Lead and Bisphenol A, two more scary chemicals that might be in our dental work. It’s enough to make you wonder whether dentists might sometimes be doing more harm than good.

What’s worse, the scientific evidence isn’t clear.

Sighed one dentist, “I’d like to be doing all gold restorations.”

Another dentist commented, “I feel it’s ironic that some patients don’t want ‘artificial chemicals’ in their mouth and decline the natural elements in amalgam in favor of the complex chemistry of composites!”

The Wealthy Dentist conducted a survey of dentists asking how concerned they are about various potential public health threats linked to chemicals in dentistry.

Click on Play to hear what chemicals concern dentists the most –

What dental chemicals concern you?

The Wealthy Dentist decided to survey dentists to find out their thoughts on this subject, and if they are still using amalgam.

40% of the dentists who responded are still placing amalgam. Another 27% place amalgam in only special circumstances, while 33% do not use amalgam at all.

What is even more interesting are the comments we received –

The positives

“It’s still an excellent restorative material that has a proven track record. I don’t understand what the big hoopla is about banning it entirely. Health concerns? Unproven. Mercury in environment? Don’t blame the dentists.” (New York dentist)

“A much maligned, but excellent restorative material that in some, but not all instances is superior to composite, depending on the situation.” (Ohio dentist)

“The greatest posterior restoration ever!” (General dentist)

“In children’s primary teeth, they will last and not re-decay until they lose them. In the elderly, they are resistant to root decay and will last when crowns are not in their budget. I would grieve if I could not use this material.” (Texas dentist)

“They are the most technically forgiving, economical workable restorative still.” (New York dentist)

“There is nothing wrong with amalgam restorations — they are efficient and cost effective for the patient!” (Oklahoma dentist)

“It’s still a wonderful filling material posteriorly, and affordable for most dental patients.” (Suburban dentist)

“They last much longer, less sensitivity and there is no credible evidence they have killed anyone. Remember composites contain Bis-Phenol and I still place many more composites, GI’s, then amalgams. Because of their proven longevity, it is unethical to not offer amalgam to your dental patients.” (California dentist)

“I still love amalgams. I am also tired of all the amalgam-bashing. I believe most of it is profit-driven. I had great gold and amalgams placed years ago in my mouth. No one ever notices. I realize people think composite looks nice but who sees these restorations?” (California dentist)

The negatives

“I haven’t placed an amalgam in 30 years. I quit because I couldn’t think of a benefit that outweighed the risks!” (Texas dentist)

“The material should be banned!“ (Kentucky dentist)

“There are far better materials available. The vapor is toxic. Have you seen the “smoking teeth” video?” (California dentist)

“Do the research. Mercury, even in small amounts, is ultra-toxic — probably the most toxic heavy metal to which people are routinely exposed.” (Ohio dentist)

“I have not placed an amalgam since 1986!” (Massachusetts dentist)

“I haven’t place an amalgam since Reagan was President…you have got to be kidding!“ (General dentist)

“My biggest concern is with the fact that amalgam imbibes moisture for the first 24 hours after placement and swells internally within the tooth, creating crazes and cracks, ultimately leading to fracture of the tooth (see article by Drs. Assif, Marshak, and Pilo in the JPD 1990). After reading the article, I photographed 50 consecutive teeth on which I had just removed amalgam restorations. The number of teeth with cracks or crazes: 50.” (Massachusetts prosthodontist)

“Haven’t placed them in 30 years. Any doctor who doesn’t know mercury is a poison should have his degree cancelled!“ (Florida dentist)

This issue is still one of the most contentious in dentistry for the last 30 years. Recently Dr. Mercola, a well-known health care advocate, interviewed Charlie Brown a leader in the mercury-free dentistry movement.

Here is the interview -

Your comments both pro and con are appreciated.

The proposed rule would likely take effect by 2014. Twelve US states already require separators.

In their announcement, the EPA stated that 3.7 tons of mercury are discharged each year by US dental practices. A 2003 study funded by the ADA found that dental mercury is the source of about 50% of the mercury encountered by water treatment plants.

Expect this to be a topic of discussion at the ADA annual meeting later this month.

Read more: US EPA to regulate dental mercury waste

Past surveys have consistently shown dentists split on the topic of amalgam, as about half of dentists place amalgam fillings. But in this survey, 74% of dentists said that dentists should be able to make their own choices about restorative materials.

“I’ve personally not used it for 30 years,” said one dentist, “but I would guard the right of others to use it when indicated by their ethics and philosophy.”

