their dental fillings. Some of the most common alternatives include:
Composite Fillings: These are tooth-colored fillings made from a blend of resin and glass or ceramic. They are often preferred for fillings in the front teeth due to their aesthetic appearance, but they may not be as durable as amalgam in the back teeth.
Ceramic Fillings: These fillings are made from porcelain or other ceramic materials and are highly durable. They are also tooth-colored, making them an excellent choice for aesthetic fillings. However, they are more expensive than amalgam or composite fillings.
Gold Fillings: Gold is another option for dental fillings, known for its durability and strength. Gold fillings are more expensive than amalgam but are highly resistant to wear and corrosion.
Resilon: This is a newer material used for root canal fillings. It is biocompatible and non-toxic, but it is not commonly used for cavity fillings due to its cost and limited availability.
Conclusion
Dental amalgam has been a safe and effective material for fillings for over a century. While concerns about the mercury content are understandable, the available research supports the continued use of amalgam for most individuals, especially given its durability, cost-effectiveness, and proven track record.
However, for those who are concerned about the mercury content or who fall into vulnerable groups such as pregnant women or young children, alternative materials like composite or ceramic fillings may be a better option. Always discuss the available choices with your dentist to determine the best filling material for your specific needs.
Ultimately, dental amalgam remains a safe and reliable choice for many patients, but the decision to use it should be based on individual health considerations, aesthetic preferences, and budget. By staying informed and consulting with a dental professional, patients can make an educated choice about the best filling material for their oral health needs.
