Dentists Split Over Mercury Amalgam

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In this poll, we asked dentists: Does your practice place amalgam fillings?

It's getting hot in here! In a heated debate, dentists were passionately split over the issue of amalgam. Fifty-two percent of dentists in our poll responded, "No, we are no longer using mercury amalgam." The other 48% replied, "Yes, we are still placing amalgam fillings."

Dentists are so interested in this issue that a record number of dentists responded to this survey. With the ADA supporting amalgam's safety, health and consumer groups touting its toxicity, and the FDA still refusing to make an official ruling, it's hard to know who to believe.

Read the dentists' comments

General dentists versus specialists

There is a huge difference between general dentists and specialists on the issue of mercury amalgam. About one out of two general dentists still uses mercury amalgam, whereas fully four out of five specialists are using amalgam. In support of amalgam, specialists cited the lack of scientific evidence proving its toxicity and the superiority of amalgam in certain situations.

"Amalgam is a durable and cost effective restorative material," said one Colorado prosthodontist. "I believe dentists who refuse to use mercury amalgam are misinformed." A prosthodontic colleague from Kentucky agreed: "Dentists who advocate elimination of dental amalgam are building their practice at the expense of the rest of the profession. Dental amalgams are perfectly safe."

Urban, suburban and rural dentists

Location was not highly correlated with amalgam usage, but it is worth noting that suburban dentists were least likely to use amalgam.

"I practice in an affluent town," commented a general dentist from suburban New Jersey. "Amalgam fillings would not be acceptable to my patients."

Male dentists compared to female dentists

Gender differences were minimal, which is not particularly surprising. In fact, it would be alarming if a dentist's gender affected his or her interpretation of the scientific evidence surrounding mercury amalgam.

For state-by-state results, just click on this interactive map. (Flash required)

For more insight into what our respondents are thinking, check out their comments!

No one wants amalgam fillings these days

"Patients just don't want them any more, regardless of the higher cost of resins." (Virginia)
"Amalgam is very unaesthetic and boring to do." (California)
"Amalgams are great, they just look so bad that nobody wants them." (Idaho)
"In the UK, there is no evidence to either way to suggest it's safe or unsafe. Therefore we still place amalgam fills, although more composites, as we are mainly private." (UK dental office worker)

In defense of amalgam

"Amalgam is my friend. Larger composites after 3-5 yrs usually look worn and leaking." (Nebraska)
"Although we place amalgam restorations rarely, there are occasions where this is truly the most appropriate restorative material. Dentists who have completely eliminated it from their practices are really doing their patients a disservice by not giving them a safe, reasonable option." (New York)
"I truly wish I could tie one of these idiots down and find out what they personally have to gain from bad-mouthing a material that has been around for 150 years. If it really were a danger to life, given all the trillions of amalgams that have been placed, the world would not be facing an over-population crisis." (California endodontist)
"Amalgam is a durable and cost effective restorative material. I believe dentists that refuse to use mercury amalgam are misinformed and are simply promoting an ivory tower self-esteem. In cases where either mercury amalgam or composite resin would work, why not present the pros and cons of both materials and let the patient make the choice?" (Colorado prosthodontist)
"As long as ADA and FDA say it is safe, then that is good enough for me." (California)

In criticism of amalgam

"No dentist should be placing these. Porcelain is safer, healthier, and not Civil War era dentistry. The insurance companies love amalgam because it is cheap, period. Time for a change. I can't believe there are dentists out there still placing amalgam. They should be ashamed." (Pennsylvania)
"I'm a periodontist. I imagine all fillings should be cast gold, gold foil or full porcelain. Perhaps IRM if it's too costly." (Pennsylvania periodontist)