Here are some further dentist comments:

• “All studies demonstrate amalgam is safe and very effective.” (California dentist)
• “Composites are not without their own toxic byproducts.” (General dentist)
• “Once the ‘Old Guard’ passes, retires or fades away, there will be no more dental amalgam.” (General dentist)
• “I just travelled to Haiti to do volunteer work in a make shift mission. In the end, the amalgam was the best material of choice… Each dentist must be given the option of selecting the material of choice for the conditions in which they are required.” (General dentist)
• “It’s time to move on. Hopefully the options will get even better.” (New York dentist)
• “Most dentists cannot do a decent proximal contacted composite. I would much rather have a mediocre amalgam than an almost perfect composite.” (New Jersey dentist)
• “If amalgam was safe, OSHA would not require its disposal in hazardous waste.” (California dentist)
• “I could not, would not be able to serve the IDD (intellectually and developmentally disabled) population well if I was not given the choice of amalgam.” (Developmental Dentist)
• “I personally use amalgam probably less than 5% of the time, but at least I have that choice. Who would enforce this ban? The Government?? Let the dentist decide!!” (Florida dentist)
• “It works well, is very forgiving, seals its own margins. It is not the universal restorative material, but neither is anything else, including resin. Dentists should have the skill, knowledge and option to use a variety of materials.” (Indiana dentist)
• “If this were a new material applying for FDA approval, how long would the process take? How hard would the FDA laugh before saying ‘NEXT!’?” (Texas dentist)
• “Unless evidence exists – which it does not – a ban is totalitarian. What’s next – McDonalds? Pizza? Meat?” (Orthodontist)
• “You can’t do repairs under dental crowns with anything other than amalgam.” (General dentist)
• “I wouldn’t use it on myself or my family. So I haven’t used it on my patients in 17 years.” (Texas dentist)
• “Amalgam works fine. Never seen a negative effect of amalgam use.” (Prosthodontist)

Read more: Dentists Not in Favor of Banning Dental Amalgam

We're just talking about protecting dentists, staff and patients from mercury exposure during amalgam removals. Doesn't that seem like something everyone can agree is important, regardless of whether one is pro-or anti-amalgam?

I'd like to address some of the points readers raised about Dr. McGuire's article.

"Since when is anyone who wants to promote his moneymaking 'seminar' considered to be 'a leading authority?'On what grounds?Is he an established professor at an accredited dental school? In which department? Sheesh, if I call myself an 'expert toxicologist' six times before lunch, does that make me one?"
- Bill C., DDS

I think it's safe to call someone "a leading authority" when they're authored multiple books on the subject and founded a professional association, like Tom McGuire, DDS, founder of the International Association of Mercury Free & Mercury Safe Dentists (IAMFD).

I understand you may disagree with some of Dr. McGuire's opinions. But the fact of the matter is, he's a heavy-hitter in amalgam debate.

As for his seminars…

"Since all of the uproar about Dr. McGuire’s article I decided to visit the seminar website. I didn’t see anything about arguing that amalgams are a health hazard. All I got was that dentistry is a high risk occupation because of mercury and that it would be prudent, for many reasons, to deal with the occupational exposure to it. I really don’t see this about being pro or anti-amalgam and I still think everyone is entitled to his/her opinion about that topic. What I read was that it is about being anti-mercury and finding out what you can do to protect yourself. After looking at the website I’m going to attend his seminar, and it is a 2 hour flight for me."
- Bob B., DDS

Where Bill sees a chance to lose money, Bob sees a chance to gain important education. Either choice is fine. The Wealthy Dentist isn't endorsing Dr. McGuire's views, just giving him a chance to share his knowledge.

"Odd how the studies seem to prove whatever it is you want them to show."
- Dr. Gary Hochstetler

An excellent point. When both sides of the consumer amalgam debate claim the science is clearly on their side, it's hard to know who to believe.

That’s why we're trying to move the debate away from if having amalgam fillings is safe and towards how much mercury exposure dental health professionals face.

Mercury Free and Mercury Safe: What's in a Name?

Strictly speaking, the term "mercury free" refers to dentists who do not put amalgam fillings in their patients' teeth. But over time, the term "mercury free" came to indicate those dentists who not only didn't put amalgam fillings into their patients teeth, but those who also safely removed them.

However, mercury free isn't really an accurate description because as long as dentists still remove amalgam fillings, their offices can't officially be called "mercury free." Therefore, mercury safe is a more accurate description of those who not only don't put amalgam fillings in teeth, but also remove them as safely as possible. Another way to put it is that safely removing amalgam fillings means you are dramatically reducing the occupational exposure to mercury at the dental office.

