Dental Survey: Most Dentists Think Amalgam Is Safe Enough

Is dental amalgam safe?

This dentist survey asked if dental amalgam should be banned in the U.S.

Most dentists said amalgam is safe enough for continued use and should not be banned.

Close to half of our survey respondents (48%) think it’s a valuable restorative material.

“We are already adequately governed regarding amalgam use and disposal. We need to advise patients regarding BPA in composites and the drawbacks to composites so that patients are better able to decide on their poison. Or they can use gold.” New York dentist

“The latest from American Association of Dental Research and the International Association of Dental Research is that Amalgam is the most cost effective restorative material, and it has no adverse health effects.” Florida dentist

“Amalgam is still the best restorative material in many situations where it is impossible to keep the field of operation dry.” Illinois dentist

A quarter (25%) of the dentists in our survey think amalgam should not be banned, even though they don’t necessarily think it’s the best material.

“Since it hasn’t ever been proven to be unsafe, it should be left alone – very few people want amalgam in their teeth, and it will die a slow death of it’s own.” New Hampshire dentist

“It may have a place in certain situations, but I personally have not used it since 1999.  I also do not think it has definite, dreaded effects on our patients’ health. After all, if it were the deadly material that some have described…why is it safe to bury deceased amalgam patients conventionally and not in toxic waste landfills?” General dentist

“What is leaching out of our composite restorations? I haven’t seen a conclusive study that absolutely proves amalgam is dangerous.” West Virginia dentist

However, 28% of our respondents are on the other side of the amalgam issue: 10% said they tend to think it should be banned. Another 18% think it should be banned, and no one should be using amalgam at all.

“The most toxic heavy metal on the planet! We can’t throw it away, but ok to put it in our teeth? Really??” Tennessee pediatric dentist

“The EPA deems it a bio hazard for the environment. Enough said. The retentive undercuts [required for amalgam] further weaken tooth structure which leads to fractures. With resins a dentist may do minimally invasive dentistry which results in better tooth strength and potentially fewer fractures. I have clinical pictures of an old, class II resin which was placed in 1985 that is still functionally intact with no signs of any marginal breakdown. That shoots down the knock that resins don’t last.” North Dakota dentist

“Anyone interested in the subject should check out the Compendium February 2013, volume 34, number 2. The article “Mercury from Dental Amalgam: Exposure and Risk Assessment”. It’s an eye-opener and reinforces what I have thought about for a long time. Clearly the ADA is avoiding the subject because it knows that all h**l will break loose liability-wise when it finally issue recommendations against it.” Florida dentist

What’s your opinion about using dental amalgam?

What Do Dentists Think About Using Amalgam? (Video)

Dental practice marketing with internet videoOne of the biggest controversies in dentistry is about the use of amalgam.

Some dentists think it’s a great material for filling cavities, but others worry about its possible toxicity.

“I haven’t placed an amalgam in over 25 years,” said a Kentucky dentist.

I live in rural America, and crowns are not financially feasible for many; so I shovel a lot of alloy!” said a Wisconsin dentist.

Jim and Julie report on a survey asking dentists how frequently they place amalgams.

Our past surveys at The Wealthy Dentist have consistently shown dentists split down the middle on the topic of placing amalgam.

Some things never change. Doctors are still split on the issue. In this survey, 58% of dentist respondents indicated that they still place amalgam restorations, while 42% do not.

How frequently are dentists placing amalgams?

Well, 27% said they place multiple amalgams per day, another 19% do at least one a week, and 12% only do a handful each year.

“I stopped using amalgam about 2 years ago. I do NOT believe it is a health risk, but I believe that composites have improved to the point that they are very serviceable – and of course look much better!” said a New York dentist.

“Amalgam still has a place in dentistry,” declared an Illinois dentist.

“According to some reports 1/3 of the restorations placed in this country are amalgams.”

We have better materials. We don’t need to use a restorative that was developed in the 1890’s just because it’s easier and cheaper,” said a general dentist. “If it were introduced as a new material today it would never make it or even be allowed. It just doesn’t make sense to use it. Yes, they mostly last ‘forever,’ but at the expense of the tooth.”

“Any dentist still placing silver amalgams is an idiot. It has nothing to do with the material, but the public’s perception of its dangers,” said a general dentist.

That’s a valuable perspective. We could argue the science all day long – but what about the dental marketing aspects?

Just the language you use affects how your patients will react to amalgam restorations. Most dentists call them “silver fillings,” but I know of at least one doctor who refers to them as “mercury-containing fillings.”

It’s not just a matter of the dentist’s personal preference. It’s also about the patient’s preference, cosmetics and finances.

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: BPA is Back Making Front Page Dental News Again

BPA in Children is Making Front Page Dental NewsBisphenol A (also known as BPA), a chemical used in lightweight plastics, dental sealants and dental fillings is back making news headlines once again.

First, the federal government announced this month that baby bottles and sippy cups can no longer contain BPA.

This was followed by reports from a new study stating that children getting dental fillings made with BPA are more likely to have behavior and emotional problems later in life.

