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We asked, “Does your dental practice place amalgam fillings?” Two years ago, 48% of dentists said they placed amalgams, and 52% did not. The numbers have changed very little since 2007. Today, 47% place amalgams and 53% do not. No survey topic we have ever run collects as many responses and passionate comments as the question of amalgam.
The Wealthy Dentist is a dental marketing information resource. We’re not scientists, and we don’t pretend to have answers for dentistry’s big scientific questions.
We don’t have a stance on amalgam. So far, the ADA and FDA say it’s safe, but no scientific study has conclusively demonstrated if amalgam is safe or not. It’s one of the most divisive issues in dentistry today, and we wanted to see what dentists think.
But we were accused of bias merely by asking the question. However, some accused us of being blatantly pro-amalgam, while others declared us obviously biased against amalgam. With an equal number of complaints on each side, hopefully that means we average out to neutrality.
We received well over 100 comments on this survey (you can read them all here), but some themes were common.
Top reasons dentists like amalgam:
- Been around for over a century
- Better than composite in some cases
- Composite and resins may not be safe
- Last longer and have less redecay
- Affordable and paid for by insurance
Top reasons dentists avoid amalgam:
- Mercury is bad for patients, dentists and the environment
- An old dental technology
- Today’s composites are superior
- Silver fillings are ugly
- Amalgam can crack teeth
Reviewing dentists’ comments on the subject, it’s clear that a doctor’s personal opinions about amalgam do not always line up with the policies of their dental practices. A number of dentists who don’t place amalgams think it’s a valid restorative material, and some dentists who do place silver fillings would prefer not to. Whether or not a dental practice offers amalgam fillings is often related to two things: (1) is the practice focused on cosmetic dentistry, and (2) does the practice serve lower-income patients.
Many dentists scoffed at the idea of there being a scientific controversy over the safety of amalgam. “There is no controversy — it is a safe material with the longest history of use, declared a Vermont dentist. On the other hand, a Virginia dentist stated, “There is no real controversy in the scientific arena. Mercury release from amalgam is the primary contributor of human body burden and causes pathophysiology. It should be banned.”
With so many comments, many doctors chose the same words to describe their feelings about the amalgam issue. Here’s how many times different dentists used the same phrases in their comments:
- 6: “Overblown”
- 5: “BS”
- 5: “Much ado about nothing”
- 4: “What controversy?”
- 3: “Crap”
Interestingly, doctors on both sides of the issue dismissed the controversy as “crap” or “BS.”
In addition, each side accuses the other of being motivated by money. “The controversy is fueled by greed. Posterior amalgams are easier to place and last longer than composite,” said a general dentist. A dental machinist & engineer disagreed, saying, “It’s difficult to get a true picture; there’s a great deal of money on the pro-amalgam side that has a potential to bias the data.”
In a sea of loud, zealous voices, one dentist’s calm neutrality stood out.
“If you stop and listen to the people that are arguing about this point, you will get two skewed views. If you present the science in an unbiased way to your patients many will choose amalgam and many will choose composite. You need to be honest about all the treatments you present.”
- Colorado dentist)
Read more: Dentists Still Arguing about the Safety of Silver Fillings
Post a comment
June 3rd, 2009 at 7:07 am
The biggest danger of mercury-silver amalgam is to the dentist and his staff who get daily exposure. The U S Nsvy found mercury to be so toxic in a closed enviroment that they banned its use in nuclear submarines way back in the 1950’s. It is a neurotoxin and a depressant. Perhaps that is why restorative dentists have such an unusually high suicide rate.
June 3rd, 2009 at 7:09 am
when the coefficients of expansion and contraction of composites match those of enamel and dentin, I’ll switch to all composites. Meanwhile, we’ll just keep referring those now painful 3-4 year old “white” restorations with their usual brown line at the margins to endo and then pros for a crown.
June 3rd, 2009 at 7:49 am
An MD friend of mine asked me “Since Hg is so toxic and we should avoid it in our fish and the coal burning industry is villified for releasing Hg into the atmosphere,why do you put it in people’s mouths?” Do I really believe that the Hg is “locked up” in the amalgam? I never do amalgams ’cause pts. do not want them. I still have some amalgams in my mouth. Who knows!
