Dental Questions: Are Metal Fillings Safe

One of the most widely discussed topics in dentistry is the use of mercury in metal "amalgam" fillings. It is proposed that the mercury contained in these restorations can cause various health problems from lethargy to mental impairment. If you personally have metal fillings, you may be worried about the effects on your own well being. In this article, we would like to take a moment to alleviate any concerns you might have about your dental treatments!

For starters, amalgam fillings have been used in dentistry for nearly 200 years. They are safe, convenient and stand up well against regular use and wear. Amalgam uses mercury as a mean of binding loose metal particles together. As the mercury dries, the once malleable filling becomes rock solid. What is left behind is a blend of the various metal components locked together creating a strong structure. 

The mercury found in amalgam fillings is stabilized by the other metals in its mixture, making it inert (unable to affect the body). This contrasts with methylmercury (found in seafood) that accumulates in the body and causes poisoning and elemental mercury which has various toxic effects on the brain. Over time, amalgam does not leach an appreciable amount of mercury and has not been shown to have any affects on physical or cognitive function. Thus, it is just as safe as any other dental material used today. 

With this information in mind, our office does not remove amalgam fillings simply because they contain mercury. This often creates more problems than it solves by requiring unnecessary modifications to the underlying tooth. We will only change out amalgam fillings if they are defective, broken or have new decay emerging underneath them. If you would like to know more about the fillings and other services offered at our office, please give us a call!

Metal Fillings and Mercury

One of the most controversial topics in dentistry today is the use of mercury in dental materials. Metal fillings, known as amalgams, utilize the low melting point of mercury to create a metal substance that starts out moldable and solidifies to make a strong restoration. Knowing that mercury has harmful properties, why does the dental profession still utilize this material? We wanted to take a moment to explain how (and why) mercury is still used as a safe and predictable dental treatment. 

For starters, our office currently does not place amalgam fillings. This is not due to mercury toxicity or metal content, but rather that tooth colored fillings can now offer similar structural properties as amalgams, but with much better esthetics. All things equal, most patients would prefer a natural looking restoration over a metallic alternative. Still, many dental practices still place amalgams. The metal fillings are occasionally preferred over tooth colored materials due to location, size and user choice. Our office has a number of materials and technologies (such as the sonicfil system) that allows us to place tooth colored restorations with great predictability in a number of scenarios.

An important point in understanding mercury toxicity is acknowledging the different ways that mercury exists in our environment. Elemental mercury can be found in older thermometers, blood pressure cuffs and certain types of lightbulbs. While it is a toxic substance, it does not “stay” in our system; after exposure the harmful vapors are processed and released. This is contrasted to organic mercury (methylmercury, organomercury, etc.). Organic mercury “builds up” in ecosystems and causes health concerns associated with eating large fish, sushi and other seafood. Our bodies have a hard time clearing this compound, which can eventually lead to conditions such as mercury poisoning. 

The mercury found in amalgam fillings is unique, as it is “locked in" with other metals in an alloy. Extensive research has shown that properly maintained metal fillings leach little to no mercury into the body. In other words, while there may be mercury present in your fillings, it is largely shielded from causing any effects or systemic health issues.

The only real concerns with mercury in amalgam fillings are during placement and removal. These are the only occasions when the mercury is aerosolized or free to release vapor. However, dentists are very aware of this, and take many precautions to eliminate any potential harm. For example, our office uses two forms of isolation/suction when removing amalgam fillings, as to maximize the speed at which the vapors are evacuated.

Please do not heed the advice of television medical personalities who proclaim the many “evils” of amalgam. It is a strong, safe and effective dental filling material. Our office only removes dental amalgam due to patient preference or recurrent decay. We never recommend removing sound amalgam fillings due to mercury concerns. If you would like to know more about the mercury content in amalgam fillings, our office’s policies or why we place fillings, please give us a call. We want you to be confident and satisfied with all aspects of your dental treatment!

Removal of Amalgam Fillings

One of the hundreds of beautiful amalgam swaps we have performed at our office. 

Amalgam fillings are a tested and proven dental material and have been in effective use for over 100 years. There are many aspects of these metal fillings that make them excellent candidates for tooth restoration; they are durable, easy to place and have many of the same physical properties as natural tooth structure. However, they are not perfect (there are no perfect materials in dentistry). Over time, amalgams can crack, “leak” or become surrounded with decay. Furthermore, they are not as esthetically pleasing as tooth colored materials and can tarnish from silver to black very quickly.

These are some of the compelling reasons that we remove amalgam fillings at Thousand Oaks Family Dentistry. While we recommend replacement for ALL compromised fillings (both metal and tooth colored), we only replace amalgams for esthetics upon patient request. Additionally, we do not recommend removing metal fillings over concerns of mercury exposure. The long term safety of amalgam fillings and their associated mercury content is well understood and documented. Additional information can be found at http://www.ada.org/en/member-center/oral-health-topics/amalgam or by calling our office.

The result of an amalgam replacement procedure. While amalgam fillings are easy to spot, composite fillings blend very well with natural tooth structure. However, this difference in esthetics does not necessarily make one type of filling functionally superior. 

The removal process is a simple procedure that parallels how we place fillings on decayed teeth. We start by removing the existing amalgam from the tooth by carefully cutting it with a high-speed handpiece (“drill”). While amalgam fillings are very safe, there is a slightly elevated risk of mercury exposure upon their removal, as the material becomes loosened and aerosolized. To counteract this, we rely on two forms of suction and isolation to prevent any of the metal from being swallowed. Typically, we pair an Isolite suction/bite block with our high speed suction to gather any stray metal.

Once the amalgam is removed, we eliminate any decay under or around the filling and reshape the tooth to better accept the new composite. Once the tooth is “prepared,” we proceed by bonding and curing in tooth colored material. After it is set, we recontour the filling to the natural shape of your teeth and adjust so it feels natural in your mouth. The entire process takes under an hour, and can be considerably shorter depending on the size and shape of the existing amalgam.

If you have any questions, or would like more information on how and why we remove amalgam fillings, please call our office. We regularly remove amalgam fillings under a number of different scenarios, and would be more than happy to walk you through the process.