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Should You Replace All Your Amalgam Fillings?

April 10, 2013

If you watched a recent episode on Dr. Oz, you would initially think that everyone should race to the dentist and have all their amalgam (silver) fillings removed because of mercury vapors that are released from amalgams. Sensationalism makes money on TV, so may I suggest you watch all three parts of the episode before you call the dentist. The tone at the end is very different than the fear at the beginning.

The debate about amalgam fillings has been going on since the 1980’s when there was concern raised about the mercury that is part of the silver filling. Studies have been done with suggestions that mercury vapors are released from amalgams and in fact, some countries in Europe have banned the use of amalgams. Research still is not complete and part of the issue is that we don’t know how much mercury is released and how much is too much.

The main concern with mercury is that it is neurotoxic – meaning that it affects your nervous system. The following is a list of symptoms that have been associated with mercury toxicity: memory loss, auto immune disorders, fatigue, tremors and the inability to concentrate. Patients who suffer from these conditions may ask to have amalgams removed in an effort to eliminate the symptoms. In fact, over the years, I have had a few patients with multiple sclerosis and others who felt they had metal toxicity, request removal of their amalgams. We developed a plan for those patients and replaced amalgams, but I didn’t see significant improvement in their symptoms. My patient sample in this case was too small and no research study was conducted by me to prove or disprove any theories.

As a dentist who has been practicing for 22 years, these are my thoughts on silver fillings:
• Amalgams are a solid, dependable restoration that many adults have had in their mouths for 30-40 years. I had a 91 year old patient in recently who had stable silver fillings in place for over 50 years!

• Amalgams were a popular material in the past, and are still used by many dentists today, because they are easy to place, hold up for a long time and are inexpensive.

• Amalgams require more tooth removal than the new restorations that we have. Because amalgams don’t bond to teeth, you have to cut an undercut in a tooth to hold it in place. In small cavities, that doesn’t normally present a problem, but with larger cavities it can significantly undermine the tooth and lead to fractures later on.

• There are alternatives to amalgam that are more supportive to the tooth, look better and don’t come with the suspicions associated with amalgam. They range from bonded composites to porcelain crowns and onlays. Because these materials are more technique sensitive and sometime involves multiple visits and lab fees, they cost more than amalgams. I believe the alternative materials are better, and therefore, I don’t place amalgams. For patients with insurance, many times policies will not cover these restorations and pay an “alternative benefit”, which is the fee of the less expensive amalgam. Personally, I have issues with insurance companies deciding which restoration is the ideal material for my patients….but that’s another topic.

• The most exposure to mercury from amalgams is when they are removed and the fillings are aerated. Appropriate suction and isolation are important to limit exposure to patients. Dr. Oz suggests that if you have eight or more fillings you should have them replaced, but I question that because removing eight fillings at once creates a lot of mercury exposure. I would prefer addressing the amalgams as there is a problem, or if there are one or two next to one another, instead of taking them all out at once.

Dr. Oz’s guests discuss the reasons why you might be at greater risk and how you can prevent toxicity. The belief is that grinding teeth together and having high acid levels (from coffee, soda, vinegar, oranges) elicit more mercury vapor. They suggest drinking soda and coffee with a straw (I prefer eliminating soda for many reasons). They recommend incorporating garlic, cilantro and Chlorella (a fresh water algae supplement) in your diet because they all help to bind and remove mercury from the body. They suggest removing amalgams if you have eight or more fillings, if you grind your teeth or if there is a sign of corrosion or decay.

So, what’s my plan….I have seven amalgams in my mouth! They’ve probably been present for at least 35 years. I actually had eight, but had one replaced in dental school with a gold onlay because of decay around the old filling. I have no intention of removing the others until they break, have decay or open margins. I believing in treating my patients the way I would treat myself or my family.

• For me, the biggest reason to replace an amalgam (or any other filling) is because it is no longer doing what it should be doing. If the margins are open, there is a cavity around it or it isn’t supporting the tooth, it needs to come out and be replaced.
• Do I worry about amalgams? No, I don’t worry about the existing amalgams that are in my patients mouths. However, I am very careful when I remove them to limit their exposure to the aerated mercury. Which brings up something to consider…if removing the amalgams puts you at greater risk for neurotoxicity, wouldn’t you expect every dental staff member to have issues since they are the ones constantly being exposed?

I suggest if you have amalgams present, that you have a conversation with your dentist. I urge you to make decisions based on fact and your individual situation, not television hype. I’ve included the link to Dr. Oz, but be sure to watch all three parts of the episode. http://www.doctoroz.com/episode/are-your-silver-fillings-making-you-sick?video=18173

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