June 3rd, 2009 at 11:53 am
In your article you note:
a Virginia dentist stated, “There is no real controversy in the scientific arena. Mercury release from amalgam is the primary contributor of human body burden and causes pathophysiology. It should be banned.”
Now I am all for having your opinion, but don’t get on your high horse and claim that science is 100% behind you. Mercury is measurably released from amalgams, but is not the primary contributor of human body burden. And the statement that it causes pathophysiology is also a huge leap of unsubstantiated BS.
Do this mental exercise: Look at that amalgam in your elderly patient that has been in place for over 30 years. If you could take it out and weigh it and then compare that with its weight when it was originally placed, I am guessing that the two are almost identical. So where is all the exposure/body burden?
Next exercise: That composite that you placed into that same tooth today; how does it look in 30 years?
June 3rd, 2009 at 4:38 pm
“The most savage controversies are about matters as to which there is no good evidence either way.”
–Bertrand Russell
Having submitted that quote, let me say that I have yet to find a tooth where I removed an old alloy that didn’t have some kind of crack in the surrounding tooth structure. To me, the underlying issue, irrespective of the mercury, is delayed expansion and tooth fracture. That can lead to what we call “money pit mouth” in our practice. Large alloy, cracked tooth syndrome, crown preparation and placement, root canal, root canal failure if the original crack microscopically compromised the root structure, extraction and eventual implant placement. I quit using alloy in 1980 for strength and mercury reasons. That ought to provoke some feedback!!
June 3rd, 2009 at 4:57 pm
Composite restorations, though aesthetic, have proven to be a great gift to the practice of endodontics.Compare a 20 year old amalgam to a 20 year old composite…..if you can find one……the evidence speaks for itself
June 5th, 2009 at 7:46 am
Mercury from amalgam is the predominant source of human exposure to mercury.
Eggleston and Nylander 1987 study by Autopsy reveals that the amount of mercury in your brain and kidney the day you die is proportional to the number and size of amalgam fillings in you teeth at time of death. Controls were people with 32 perfect unrestored teeth. Confirmed numerous times by other investigators.
June 11th, 2009 at 10:19 am
The only mercury in my office resides within the teeth of patients who bring them in. There are better and more safe materials available. The coefficient of expansion between tooth structure and amalgams causes cracks, and if you don’t think that mercury is released from them, check this out:
http://www.youtube.com/watch?v=9ylnQ-T7oiA
June 16th, 2009 at 7:39 am
When I had my cracking amalgum fillings (3 large per each of the 4 sections of my jaw, upper and lower, left and right, 12 total) replaced at the age of 45, I immediately developed all the symptoms of alzheimers, and parkinsons. I could not remember anything from the previous day, just blackness, and my hands shook and trembled severely. I was unabable to work and was tested by the doctors at the Oregon Health & Sciences Hospital in Portland. They could not figure it out. The symtoms gradually diminished over a couple of years, but I remained a very nervous person. When I was 58, I had the upper right quadrant replaced with resin composites. But the dentist drilled the fillings to dust instead of removing in chunks, and did not provide me with a rubber damn or breathing mask. Immediately, I developoed a large cararact on my right eye (rapidly over a period of only 3 months) My vision went from 20/40 to 20/600! Last year, I went to a Health Conference in Austin, Texas and attended a lecture by a well known and respected Opthamologist and Toxicologist speaking about the dangers of mercury poisoning. Afterwards I began to tell him of my experience, and before I could ask if he thought there was a causal relationship between my cararact and the clumsey removal of my amalgums, he asked me if I thought there was, I nodded, and he said very affirmatively that there absolutely was. I had the other 9 fillings replaced by a knowledgeable dentist who protected me and himself and his staff during removal.
I still suffer from my cataract-limited vision as I have no insurance to pay for its removal, but…my nervous disorders have gone almost completely, my liver now functions normally, and I feel so much better without mercury in my body.
August 5th, 2009 at 3:00 am
Neither me or any of my patients have experienced any symptoms mentioned which could be releated to the use or removal of amalgam. However I very much prefer to place composites as they look much better and I just simply enjoy doing a nice natural looking work. Mercury in the air after filling removal is not the best thing but what about dioxine from laser printer toners, car fumes (we have quite a lot here in london) or conservatives in food?