Thus, I encourage true mercury free dentists to use the term "mercury safe" to describe themselves if they not only do not place amalgam fillings but also use a safe protocol to remove them. There can also be distinct promotional advantages to being mercury safe. (You can click to access a list of amalgam removal protocols and read why they are so important.)

While I absolutely respect the right of pro-amalgam dentists to expose themselves to mercury, I don't believe they have the right to expose their patients, their staff and the environment to mercury – just because they've chosen to believe what the ADA tells them; that mercury amalgam fillings are safe.

It's one thing to believe that the mercury released from a patient's amalgam fillings on a daily basis isn't a health hazard. But it's another thing entirely not to offer the dental patient protection against mercury vapor exposure during the removal process. These are really two separate issues because there's a huge difference between the amount of mercury emitted from the fillings on a daily basis and the amount released during their removal at the dental office, up to 1000 times more during unsafe removal.

The only effective way to protect the patient, the dentist and staff, and the environment from unnecessary and excessive exposure to elemental mercury vapor is to make your office mercury safe. I simply can't imagine the ADA not supporting the practice of mercury safe dentistry.

Amazingly, the dental profession uses more mercury per year than any other business. In fact, it's the only industry using elemental mercury that isn't regulated by the government.

Written by Tom McGuire, DDS

Tom McGuire, DDS

Dr. McGuire and Dr. Paul Rubin will be presenting a one-day seminar on "How to Make Your Practice Mercury Safe" in San Francisco on September 26 and in Portland, OR on October 10. Learn more at www.NewDirectionsDentistry.com.This unique seminar is the only one of its kind available to dentists and nothing you could do for your practice will be as important to you, your staff and your patients' as making your office Mercury Safe.

Dentists are passionately divided on this issue. In fact, it’s hard to find a dentist who doesn’t have a deep-seated opinion on amalgam versus composite fillings. Even what to call the dental restorations is a big deal: names range from “silver fillings” to “mercury-releasing fillings.”

Read more: Silver Mercury Fillings Are Amazing… Or Maybe They’re Terrible

"Let’s be clear, the classification (Class II) assigned implies increased risk, though the contention is that it is as safe as it has always been believed to be?" asked one commenter.

Indeed, it's a complicated issue. Let's review a few of the big questions surrounding mercury:

• Are amalgam fillings bad for patients?
• Does amalgam threaten the health of dental professionals?
• What about the presence of mercury in vaccines, particularly the H1N1 vaccine?

Allow me to discuss these one at a time.

What about the presence of mercury in vaccines, particularly the H1N1 vaccine?

Frankly, the FDA is in a Catch 22 situation on this issue. I think the logic is that, since H1N1 is likely to kill more of us quicker than mercury fillings, the FDA should say mercury is safe in vaccinations and only marginally unsafe in dental fillings.

"This genocidal reaction of the FDA pertains to vaccination mercury, and their certification of this toxic ingredient in the flu vaccines in particular. They could not outlaw mercury amalgams and at the same time advance and encourage 'fast-tracked' mercury poisoning using thimerosal in the H1N1 and season flu (and other) vaccines."
- Dr. Leonard Horowitz

Are amalgam fillings bad for patients?

I'm an authority on many subjects, but does anyone really think that a dental management consultant is the right person to answer this question?

Does amalgam threaten the health of dental professionals?

Obviously consumer safety is a top concern, but dentists have to also consider if there me be any negative impacts to the health of everyone who works at the practice.

"Dental personnel are being injured. There are case controlled studies of women in dentistry rendered infertile from occupational exposure."
- Dr. David Kennedy

Dr. Tom McGuire, founder of the International Association of Mercury Free Dentists, told me, "I've no doubt that amalgam fillings will be banned in the near future, either by government regulation or by a class action lawsuit. But regardless of whether or not they are banned, or whether or not they are a health hazard, it will still be important for dentists to make their practices mercury safe… and as quickly as possible."

He'll be conducting a seminar about "How to Practice Mercury Safe Dentistry" in San Francisco on September 26th and in Portland on October 10th. "As I tell patients, you have to have the information to be able to make an informed choice. Some dentists have made this so emotional that it is like religion or politics."

Indeed, it is a lot like religion or politics, with people preaching zealously from both sides. Whew!

Some dentists criticized amalgam for its possible toxicity and tendency to fracture teeth; other dentists defended amalgam’s long history and superiority to more modern composite fillings.

Read more: Dentists’ Thoughts on Amalgam Fillings

Some worry the silver/mercury alloy may cause health problems, while others think it’s still superior to tooth-colored composite fillings.

Read more: Silver Mercury Fillings Are Amazing… Or Else They’re Terrible