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)