Speaking of stats, the latest Wealthy Dentist poll shows that 53% of dentists shun mercury amalgam fillings, while 47% still place them. This isn’t really news, though, as the numbers have changed little since the site’s last survey.
It’s the dentist explanations for their decisions that we’d like to draw your attention to.
Some anti-mercury dentists cite the better aesthetics and functional superiority of composites, but most, as expected, describe concerns about patient, dentist and environmental health. In this respect, there is just “no controversy” says one North Carolina dentist, who then poses a pointed question: “It’s bad for kids to play with toys whose paint is .08% lead, but ok to chew on 50% mercury?”
Some other astute remarks from those opposed to mercury fillings:
“I think that doctors should have stopped this a long time ago. Funny how we find out that meds cause certain side effects and we are made to state them but knowing what amalgam could do, we have to say nothing.” (Texas dentist)
“Why risk it? Discontinue amalgam since other suitable materials are now available.” (Maine dentist)
“This is something that worked; it did the physical mechanical job. But like most things from that era, no one looked into the components’ effect on the biology. You can’t make a deadly poison into a health food!” (New York dentist)
“l would not place amalgam. It is ugly, corrosive and causes teeth to fracture in addition to the mercury content which is unhealthy. If you have to put amalgam scrap in a special container and treat it as hazardous waste, then I would not put it into someone’s mouth.” (California dentist)
As for the pro-mercury dentists, most repeat the party line:
“Hey, if they want amalgam – it worked for 180 years. They can pay me to put it in.” (California dentist)
“I don’t agree that amalgam is unsafe. It’s been used in dentistry for over 150 years.” (Arizona dentist)
“No illness from amalgam in 150 years.” (New York dentist)
“It’s a long lasting durable restoration. Not pretty, but you can’t beat the proven track record.” (Oklahoma dentist)
With this, of course, comes the usual assertion of the myth that there is no science behind the health concerns, along with arguments that amalgams are durable and functionally superior at least some of the time. Some also mention the potential of health risks from some composite resins, particularly those containing BPA. This last is an absolutely valid concern, of course. However, it does not absolve mercury, let alone make it any less neurotoxic.
As familiar as all this talk is, there was one comment that absolutely startled us, from a Virginia dentist who mainly places composite fillings:
I primarily place composite posterior restorations primarily because that is the option my patients have opted. I like the composites because of the esthetics and the bonding. However, for heavy bruxers, particularly in the second and third molar teeth and also for deep subgingival and bloody restorations, I prefer amalgam. I do not see the scientific evidence contraindicated my usage of amalgam. This could change tomorrow.
A “bruxer” is someone who clenches and grinds their teeth. Obviously, this creates a lot of friction, wearing down the biting surfaces of the teeth and any restorations placed within them. If those restorations are made of mercury amalgam, the bruxing will release an even greater amount of mercury vapor than would be released under normal, non-grinding conditions. Unless the person happens to be an efficient excreter of this potent neurotoxin, illness and dysfunction are sure to follow.
As far as we can guess, the justification for using amalgam for heavy bruxers stems from the belief that it’s a more durable restorative material than composite. But this is no longer strictly the case, as new generation composites show greatly improved durability, lasting as long or even longer than mercury fillings. Additionally, there are other restorative materials that are stronger and even more durable. Although inlays, onlays and other lab-made restorations cost more to place initially, their biocompatibility and longevity make them a sound investment for the long run.
But beyond such questions, the simple matter remains: mercury is toxic, both inside and outside the mouth, and bruxers with amalgam fillings are exposed to more mercury vapor. Thus, it seems particularly unconscionable to place the stuff in such a person’s mouth.
Perhaps the Virginia dentist should do a little more research so “tomorrow’s” change can come a little faster to his or her patients. Here’s a good starting point ( PDF )…