Amalgam fillings can lead to fractured teeth

"I am not worried about the mercury issue. To me the larger issue is the fractured tooth syndrome." (Minnesota)
"Too much fracturing of teeth with amalgam restorations." (Colorado)
"In my 30 years of practice I have observed the failure of amalgam to adequately restore teeth. 99% of the time it is the source of fractured teeth. When removing it the 'black scuz' found underneath indicates poor seal. Interproximal restorations are many times sources of periodontal inflammation. That is enough for me to discontinue its use." (Kansas)
"They expand and contract with hot and cold and crack and break teeth - we do not use them." (Kansas)
"While it may still be a safe material for use, its long-term use leads to cracked and broken and often devitalized teeth. With the bonding age extant, and improvement in these resin materials, the superiority for use of tooth colored restorative materials is obvious. We haven't placed an amalgam in a tooth for at least half a dozen years. I believe that's the current trend for the majority of dentists today." (Arizona)

Amalgam works better in certain situations

"We only use amalgam for subgingival restorations in the posterior where moisture control is poor." (California)
"All studies to date show it's safe. Plus, how do you place a composite on the DL of #31 with a strong tongue and lots of saliva. You're a much better dentist than I am if you can do it EVERY TIME." (Ohio)
"There is a time and place for things I place them when that is the only or best restorative material. e.g., isolation is not possible and things are wet. patching a metal crown. Otherwise I use alternative materials." (Connecticut)
"Amalgam is not my material of choice but on posterior root surfaces and areas composite will not hold I still use amalgam." (Texas)
"In rare cases, subgingivally on elderly patients, where composites would have a poor prognosis, even glass ionomers may not be able to be placed, etc." (Illinois)
"It is an indispensible part of our practice. Plastic just doesn't work in all situations." (Florida)
"It is still the only filling material that will hold up in damp, wet, nasty conditions when control of saliva, cervicular fluid and/or hemorrhage is impossible." (Colorado)
"We don't use them often, but sometimes, in a difficult spot, where moisture control and finishing a composite resin would be a problem, we use amalgam." (Delaware)
"The water sorption characteristics of composite make it highly questionable as a foundation material, particularly with large buildups (especially if not carefully and very incrementally placed). Bonded amalgams are still the best choice for foundation restorations and root caries repairs in caries prone patients." (California prosthodontist)
"In certain cases, amalgam I believe is the choice restoration, particularly with high caries index and elderly patients." (Florida)
"Only when patient requests or conditions require due to poor isolation etc. It is very rare." (Colorado)
"Contrary to politically correct brainwashed public opinion there is nothing wrong with a properly placed amalgam. We dentists have probably saved millions of teeth in over a hundred years of use with this 'hazardous' material. I don't think you can get 50 to 60 years or more out of a 'plastic' filling anywhere's in the mouth as I have seen with the silver filling. It is so impractical to place a deep subgingival disto-occlusal composite let's say in a max/mand second molar situation where you are fighting either gravity with your flowable or saliva where you cannot place a rubber dam. All this cosmetic dentistry is full of beans if you cannot protect the tooth from further leakage down the line. Hooray for the amalgam. It came along in our dental history when we had nothing else as good. And it is still a useful restoration today. It is more practical to use especially in difficult to reach areas, easier to get a good interproximal contact, seals off the margins without the additional steps of bonding and is stronger. I'd take an old worn out amalgam with corroded margins over an any composite that has dark stained margin anytime, because of the rapid way decay will spread." (California)
"Although resin or porcelain restorations are better, we still offer amalgams to those on very tight budget or for those with limited cooperation where placing bonded restorations would be very difficult." (Wisconsin)

Have composite resins been proven safe?

"Amalgam lasts significantly longer than composite; composite is not inert, it releases formaldehyde - what foreign material would you rather have in your mouth?" (Connecticut)
"Amalgam remains the longest lasting of the economical restoratives. Unlike composite, however, it is not as technique sensitive, does not break down as readily, and moreover, amalgam does not release estrogen as a byproduct - not something that we should have in our bodies, considering its connection to a higher incidence of breast cancer." (New York)
"Too many teeth with rapid cervical caries after large resins. My wife has a PHD in Biochemistry, but has patents from resin chemistry research. Big concern with Bis-phenol A components of resins." (Wisconsin)
"Have there been any studies on the resins leaking into the bloodstream? Amalgams still have a place in restorative dentistry." (Ohio)

