Amalgam Fillings: Are They Good for Me or a Health Risk?
Amalgam fillings also known as silver fillings or mercury fillings were the standard of care for dental offices for years and years.
Many of us baby boomers can probably look in our mouths and see silver looking fillings in our teeth that can range from the size of a small dot to something that appears to be almost a whole tooth. Exactly what are these silver fillings? You’ve probably had them for many years and they seem fine. But, is there something going on with them that you can’t see? Should I be worried about my old amalgam fillings?
Q. Should I be worried about my old amalgam fillings?
A. There has been an ongoing debate about this in the dental community for many years. Most dentists including Dr. Corey Jensen and Dr. Brett Moore at Smile Design Dentistry have chosen to use composite fillings as the care of choice for their patients and have been doing so for over 20 years. Similar to our children not knowing life without computers most of your children will never have a silver filling placed in their mouths. Why the shift from amalgam (silver) fillings to tooth-colored composite fillings? To first understand why the industry has slowly progressed away from amalgam fillings as a standard of care we need to know what an amalgam filling is. Per Dictionary the definition of an amalgam filling is: “an alloy of mercury with another metal, especially one used for dental fillings”.
In the definition of an amalgam filling the first word that pops out is “mercury”. For most of us, this causes red flags go up everywhere. Mercury is a substance that is toxic to humans and if levels are high enough, can cause death. Over the years many people who have had health problems reported that those problems were reduced or disappeared when the amalgam fillings were removed from their mouths. This correlation created suspicion and research began to see if amalgam fillings could be creating the health problems that people were experiencing. Specifically, researchers wanted to see if the mercury in the fillings was somehow leaching into our bodies and causing health issues.
As I mentioned before, in high enough levels mercury is toxic to a human body, so why is it in a product that we put in our mouths? The reason that mercury is in amalgam fillings is that it makes the rest of the material in the filling more pliable. When it is mixed with an alloy powder, it creates something that is soft enough to press and mold into a tooth cavity and make it into a tooth shape that the dentist wants, so even though it is silver in color at least it has the shape of a tooth. Also, the mixture in the amalgam material will harden quickly and turn into something that can withstand forces a person puts on it through biting and chewing. It has also proven very durable, able to last for years and years. While this is a good explanation for why mercury is present in amalgam fillings it doesn’t address if we are also inadvertently poisoning our bodies.
Q. How does a person get high mercury levels?
A. The answer to that question has proven not to be easy. We can actually get mercury in our bodies from many different sources. There has long been a correlation to people who eat a lot of fish and building up mercury levels in their bodies. That is because the fish they are eating have built up mercury in their bodies from pollutants in the water. You may have heard warnings about eating too much fish, especially for fish taken from rivers because the fish have mercury built up in their bodies that can transfer to us when consumed.
Another source of mercury can be from the very air we breathe. When mercury is burned the vapors go into the atmosphere. We breathe the atmosphere and the vapors enter our body. That is why proper disposal of items that contain mercury is important. We don’t, or shouldn’t, put fluorescent light bulbs in the trash. When they break a small amount of mercury is released. While one bulb is not a problem if all the millions of bulbs around the world were broken and thrown into the trash it would create a lot of mercury pollutants. This is why recycling of bulbs is important and businesses must document proper disposal of fluorescent bulbs from their businesses.
Because of the known dangers of mercury and the incidental report of health improvement upon removal of amalgam fillings, researchers have conducted studies to see if there is any correlation. Several reviews have shown that the amount of mercury released into our bodies from amalgam fillings is very low, less than the amount that people are exposed to on a daily basis. Furthermore, these studies do not show evidence of a danger of mercury poisoning from amalgam fillings. However, it is not yet understood why some people who have experienced health problems have become markedly improved upon the removal of their amalgam fillings. For this reason and with the advancement of bonding science of tooth colored fillings, many dentists have chosen not to use amalgam for their patients. This is especially true when there are alternative treatments that are very effective and don’t use amalgam.
Q. Are there people with allergic reactions to amalgam fillings?
A. On a side note that I find interesting regarding the mercury in amalgams. While it has been decided that it is not unsafe to put material that contains mercury into your mouth it has been determined that it is unsafe to dispose of an amalgam filling that has been removed in any way except in only the most careful, government regulated manner. Once an amalgam filling is removed from your mouth it can absolutely not go through regular disposal. It must be separated from other items for disposal and kept in a container identified as having hazardous material. This is shipped to licensed disposal companies to ensure the material does not go into the water or air. It seems odd that something has been determined to be ok to carry in your mouth for years and years is also considered hazardous to be disposed of except for in the most careful, regulated manner. Hmmmm!
