PROCEDURES
THE AMALGAM (SILVER FILLING) "CONTROVERSY"
For more than 150 years dentists have placed amalgam dental restorations ("silver fillings") in the teeth of their patients with remarkable success. To date this single restorative material is responsible for the health and retention of more permanent teeth than any other dental material.
What is amalgam? As the name suggests, amalgam is an amalgamation (mixture) of many metals (namely silver, copper, tin and mercury). The generic name, "silver filling," comes from the high content of silver and mercury in this compound; hence the silver appearance of the material.
Due to the presence of mercury (a known human toxin) in amalgam, a controversy surrounding amalgam has raged for decades within the dental profession. The reality that a, small percentage of the population may show a hypersensitivity to amalgam (ostensibly the mercury portion of the material) cannot be denied. However, since many heavy metals exist in this compound, the patient's specific hypersensitivity may be due to a metal other than mercury. For those persons who demonstrate unclear heavy metal sensitivity, it is recommended that amalgam not be used as a substitute for any damaged or decayed portions of their teeth.
Modern pre-capsulated amalgams demonstrate little or no "free mercury" (mercury that is not bound or chemically tied-up with other amalgamating metals). When properly placed within the functional limits of the material, these advanced amalgams are durable, dimensionally stable, decay resistant and cost effective. Also, pre-capsulated amalgam combined with appropriate adhesive agents virtually eliminates the problems of weakened teeth and micro leakage commonly associated with most restorative materials. For these reasons the American Dental Association continues to list the pre-capsulated dental amalgams as an approved dental restorative material.
Dental professionals generally agree that amalgam, in the long-term, has been successful. Further, it is considered unethical for dentists to suggest that amalgam restorations be removed and replaced with alternative materials to alleviate obscure or ill define patient's symptoms or complaints. Dental insurance carriers will routinely deny benefits for the replacement of amalgam restorations unless these restorations are failing or the lack of a more suitable restoration will result in a further compromise in the dental health of the patient.
Numerous material alternatives for amalgam restorations currently exist; however, each of the material has its own unique limitations. Unfortunately, a non-toxic easily placed, cost-effective, decay-resistant and long-wearing restorative material has yet to be identified. Therefore until more conclusive evidence regarding the toxicity of amalgam has been established, it is recommended that amalgam restorations not be universally condemned. Dentistry needs less anti-amalgam "hysteria" and more scientific research to develop the most ideal restorative material.
Presently, pre-capsulated amalgam, composite resins, cast porcelain, cast gold, porcelain crowns and porcelain fused to-metal crowns offer genuine treatment alternatives to the older amalgam restorations. Unfortunately, substantial increases in treatment time and costs are associated with most of these alternatives. These current material alternatives are photographically represented on the following links on this website page.
Dr Ajay Dhankhar DDS and Dr Rehan Bashar DDS - Providing services in cosmetic dentistry and sedation dentistry to the areas of Bellevue, Issaquah and Seattle, Washington.
Seattle Dentistry
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