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.

FDA Finally Takes a Stand on Mercury… Sort Of

Agency Promises to Make a Decision Next Year

The Food and Drug Administration (FDA) has long avoided taking a public stand on the safety or danger of mercury in silver dental fillings. However, with a recent settlement in a lawsuit brought by the organization Moms Against Mercury, the governmental health agency has finally agreed to take a stand on the issue. Eventually.

The agreement calls for the FDA to complete its reclassification of dental amalgam by July of 2009. (The agency began that process in 2002.)

Some news articles have heralded this as a major change in the FDA’s attitude toward amalgam, with headlines making grand proclamations about a new post-amalgam era.

Can you guess which of the following is not a genuine headline?

These are attention-grabbing headlines, to be sure! The problem is, they’re not necessarily true per se. (And okay, I made the last one up.)

In the ADA’s response to news of the decision, the dental organization disputes these suggestions. “As far as the ADA is aware, the FDA has in no way changed its approach to, or position on, dental amalgam,” reads the statement.

As part of the agreement, the FDA has updated the consumer information provided by its website on the subject of mercury and dental amalgam.

“Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses. When amalgam fillings are placed in teeth or removed from teeth, they release mercury vapor. Mercury vapor is also released during chewing. FDA’s rulemaking will examine evidence concerning whether release of mercury vapor can cause health problems, including neurological disorders, in children and fetuses.”
Questions and Answers on Dental Amalgam (FDA Consumer Information)

What do you think? Is this a new era, or just more of the same?

Dentists Passionately Love and Hate Dental Amalgam (Video)

Dentists have used dental amalgam to make metal fillings for a long time, but the material is more controversial now than ever before.

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

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

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