Dentists Split Over Amalgam Fillings (VIDEO)

Amalgam dental fillingsDentists are deeply divided over the issue of mercury in amalgam fillings. In this survey, 52% of dentists reported they are no longer using amalgam. The other 48% are still placing amalgam fillings.

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

The Amalgam Controversy Is Alive and Thriving

Amalgam dental fillingsWe 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

Mercury Safety Is Different from Amalgam Safety

Mercury safety: Amalgam issues divide dentistsMercury safe dentistry seems like a good idea for everyone, so I wasn’t expecting so much controversy from Dr. Tom McGuire’s article on the topic (read the article). Though dentists have lots to say about the consumer safety of amalgam fillings, that’s not what we’re talking about here.

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.

1 Dentist in 4 Would Ban Silver Fillings

3 out of 4 dentists would not ban dental amalgamOnly one dentist in four would support a ban on silver fillings made of dental amalgam.

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

Dentists Not Concerned About Chemicals Used in Dentistry

Dentists Not Concerned About Chemicals Used in Dentistry“Not particularly worried” is the most popular response for concerns about the chemicals in dentistry among dentists, according to a new The Wealthy Dentist survey, but the results are pretty evenly split.

The online survey asked dentists from the U.S. and Canada if they are concerned about the safety of dental composite and sealants.

54% were not worried, while 46% had concerns about safety.

Here’s how the dentists responded —

  • 21% – Definitely yes! I am very concerned about this issue.
  • 25% – Somewhat. I have some worries about safety.
  • 38% – Not really. I’m interested, but not particularly worried.
  • 16% – Definitely not! I’m not worried at all.

Chemicals Used in Dentistry Survey Results Graph

“It’s about the same argument as the amalgam and mercury issue. I don’t see that the literature to date points in any direction toward concern about BPA!” a Mississippi dentist said.

BPA in tooth fillings has been in the news recently due to a study linking the chemical to behavioral problems in children.

According to Dr. John Reitz of Reading Eagle Press, “When dental manufacturers became aware of the health risk of BPA they made a conscious effort at eliminating or at least limiting the amount in dental products. According to research by the American Dental Association, BPA is rarely used today as an ingredient in dental products.”

Most of the dentists who responded to this survey agree that there are minimal risks from dental chemicals.

Here’s what many dentists had to say on the subject —

“We need more long-term studies.” (New Jersey dentist)

“To temper this, we have to remember that ANYTHING in the body outside of what is indigenous is considered foreign and has potential to elicit yet another of those unexpected side effects, sort of like most of Congress’ laws. Since I stopped doing sealants years and years ago, I am less concerned about the effect on most adults.” (General dentist)

“Amalgam is on its way out. Let the chemist reformulate BPA-free dental products!” (Alabama dentist)

“I didn’t know that I need to be concerned…” (California dentist)

“No patients have shown any worry. I do feel extensive research should be conducted.” (Mississippi dentist)

“Yes – patients ask about it! But I understand there are different kinds…some more damaging than others.” (Michigan dentist)

“I’ve never had a patient even mention it, unlike the ‘wackos’ who won’t let fluoride touch their kids lips…” (General dentist)

“None of our patients have mentioned it, yet. But, I won’t be surprised if or when they do in the future. I’m personally concerned about BPA in composites. I certainly didn’t want it in the plastic baby bottles my child used, so why would I want it in composite resin dental restorations? Dentistry certainly needs to have BPA free restorative materials.” (Ohio dentist)

“Parents are now asking me about our materials and if they contain BPAs.” (Pediatric dentist)

The ADA Council on Scientific Affairs has not identified evidence to suggest that the use of resin-based dental sealants or composite resin restorative materials is linked to adverse health effects from BPA exposure. (Source: ADA)

Dentists, what are your thoughts on chemicals used in dentistry?

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