It's not clear that amalgam is dangerous

"Amalgam is safe. It is a good dependable required restorative material. It is needed until someone can develop a truly dependable composite that can be cured underwater on a screaming 5 year old." (Georgia)
"The dangerous form of mercury, methyl mercury, does not exist in the human system. Dentists who advocate elimination of dental amalgam are building their practice at the expense of the rest of the profession. Dental amalgams are perfectly safe. So are base metal casting alloys (Co, Cr, Ni, Ti, Be)." (Kentucky prosthodontist)
"The refusal to place amalgam and especially putting fear into patient's minds is unethical. Only way I will stop using amalgam is if public opinion absolutely dictates and then I will change grudgingly." (Ohio)
"Silver Amalgam has been used for over a hundred years as a restorative material. It is an excellent material. Ugly, yes. Dangerous, I don't think so. I am aware of NO epidemiological study that links ANY human malady to the presence, or placement of silver amalgam restorations. The two most probable times to be exposed to elemental mercury from amalgams are during placement and during removal. If there is a problem of mercury exposure associated with amalgam, dentists should be the ones falling like flies to all the ills that supposedly result from that exposure. Any of you guys having trouble?" (Louisiana)

In fact, some dentists do report having trouble

"I have not used amalgam for almost 20 years, I now wear gas mask & use special suction for removal of amalgam for protection from vaporized mercury. It is toxic." (Florida)
"I have high levels of mercury in my system based on testing with my doctor." (Texas)
"I don't place amalgam fillings due to the exposure of mercury for my staff and myself. The excess mercury that pools during compaction and is then taken up by our suction is exposure for us." (Arizona)
"We quit using mercury fillings almost 20 years ago due to the health concerns. In that time I have seen hundreds of patients health restored after having old leaky mercury fillings removed. My health has definitely been compromised, and so were my patients, as I handled and placed these material for almost 20 years before learning the dangers." (Kansas)
"Mercury is a toxin!!! We all seem to be concerned about the welfare of the patient, but I worry about the long-term effect of exposure to mercury to dentists and staff. For the last ten years, I have been conducting a research study on this very topic. I have discovered that all dentists and staff who either place or remove mercury fillings have extremely high levels of mercury in their systems. Some of the offices, like mine, do not place mercury fillings; they only remove them. Therefore, they are breathing in the mercury dust and vapor (a regular mask does not help...you need to wear a respirator) and this toxic material enters their systems via the respiratory tract. Absorption through the skin is another mode of transport. Dentists and staff when compared to the general population have a large mercury content difference. And it is not because they eat a lot of fish!!! Forget about the aesthetic component; we as a profession need to concern ourselves about the health aspect. It is amazing to me that the EPA has not gotten involved with this. I could go on about the long term dangers of mercury inhalation, but my profession has decided it will punish those of us who speak negatively about both mercury and fluoride. It makes you think we might be hiding something, doesn't it? Allow me to ask this question: Why is it that dentists have the highest suicide rate among professionals? Did you know that one of the side effects of mercury toxicity is depression and suicidal tendencies, known years ago as the 'mad hatters' disease'? Bottom line: stop using the crap!!!" (Missouri)

Amalgam has been tested by time, and fillings can last for 50 years

"Has anyone compared 50-year-old resins with 50-year-old amalgams?" (Florida)
"For all those who say this is a 'horrible' material: how many 20, 30 and even 40 year old amalgams do you see out there?!?" (Florida)
"I have fifty year old amalgams in my mouth and am constantly amazed when I see 30-year-old restorations I have placed looking good and going strong. Composites, while useful, do not have the in vivo history of amalgam." (Delaware)
"Properly placed, they are still the most effective and durable restoration we have at this time. Composite restorations have come a long way. However, they are still made of plastic, and no matter how well they are bonded, they will fail in a relatively short period of time." (Louisiana)
"The amalgam restoration has years of proven effectiveness and only anecdotal incidences of unwanted reactions. Until I find posterior composites that can last fifteen or twenty years, I will continue to offer the amalgam as a restoration." (Texas)
"They are the most durable of all restorations, with the exception of gold, that are available at this time. I have a problem placing a restoration that will be of limited life in an area of the mouth that is not seen in normal conversation. Combine that with the reduced coverage that most insurance policies provide for composites, the only reasonable and fair approach is to provide the patient with the most durable and reasonable product." (Louisiana)

I haven't placed an amalgam filling in years...