The study, as reported in Pediatrics Online, “makes a strong case that in the short-term, use of BPA-containing dental materials should be minimized,” asserts Philip Landrigan, director of the Children’s Environmental Health Center at Mount Sinai School of Medicine in New York City.

The researchers in the study tracked 534 children with cavities from when each child received their first dental fillings. Over the following 5 years, the researchers noted that those children who had cavities filled with a composite material containing traces of BPA consistently scored 2 – 6 points less on 100-point behavior assessments than those who didn’t have fillings.

As reported in Science News, the researchers never administered clinical diagnostic behavioral tests to the children.

Instead, they periodically administered some widely used checklists to the children or their parents, allowing each to self-assess features such as a child’s attitudes toward teachers or others, depression, self-esteem, attention problems, delinquent behaviors, acting-out or problems with attentiveness.

Since the children were 6-12 years old at the time, these type of behaviors are not uncommon for children living with a variety of circumstances like divorce, bullying, and problems at home.

However researchers argue that the behavior problems being reported seemed to happen more with the children who had BPA fillings, causing them to believe that some dental fillings may start to break down over time, thus exposing these children to the chemical.

The U.S. government is currently spending $30 million on its own BPA research to determine the chemical’s health effects on humans.

As a dentist, what are your thoughts on the use of BPA?

For more on this story see: Putting BPA-based Dental Fillings in Perspective 

Dental Care: Dentists Justify Placing Amalgam

Dental Care: Dentists Justify Placing AmalgamDental news articles have reported a reduction in the use of amalgam for dental care by dentists over the past 20 years with new restorative techniques.

In the past, The Wealthy Dentist surveys have consistently shown dentists split on the topic of placing amalgam, with about half of dentists remaining loyal to placing amalgam fillings.

In our most recent survey the amalgam dental care trend holds steady with 58% of dentists responding that they still place amalgam.

“Amalgam is still a great restoration,” said one dentist, “and a good service for the patient.”

How frequently dentists place amalgam varies widely —

27% place multiple amalgams per day, or over 300 per year.
12% place about 10 amalgams per year.
8% place about 1 amalgam per day, or at least 200 per year.
6% place 1 amalgam per week, or 50 per year.
5% place 2 amalgams per week, or about 100 per year.

Dental Care: How Frequently Dentists Place Amalgam

Here are some further dentist comments–

Support placing amalgam:

“It’s easier to work with amalgam versus composite on posterior teeth.” (Arizona dentist)

“A well-placed amalgam can be the difference for a patient who has financial concerns and cannot afford a casting or resin.” (Pennsylvania dentist)

“I offer it for patient’s finances and in difficult areas.” (South Carolina dentist)

“Amalgam is an efficient, cost effective, long lasting restoration if done correctly.” (Massachusetts dentist)

“I certainly place more composites and all-ceramic inlays and onlays when it is necessary. Amalgams are good restorations for non-visible/non-esthetic areas and when the restoration will be small. We allow the patient to decide amalgam or composite in that situation. Sometimes they tell us their financial situation dictates amalgam over composite.” (Ohio prosthodontist)

“I live in rural America and crowns are not financially feasible for many; so I shovel a lot of alloy!” (Wisconsin dentist)

“It’s the best restorative material to use in some instances.” (Tennessee dentist)

“The most inexpensive restorative material- coefficient of thermal expansion close to tooth structure is key to why it lasts so long compared to composite resin; ease of placement and manipulation is best of all direct restorative materials.” (Indiana dentist)

“They last and last and last!” (Texas dentist)

Against placing amalgam:

“Why would I place amalgams in people’s teeth when I can’t throw them down the drain. It seems that fish get more protection than humans.” (General dentist)

“My thoughts about all things that go into the body are: If there is a question about the safety of a product — don’t use it. I hear many questions about the safety of amalgams. There are other dental care products I can use until the questions are answered.” (Texas dentist)

“Amalgams cause the teeth to fracture.” (California dentist)

“I stopped altogether in 1995 when resins became usable as a replacement. Primary reason was I feared a potential class action type suit against any dentist using the material. Pretty pathetic but in this litigious society you have to CYA.” (New Jersey dentist)

“I wouldn’t put it in my dog! I can’t throw it in the garbage legally, but I can place it in your mouth?” (New York dentist)

“We have better materials. We don’t need to use a restorative that was developed in the 1890’s just because it’s easier and cheaper. If it were introduced as a new material today it would never make it or even be allowed. It just doesn’t make sense to use it. Yes, they mostly last “forever,” but at the expense of the tooth.” (General dentist)

“If the scraps are a danger to my assistant, how can I justify placing one in anybody’s mouth?” (California dentist)

“Interesting that the government has rules on the collection and disposal of amalgam as a hazardous waste from the dental suction system BUT feels there is no problem placing the material in someone’s mouth??? Go figure!” (Connecticut dentist)

“I don’t place them, and haven’t since the beginning of my career. However, it’s not because I think they are inferior or toxic. On the contrary, I believe amalgam is a great material. It’s just that composite is a great material when placed properly, AND it looks better.” (Texas dentist)

The ADA states that dental amalgam is a safe, affordable and durable material containing a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance for dental care.

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