Patients often ask me about their silver fillings. “Hey Doc, do these old fillings need to come out?” , they might ask. It’s a valid question. Usually they are referring to their amalgam fillings they had placed when they were a kid, or maybe even fairly recently. Most people just don’t like the way they look. They’re often silver or black, and don’t look at all what a tooth should look like.
Others are more concerned about what’s in the filling, in particular does it contain mercury and is it harmful. Well, yes it does contain mercury. It also contains other metals such as silver, tin, and copper. But, yes, it contains mercury. That mercury. The stuff in thermometers. Quicksilver.
Is it harmful? Well, first a little history. Mercury has been used as a component of dental amalgam, and has been placed in teeth since the 1800’s. It has it’s uses. Strictly from a restorative perspective, it fills up a hole in a tooth quite nicely. Recently it has come under scrutiny because mercury is toxic. No one has really produced any scientific evidence as to whether the mercury in all those fillings are causing problems. On the other hand, anecdotal evidence has reported that patients who have had their mercury-containing amalgam fillings removed have been cured of varying ailments and diseases. However, no scientific studies have been produced to support these claims.
The American Dental Association and the Food and Drug Administration recently issued a statement on the safety of dental amalgam. According to Dr. Susan Runner acting director of the FDA’s Division of Anesthesiology, General Hospital, Infection Control, and Dental Devices, Center for Devices and Radiological Health, during a July 28, 2009 press conference “the best available scientific evidence supports the conclusion that patients with dental amalgam fillings are not at risk for mercury-associated health effects.” The FDA went on to state that with reference to developing fetuses, breast-fed infants, and children under the age of 6 “the scientific evidence that is available suggests that these populations also are not at risk.”
So what’s all the fuss about. As a dentist I see statements like this and think, no big deal. On the other hand, as a dentist, if I spill amalgam, I am supposed to dispose of it properly … like a hazardous material. But apparently I can put it in someone’s mouth and that is a perfectly fine place to put it.
So here’s what I think: I am not going to tell someone to take all the mercury containing amalgams out of their mouth because they are at risk of health problems. I just haven’t been convinced that the mercury in your fillings will make you sick. You’re likely to have more exposure to mercury from eating certain types of fish. But over time, these fillings break down. They leak, and do not seal the tooth effectively. Crack and fractures form around them in the tooth. The time will come when they need to be replaced and I will replace them. But I will replace them with something other than amalgam.
Why? I just think that there are better options. Composite resins do not contain mercury, and when properly placed can be a great option. Why take the risk. Laboratory made restorations made or ceramics or gold, yes gold, are excellent alternatives as well. And just so you know, my wife has amalgam fillings that are still in her mouth, but she has one that needs to go, and I will replace it with a lab made restoration.
To see the FDA’s statement on its Web site, visit http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173992.htm ￼.
The ADA has comprehensive information on ADA.org for both dental professionals and consumers regarding the safety of dental amalgam. To access this information, visit http://www.ada.org/prof/resources/topics/amalgam.asp
What do you think? Do you feel like you are at risk by having mercury-containing fillings in your mouth? Would you want to have them removed?