"Haven't used it for over 12 years. Even if it was a beautiful, tooth-colored material, it would still suck... big-time!" (North Carolina)
"It's been over 12 years since I've done an amalgam filling." (Illinois)
"Last amalgam I placed was 1981!" (Massachusetts)
"Quit using them in 1983!" (Texas)
"Haven't placed any in 15 years." (Ohio)
"Haven't used amalgam in twenty years!" (New Hampshire)
"Last amalgam was placed in 1988." (Illinois)
"I stopped using amalgam in 1984. The 3M composites I placed then are still serving my patients today." (Colorado)
"If a patient has amalgam fillings and are still doing fine, I say leave them.... but I haven't done amalgam in 15 years." (Arizona)
"Not since 1979." (Georgia)
"Not since 1993. Patients claim they are not bothered, but many come to us when they hear we only use non-mercury fillings." (Florida)
"I stopped using mercury-releasing fillings in 1985. I have seen hundreds of sick people get well from many diseases who believe it was their mercury fillings causing their illness." (Arkansas)

How can it be safe in your body but toxic waste outside of it?

"The toxin should be banned nationally. There is just no reason to be placing this material into human bodies. It's a toxic waste when I remove from someone's body, but not when it is in a human body?" (Washington)
"The city where I live restricts discharge from a dental office. OSHA is concerned how we store waste amalgam in the office. The ADA didn't fight them on this, so I conclude their position is that the only safe place to store amalgam is in the patient's mouth." (North Carolina)
"I haven't had mercury in the office for 25 years. If children break a thermometer in their school room the Has-Mat team gets called. It seems according to the ADA and governmental organizations the only safe place to put mercury is in someone's mouth. We are not being told the truth!" (Illinois)
"Mercury is one of the most powerful neurotoxins known. We can't put it in landfills, and any excess has to be picked up by hazardous waste haulers. Yet we can bury a filling that is 50% mercury, which has been unquestionably proven to continuously leach out over its lifetime, 3 inches from a person's (including a developing child's) brain. DUH!!!!" (Pennsylvania)

Amalgam is cheap, easy and good for patients with poor hygiene habits

"We have patients that cannot afford crowns, and composite will not hold up to some of their habits." (Illinois)
"I think it is fine to use. Many patients do not floss and I think it holds up better for patients with poor oral hygiene." (Missouri)
"I do see the need, and have determined that amalgam placement is a socio-economic issue." (Texas)
"It has been found safe by numerous studies and organizations. It is the most reliable, cheapest restorative and is useful for those who cannot afford higher price materials." (New Mexico)
"Amalgam is still regarded as one of the best materials a dentist can use. It's obvious as all other materials, except gold, continue to try to compare themselves. Keep the leftists out of dentistry." (Texas)

Controversy over the term "Mercury Amalgam"

"The usage of the term 'mercury amalgams' show a bias on your part. They still have a place in dental health, and are safe and cost-effective." (Montana)
"First of all when we were in Dental School we were taught they were 'Silver Amalgam' fillings. 'Mercury Amalgam' fillings was a term invented by the MEDIA. I first heard it on 60 Minutes in 1990. Second of all, I will tell you that I only place silver amalgams on primary teeth and in areas where placement of a composite or other restoration is impossible if not extremely difficult (i.e. the distal of a max. 2nd molar near the gum line or patients who cannot tolerate a dry field do to an unusually strong gag reflex)." (Wisconsin)
"Your use of the term 'Mercury Amalgam' adds an apparent bias. Were you to list all of the ingredients of either material, nobody in their right mind would want them in their mouth!" (Pennsylvania)