The Specialist

Removing silver fillings may be more harmful than you think

Silver fillings or dental amalgam have been used as dental fillings for over 100 years.

In fact, as a child, when I visited the dentist, I received several silver fillings. At that time, silver fillings were the standard of care. They were the most durable, affordable and a safe choice. Today, silver fillings are not used as much, primarily because of public health concerns and their grey coloring. Over the past several years, there has been increasing debate and interest on the safety of silver fillings.

In this column, I will address safety concerns surrounding silver fillings and answer the question of whether patients should remove their silver fillings.

What are silver fillings and why are they used?

Silver fillings (amalgam restoration) refer to a blend of metals including silver, tin, copper, etc., that dentists use to fill cavities. These metals are mixed with an alloy of mercury into a putty and placed into the cavity. It then molds to a shape to fill the cavity and quickly hardens. For a long time, silver amalgam was extremely popular because of its durability and strength.

Silver fillings are still placed in some dental offices, hospitals and public clinics today. Other dental restorative materials, like composite resins or porcelain, are now regarded as the standard of care because they are widely accepted as safer and more attractive. They contain no mercury and are similar to the color of your natural teeth.

Dental amalgam (silver fillings) are still used for the following reasons:

• It is still the least expensive dental filling material.

• It is considered the easiest to work with, and it outlasts all other direct filling materials.

• Amalgam hardens quickly, so it is often used for areas below the gum line that are difficult to keep dry and for patients who have a hard time sitting through dental procedures.

Why the controversy?

Mercury is a naturally occurring metallic element that is found in volcanoes and fossil fuels. It is liquid at room temperature and becomes a gas when heated. According to the World Health Organization (WHO), this can be hazardous because mercury can be toxic on the nervous, digestive, and immune system. Even small amounts of exposure can result in serious health problems, so if mercury contaminates the air or water, it can be deadly to humans.

Since the toxic effects of mercury have long been recognized, you may wonder whether it’s safe to use in the human mouth. While the American Dental Association has stated that silver fillings are safe despite the use of mercury, many dentists and patients are concerned about the negative effects of any mercury being placed into their bodies. As a result, many patients choose to replace their silver fillings because of the health and cosmetic concerns.

The American Dental Association (ADA) Scientific Council continues to state that silver fillings is a safe and effective restorative material. Studies revealed that even in a mouth full of amalgam fillings, the amount of mercury released is far below the level associated with the ill effects as established by the WHO. Reportedly, we get 10 times more mercury from our diet, especially from fish but also from some vegetables, breads and beverages.

Best practice approaches in dealing with silver fillings

Silver fillings were the standard of care for many years. Today, there is overwhelming evidence that white composite fillings, porcelain white fillings or even gold are regarded as “best practice” when determining what is in the best interest of patients.

This is because white fillings have improved in its ease of placement, cost, durability and cosmetic application. As a result, most dentists would recommend white fillings for their patients. Many colleagues are just not comfortable using amalgam today.

So, the question is, if you have a silver filling should you immediately remove them?

I would suggest you pause for a moment and determine with the help of your dentist if your silver filling is functioning adequately and still intact. This question is important because as noted, adequately functioning silver filling gives off such small amounts of mercury.

Secondly, studies demonstrate that the placement of the amalgam and its removal are the two greatest risk factors that expose the patient to a higher concentration of mercury vapor. Additionally, tiny particles are given off and could be ingested. Plus, you will lose healthy tooth structure when you get a replacement filling.

The alternatives to silver fillings are now the standard of care. Most holistic dental practices provide composite resin, porcelain and gold as alternatives to amalgam. These options contain no mercury. Composite resin, in particular, is quite popular because the white filling is affordable and matches the color of natural teeth.

The relationship between the patient and the dentist is critical to successful outcomes.

Patients should know the facts and become informed, so they can make wise decisions.

Your dentist should be your advocate in seeking to advance your best health and wellness as we simultaneously appreciate the art and science of dentistry.

• Dr. Kendal V.O. Major is the founder and CEO of the Center for Specialized Dentistry, which is a comprehensive family dental practice operating in New Providence and Grand Bahama. He is the first Bahamian specialist in gum diseases and dental implants since 1989. He is also a certified fast braces provider. His practice is located at 89 Collins Avenue, New Providence. He can be contacted at (242) 325-5165 or  

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