Silver Mercury Removal
Recently, the subject of silver-mercury fillings (also known as amalgam) has been in the media again. Most visibly, it was the subject of an episode of the "Dr. Oz" show on TV. In the past, he has given some very bad dental advice (such as brushing your teeth with lemon juice to "whiten" them... DON'T DO IT!).
But, if you'd like to see his show about amalgam, click on Dr. Oz - Toxic Teeth: Are Mercury Fillings Making You Sick? It's a 3-part video.
I would like to preface this piece by saying that I have not used silver-mercury amalgam in my practice in nearly 15 years.
Amalgam has been around for over 150 years, and it's been controversial ever since its initial use in dentistry. Amalgam is simply a combination of metal powder (mostly silver with some copper and tin) and liquid mercury. When this combination is mixed, it forms a sort of paste that is easy to mold and shape. In a few minutes, the mixture hardens to a durable filling. The mercury is chemically bound to the material.
However, there has always been concern about the mercury component. Mercury, as an element, is known to be toxic. But, what makes ANY material toxic to humans is the DOSE. How much does it take to be toxic to humans? And, studies have shown that a very minuscule amount of mercury can escape from amalgam fillings over time. The question then becomes, is the amount of mercury emanating from amalgam fillings in a high enough dose to be a concern?
While there are many patients who report feeling better after replacing their silver-mercury fillings, the bar of scientific proof is much higher. And, so far, there is not a single credible, "peer-reviewed" study that links silver amalgam fillings to any medical issue. At this point in time, scientists cannot link the presence of silver amalgam to any disease. Nor can scientists prove that removal of amalgam will prevent or cure any illness.
That all said, our government agencies seem to be at odds. The FDA (Food and Drug Administration) has said that amalgam fillings are safe.
So, which is it? Who do we believe? The FDA says it's safe to put in your mouth. But, the EPA says it's toxic waste and shouldn't end up in landfills or water supplies.
Furthermore, many state dental boards will sanction or punish dentists who tell patients that silver amalgam is bad for them or should be removed for health reasons.
I haven't used silver-mercury amalgam for nearly 20 years. But, my reasons have nothing to do with this mercury debate. I prefer composite resin for fillings, because it is a more conservative and cosmetic choice. Silver amalgam requires more removal of healthy tooth structure to mechanically lock the material into the cavity preparation. Composite resin BONDS to tooth structure. So, I can limit my cavity preparation to only removing decay and preserving as much healthy tooth structure as possible.
The bonus: White composite fillings look great!
I have always based my professional judgment on science. If I'm going to make a recommendation, I have to be able to back it up with scientific fact. With that in mind, I cannot recommend categorical removal of silver amalgams with no defects or decay in hopes of curing or preventing any medical issues. However, I do acknowledge that patients have their own reasons, including cosmetic concerns. If my patients make an informed decision to have their amalgams removed, I am willing to help in any way I can.
It's important to mention that any time we perform treatment on a tooth, it puts stress on that tooth. However, the vast majority of the time, replacing fillings does not result in any problems.
If you have questions, or would like a consultation, feel free to give us a
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