[Oral Health#5] Dental Amalgam and Safety Concerns!

Hello Steemians!!!
Have you ever been to a dentist? Are your any teeth filled? What material did your dentist use for filling? Are you concerned about the mercury in your amalgam (silver) filling? How safe is the Silver Filling?
Looking for the Answers to the above questions!!! This post might be just right for your queries about your teeth fillings.

What is Dental Amalgam?

Dental Amalgam is a common filling material used from almost 150 years on millions of Patients to restore their Carious/decayed teeth.
Dental Amalgam constitutes different metals like silver, tin, copper and mercury which are mixed properly with each other in specific quantities.
The fillings are silver in color (silver metal) so called as Silver Fillings.

Why Mercury is used in Amalgam?

Mercury in liquid form tends to bind all the metals with each other giving it the restorative property. Elemental Mercury is used in Amalgam and it constitutes around 40 to 50% of the Amalgam. However, Extra Mercury when Squeezed off the amount tends to become lower than that.

Why Amalgam Fillings?

Well that is a complicated question. There is no proper cause as to why are these fillings given to a patient. However, some may be as;

• Cost effective than White Fillings (nearly 50% or more)
• Insurance generally covers Amalgam but don't cover White Fillings.
• Patient discretion.
• Pro-Amalgam Dentists.
  

Advantages

• The biggest advantage of Amalgam is its strength. Till now no restorative material has been found as much Strong as Amalgam.
• Cost effective
• Less technique sensitive
• Less time consuming

Disadvantages

• Un-Esthetic
• Involves larger tooth portion for cutting of cavity.
• Never bonds with the tooth material.
• Filling Expands with due coarse of time leading to Fracture of tooth sometimes.
• Creep or Deformation with time.
• Discoloration of tooth
• Leakage (microleakage) of mercury and other metals into body.

Amalgam Filling; Safety Concerns

Now coming to the core of the topic, whether the Amalgam fillings are safe or not.
Many Research papers have been published regarding the safety of Amalgam and it has been postulated and proven by many clinical trials that Amalgam is the safe and efficient(?) filling material according to the statement by FDA and ADA.
However, I would like to rephrase it as Amalgam is safe and effective filling material for the back teeth when certian important and proper points are undertaken into consideration e.g, Patient selection, Proper Technique of Amalgamation and instrumentation, Isolation,etc being some of them.
There are certian conditions where the amalgam fillings can cause problems and sometimes be hazardous.

There are two school of thoughts regarding the Amalgam use and its Safety Concern;

Old School or Pro-Amalgam Dentists
This dentists believe Amalgam to be the most efficient and Safest for the Use especially in back teeth. This School of thought says that the Mercury in the Amalgam is inert and leaches in such small quantities that they won't reach to the toxic threshold even in 3 or 4 decades. They believe and do practice extensively the Amalgam Restoration in almost all posterior teeth.

The New School of Thought

They are the ones who believe that mercury being a neurotoxin may harm our Nervous System. The Vapor of Mercury from Fillings Cause problems in Lungs when Inhaled. They consider Mercury to reach toxic levels only after few years or a decade as WHO says there is no safe level of mercury in human body.

Potential Risks with Mercury

Mercury being 50% present in the Amalgam has some issues and risks associated with it. Mercury Vapor as already said are released from the fillings which may be inhaled and absorbed by the lungs. High levels of mercury vapor has adverse effects on the kidney functioning and the Brain (neurotoxicity).
The amount of Mercury Vapor released is increased to many folds in patients with grinding habits, with acids from cold beverages, more amalgam filled teeth, with age of the fillings, etc.
Mercury as such doesn't leave our body as waste but settles in the different organs of the body like lungs kidneys, etc. The population which is exposed to mercury from other different sources like food habits (fishs) are more vulnerable to the mercury toxicity.
The immunocompromised patients are also at higher risk of Mercury toxicity.
So FDA in December 2010 proposed that Amalgam Filling to be done in chidren above 6yr of age and adults Only.
The Amalgam fillings with time sometimes fractures or breaks into pieces. This also increases the risk of mercury ingestion into the body.
Mercury is believed to cross the Placental Barrier in Pregnancy. So It is proposed that Pregnant Ladies undergone/undergoing Amalgam fillings have feotus at the risk of Mercury toxicity as mercury being neurotoxin is believed to afect the brain development of feotus. However, very few such cases has been reported. Read my post about Dental Care and Drugs during Pregnancy.
Certian countries now a days are promoting Amalgam Free dentistry. They have even imposed laws against Use of Amalgam in children, pregnancy, old persons and persons with impared kidney function.e.g, Canada and Australia.
Even in 2001, US National Health and Nutrition Examination correlated the number of Amalgam fillings to many Auto immune diseases, Mental Disorders, Cancer, nephrological problems, respiratory disorders, Disorders of Eye and Thyroid Disorders. However, no direct causation have been demostrated.
Mercury is thought to be one of the causes of Alzehmiers also.
With regard to Dental professionals, they are also at risk of Mercury hazards as they are more exposed to the mercury on daily basis.
Environment on other hand (mercury wastes from Clinic) is also at risk of pollution from mercury.

Personal thoughts about Amalgam Use in Practice

As far as my experience and personal view is considered, i suppose the advancements in the field of dentistry has been so much that the scope of Amalgam is limited to a few. The modern restorative materials are such that they provide strength like that of Amalgam while being non-toxic. I personally won't preach the Amalgam practice because mercury even if in non toxic levels is not good for the body. It can or can't cause the problem over the period of time. But why to put a risk for patient at first place when there are very efficient and advanced materials available.
Almost 72% US patients didnt know amalgam fillings contained mercury and after knowing more than 93% patients wanted to learn and know more about mercury toxicity.

Do you need Removal of Amalgam Fillings?

As long as the Amalgam fillings are in good condition with no decay underneath and no broken filling, FDA doesn't recommend the removal of amalgam fillings. The removal of amalgam fillings also makes you more vulnerable for mercury vapor during removal process and also the more healthy tooth material is lost in removal.

FDA guidelines for Amalgam Fillings

FDA continues to evaluate the available information and research on amalgam. However, they have set a few points for dentists before doing amalgam filling;

• Dentist should thoroughly evaluate the patient for any health risks with mercury.
• Patient should be made aware of the Amalgam Filling issues and Mercury toxicity.
• Populations having the higher risk of Mercury exposure like from food(fishs), occupation, etc shouldn't be given amalgam restoration.
• Dentist should evaluate whether Patient is allerigic to Amalgam or not.
• Both Patient and Dentist should take a unanimous decision whether or not go for amalgam filling.

Alternatives to the Amalgam

There are many restorative materials which can replace Amalgam. Some of them are Gold, Porcelain in cases of onlays and high strength modified composites (white filling) replace Amalgam as The filling material.

Next time you go to the dentist, discuss properly whether you want white or silver filling...
Till then

Shine On!!!

MAY THE STEEM BE WITH US

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Have you read my previous dental posts
why change toothbrush after 3months

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