So if mercury leaching into our bodies from amalgam fillings has not proven to be dangerous, are there other concerns that we should be aware of? Are there people with allergic reactions to amalgam fillings? The American Dental Association says that in rare cases, fewer than 100, there have been allergic reactions reported. Circling back to the claim by many people of improved health upon removal it creates a lot of intrigue regarding the human body’s reaction to amalgam fillings. But, similar to the suspicion of mercury leaching into and poisoning our bodies this suspicion remains unproven.
Q. What about a pregnant woman? Should she be concerned about amalgam fillings?
A. Again, there is no research that proves a direct correlation between pregnancy complications or fetus health problems brought on by amalgam fillings.
Q. Should I have my silver (amalgam) filling replaced?
A. Even though there has been a lot of research on amalgam fillings at Smile Design Dentistry we hear the question a lot form our patients, “Should I have my silver (amalgam) filling replaced?”. The answer to that question is maybe. It depends on the condition the filling is in.
Yes, when the filling is showing breakdown or cracking
A small amalgam filling with no apparent leakage and no breakdown may be left intact. A filling that is showing breakdown or more commonly a tooth that appears to have cracking occurring around the filling often should be removed, evaluated and restored with a more ideal material; either composite or porcelain. When Dr. Jensen started in his practice he used only amalgam fillings on back teeth. Over 20 years ago he made the switch to composite fillings and has never looked back. He comments; “in my early days of practice when I was using amalgam fillings I saw so many fractured teeth and had to do so many root canals. Over the last 20 years I no longer see the high incidence of cracked teeth and today only find about 10% of the teeth needing root canals compared with years past. There is no doubt in my mind that composite fillings have created much healthier and stronger teeth than fillings of the past.”
If Dr. Jensen or Dr. Moore have diagnosed removal of amalgam filling due to leaking old fillings that may have recurrent decay, one treatment method will be to place a natural looking tooth colored filling after removing the amalgam and any decay that is present underneath. It contains no mercury, is pliable and hardens quickly like amalgam. Dr. Moore states, “I love the advantages of composite fillings vs. amalgam. I need to take away less of your natural tooth structure when placing composite. The less natural tooth structure that is removed the stronger the tooth will be! What’s best is the color of the filling can be made to match the color of your natural teeth. If someone saw the inside of your mouth they would probably think you have never had a filling your whole life because they can’t see the new ones. That is how good they are!”
Yes, when your natural tooth surrounding the amalgam filling is compromised
Another reason to replace the old amalgam filling is if the natural tooth around the filling has become compromised. Perhaps a portion of the tooth has fractured. If enough of the tooth is now damaged so that a new filling cannot adequately restore the tooth to where it can properly function, you will now be advised to remove the old filling and place a crown over the tooth. A crown is a dental restoration that will cover your whole tooth. Dr. Jensen or Dr. Moore would remove the old amalgam filling, take away the damaged portion of the tooth and “prepare” it for a crown. Like the composite filling the crown will be very hard so it can function like a normal tooth and be made in a color to match the rest of your teeth. Again, if a lay person looked in your mouth they probably could not tell the difference between a tooth that has a crown vs. the rest of your natural teeth.
Yes, when you want a healthier looking smile
The last reason to replace your old amalgam fillings is that you just don’t like the look of silver in your mouth. This would be a cosmetic reason to replace the old amalgam fillings. Dr. Jensen and Dr. Moore at Smile Design Dentistry are happy to consult with their patients regarding the removal of fillings for cosmetic reason. It is important for the patient to be informed on any risks that are associated with treatment. There are always risks with any care and it is important that the patient be fully informed prior to making and treatment decisions. In this case risks of treatment are rare, but can occur.
Clinical Necessity to Avoid Risks of Mercury Toxicity
Bottom line for amalgam fillings is that current research does not show that you need to replace your old amalgam fillings because they contain mercury or because of the other suspicions about them causing health problems. Your dentist should be able to show you the clinical necessity for replacing old amalgam fillings and options to consider for treatment. Your dentist should also be able to discuss with you the cosmetic benefits afforded with more current treatment options. Just ask. I’m certain that they will be happy to sit down with you. Wikipedia says that “Dental amalgam is a liquid mercury and metal alloy mixture used in dentistry to fill cavities caused by tooth decay. Low-copper amalgam commonly consists of mercury (50%), silver (~22–32%), tin (~14%), copper (~8%) and other trace metals.
