Amalgam restorations- better known as “silver fillings” are one of the most widely used materials to fill cavities in decayed teeth. It has been used for 150 years; only gold has been used longer...

Amalgam restorations- better known as “silver fillings” are one of the most widely used materials to fill cavities in decayed teeth. It has been used for 150 years; only gold has been used longer. The use of dental amalgams or “silver’ fillings in dentistry is an extremely controversial topic. Amalgam restorations, or silver fillings, consist of mercury, silver, tin, copper, and traces of zinc. Based upon 1995 manufacturers specifications amalgams typically contain 50% metallic mercury, 35% silver, 9% tin, 6% copper, and traces of zinc.

Dental amalgam contains elemental mercury that is released over the life of the filling in minute amounts as vapor; or methyl mercury. Methyl mercury is readily absorbed through the lungs and enters the arterial blood stream. Mercury has been scientifically demonstrated to be more toxic than lead, cadmium, or even arsenic. Mercury vapor is absorbed directly into the blood.

The American Dental Association have taken the following positions on dental amalgams:

1.   The strongest and most convincing support we have for the safety of dental amalgam is the fact that each year more than 100 million amalgam fillings are placed in the United States. And since amalgam has been used for more than 150 years, literally billions of amalgam fillings have been successfully used to restore decayed teeth.

2.   The American Dental Association's (ADA) code of ethics makes the removal of serviceable mercury amalgam restorations an issue of ethical conduct. In the ADA's point of view, it is ethical for a dentist to place mercury amalgam restorations in a patient and claim their safety. However, according to the ADA's code of ethics a dentist who acknowledges that mercury amalgam restorations are toxic and recommends their removal has acted unethically ("...the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body when such treatment is performed solely at the recommendation of the dentist is improper and unethical...." ADA Resolution 42H-1986. Transaction 1986:536)

3.   If a dentist agrees to remove serviceable amalgam restorations from the non-allergic patient at the patient's request

·    The dentist should take special care to obtain the patient's informed consent to the procedure and thoroughly document that consent in the patient's records.

·     The dentist should review with the patient the current scientific thinking on the safety of dental amalgams -- that there is no evidence that amalgams pose a significant health risk to non-allergic patients and that no known health benefits result from removal of dental amalgams.

·    The patient should be informed of the risks involved in replacing amalgam restorations, including potential damage to healthy tooth structure and the loss of sound tissue in the process.

·    The patient should also be informed of the risks and benefits of the replacement materials and the cost.

·    Finally, the dentist should clearly state that he or she promises no health benefits to the patient by removing serviceable amalgam restorations.

After considerable research into the peer reviewed scientific research on both sides of this subject, I decided that I would not want this material in my mouth. Consequently since I would not use amalgam in my mouth, I do not place this material in the mouth of any of my clients.