Often referred to as ‘silver’ fillings, amalgam fillings are an incredibly popular dental option. In fact, they’re the most commonly used filling in Canada.
Consisting of metals such as mercury, copper, silver, and tin, amalgam fillings have the advantage of being inexpensive and long-lasting. Plus, putting them in place is relatively straightforward and hassle-free. Usually, your patients will only require one visit to complete these fillings.
However, you might’ve noticed more patients raising concerns about these restorations, especially those who have received amalgam fillings in the past.
Often, these conversations are rooted in the toxicity of mercury and its perceived effects on the patient’s health.
Dental Amalgam: A Quick Review
It’s worth noting that, yes, higher levels of mercury will adversely impact the brain and kidneys.
However, it is the position of both the Canadian Dental Association (CDA) and the American Dental Association (ADA) that dental amalgam is a stable, safe and affordable substance for use in dental restorations.
Further, research from the Food & Drug Administration (FDA) demonstrates that amalgam fillings are safe for adults and children above the age of six, with no known health problems linked to amalgam.
Less is known about the effects of amalgam on the long-term health outcomes of pregnant women, developing fetuses, and children under six-years-old. However, evidence suggests that infants are not at risk for adverse health effects from the mercury in the breast milk of mothers exposed to mercury vapour from dental amalgam.
Should Existing Amalgam Fillings Be Removed?
Interestingly, the risks of mercury are more than likely to be exacerbated in removing an amalgam restoration than leaving it intact.
Why? Because the toxic components are safely contained when the amalgam is left alone in your patients’ mouths, but could detach in the process removing the filling.
Though, like everything in this world, this isn’t a hard and fast rule. There are times when it’s best to replace these fillings.
Namely, once amalgam restorations reach the 2-year mark, it’s wise to consider replacements. Similarly, if this manner of filling is damaged in any way, they should be replaced. And provided such a restoration has irregular margins or overhangs and is causing resulting gingival inflammation, a replacement should likely occur. Lastly, any recurrent decay beneath the filling means that a replacement ought to take place.
Now, if a patient falls under the above categories but is currently experiencing health issues, you must consult their physician. Such ailments include memory loss, heart palpitations, deficiencies, a heavy viral or toxic load, or a sensitive nervous system.
Removal in the above cases could potentially trigger their sickness and make them far more ill.
How to Discuss These Matters with Patients
When consulting with your dental patients about keeping or removing their amalgam, the conversation should mainly center around mitigating harm.
First, you must set your patients at ease about any concerns they might have about long-term safety and potential associated with replacements. Have this conversation before you jot down any detailed notes of these discussions in your official records.
Furthermore, don’t be afraid to recommend a second opinion on the matter. Not only will this establish trust between you and your patient, but it’s a safe and sound practice as a dental professional.
Your patient’s health, well-being, as well as their mental state should be a top priority. Treatments must be in their best interest while adhering to the current practices and teachings that are deemed most sound by dental authorities.