In an FDA article titled About Dental Amalgam Fillings, we learn that “Dental amalgam is a dental filling material used to fill cavities caused by tooth decay. It has been used for more than 150 years in hundreds of millions of patients around the world. Dental amalgam is a mixture of metals, consisting of liquid (elemental) mercury and a powdered alloy composed of silver, tin, and copper. Approximately half of a dental amalgam filling is liquid mercury and the other half is a powdered alloy of silver, tin, and copper.”
The article was updated on October 2, 2015, and covers how the FDA is reviewing the best available scientific evidence and continually seeking to determine if and to what degree the low levels of mercury vapor associated with dental amalgam fillings are a cause for worry.
Some dental patients have an allergic reaction or sensitivity to the mercury element or other components found in dental amalgam (which may include silver, copper, or tin). The FDA assessed that dental amalgam may contribute to such a person’s likelihood of developing oral lesions or other contact issues. At Smile Design Dentistry, we are protective of our patient’s overall health by asking upfront if there are allergic concerns or past reactions to any of the metals used in dental amalgam. You may benefit from other treatment options; feel free to ask any dental safety questions that you have.
Insurance Plans that Cover Replacing Old Amalgam Fillings
Last, I would like to give a word regarding dental insurance. Like any treatment there is always a financial component to consider when you have care recommended. If your amalgam fillings are being recommended to be replaced due to clinical necessity and you have dental insurance there will probably be some insurance benefits afforded to you. The exact benefit will be contingent on the dental plan purchased by your employer. Many plans will cover filling around the 50% to 80% level. Some insurance plans have contingencies that if the filling is in a back tooth that benefits for a natural tooth colored filling will be reduced to the level of an amalgam filling. If you are having multiple fillings replaced there are annual insurance maximums to be aware of. For instance many plans will pay up to $1000-$1500 per year. Once you have reached that maximum no more benefits will be paid no matter what the clinical need is to have that filling replaced.
If you are concerned about the cost of any dental treatment, we can always submit treatment for a predetermination of benefits from your insurance company. Your insurance company usually will respond within a few weeks and give you an estimate of what they will pay in benefits and what your out-of-pocket responsibility is. However, if you are in pain or your care is urgent in nature you may not have the luxury to wait for an insurance estimate but it is always nice to avoid potential financial surprises if possible.
If you are considering removing your old amalgam fillings for cosmetic reasons do not count on insurance to help. It is only in very rare cases that I have seen an insurance plan cover care for cosmetic reasons
Clinical Reasons for Amalgam Treatment
One more word regarding treatment. If your dentist has recommended your amalgams to be replaced for clinical reasons, get it done. It is usually due to the financial obligation that a patient will refuse or put off treatment. It is especially easy for a patient to decline or put off care if that treatment has been recommended at an early stage, because at that point you are probably not in discomfort or feeing any pain in the tooth or teeth being recommended for care. Remember the longer you wait on dentistry the worse a problem will become. If you wait on care until the tooth is bothering you there is a much greater risk of more significant, costly treatment needing to be done. As a general rule of thumb; the earlier the care, the less the pain, the lower the cost.
“Human exposure to mercury is still a major public health concern”, according to a Genetic Aspects of Susceptibility to Mercury Toxicity: An Overview January 14, 2017 publication.
Paul B. Tchounwou, Academic Editor, oversaw the inclusion of this statement: “in this context, children have a higher susceptibility to adverse neurological mercury effects, compared to adults with similar exposures. Moreover, there exists a marked variability of personal response to detrimental mercury action, in particular among population groups with significant mercury exposure. New scientific evidence on genetic backgrounds has raised the issue of whether candidate susceptibility genes can make certain individuals more or less vulnerable to mercury toxicity”.
Your dental specialists at Smile Design Dentistry have a deep passion to reduce personal vulnerabilities to the detrimental use of amalgam fillings, which may cause action due to individual genetic makeup in some patients. Future research will likely disclose different repercussions on human health arising from the release of Hg (Mercury is a chemical element with symbol Hg and atomic number 80), giving us cause to use alternative dental fillings today.
If you are uncertain what to do about your old amalgam fillings contact your dentist or Dr. Jensen and Dr. Moore at Smile Design Dentistry. They will be happy to provide advice on the condition of your old amalgam fillings, let you know if there is anything you should be concerned about, if there is any real dental emergency, and what you can do for it!
Call to learn about all of your choices available for dental fillings and to help you decide which alternative is right for you. 763-537-1238
Brian Denn is the Clinic Manager at Smile Design Dentistry in Plymouth, Minnesota. Brian has over 25 years of dental practice management involving making practices run smoother and patient experiences better. He also leads a dental practice managers group staying abreast of the latest dental practice management trends.