What is dental amalgam?

Amalgam is a dental material used for filling. It is made up of a combination of metals, i.e. silver, mercury, tin, copper and small amounts of zinc, indium or palladium.

Advantages and Disadvantages of Amalgam

Advantages

• Less costly than other materials
• Good strength (stronger than composite and GIC)
• Abrasion resistance
• Ability to retain a good polish

Disadvantages

• Brittle in small sections, therefore a bigger cavity is prepared, removing more tooth structure
• Less esthetic (not tooth colored)
• Contains mercury

Compared to other materials, it lacks features such as esthetics, and also, unlike GIC, does not release fluoride. Fluoride helps in the remineralization of the teeth.

Why is mercury used in amalgam?

Mercury helps to make the filling material more pliable. When mixed with an alloy powder, it becomes soft enough to mix and press into the tooth, yet hardens quickly and can withstand the forces of biting and chewing.

Amalgam – mercury poisoning?

There has been much debate over the safety of amalgam restorations. There is concern over the safety of amalgam because it contains mercury, which could be released when a filling is placed, during its functional life, or when it is removed. Anyhow, the patient or the dentist is going to come in contact with mercury.

However, as with most substances, the degree of harm caused by mercury in the body is related to the amount. Very low levels don’t cause any ill effects. At higher levels, mercury can cause symptoms such as anxiety, irritability, memory loss, headaches and fatigue. In fact, the amount of mercury you are exposed to from your fillings is less than the amount that most people are exposed to in their daily environment or in the food they eat. A report in 1992 by the United States Environmental Protection Agency showed that in 1989 discarded household batteries accounted for 86% of waste mercury while dental amalgam represented only 0.56%. This amount is tiny when compared with other sources of pollution and has actually decreased by 75% in the last 20 years, demonstrating the awareness and response of the profession to the possible hazard.

However, there is no doubt that high levels of mercury are toxic and dental practitioners must handle it with care so that the local and general environment is not contaminated with either mercury or waste amalgam.  Strict mercury and amalgam hygiene procedures should be observed in while giving amalgam fillings.

Everybody – patients, ancillary staff, and dentists – is susceptible to the toxic effects of mercury. Those who should be genuinely worried are those who are actually allergic to mercury. Fortunately, a very small number of people are allergic to mercury. The American Dental Association says that fewer than 100 cases of this type of allergy have ever been reported. People allergic to amalgam can receive other filling materials.

How do I know I’m allergic to mercury?

If you suspect an allergy, do consult an allergist and get yourself tested. Most probably, they will do a patch test. This test involves placing a small amount of mercury on the skin. If the area develops a bump, it means the individual has a mercury allergy.

Should pregnant women be concerned about amalgam fillings?

Research has not shown any health effects from amalgam fillings in pregnant women. However, mercury can cross the placenta. It can also be passed to infants via breast milk. In general, dentists advise pregnant women to avoid unnecessary dental care. Women should not get amalgam fillings during pregnancy. Dentists can suggest other materials for any pregnant woman who needs a cavity filled.

Should I have my amalgam fillings removed?

You should replace amalgam fillings only when they are worn or broken. There’s no evidence that they can cause a problem. Removing them can release more mercury. If you are concerned about amalgam, choose a different material for new fillings.

However, If you really want to have the amalgam fillings removed, find a biological dentist properly trained in mercury filling removal. Dentists from International Academy of Oral Medicine and Toxicology (IAOMT) have experience using the IOAMT mercury amalgam removal protocol.

Are there alternatives to amalgam?

Amalgam used to be one of the most popular choices for fillings. However, with the development of newer materials such as composite resin, glass ionomer cement (GIC), porcelain and gold, amalgam is used less often than in the past.

Amalgam is stronger than composite resin (a tooth-colored material) and requires less time in the dentist’s chair. Because it wears faster than amalgam, composite resin can’t be used in every situation.