Tooth fillings options vary
RE: Studies find no evidence of harm from mercury in dental fillings (SDN April 24) Your Health and Fitness section led with nearly a full-page article released by the Associated Press and previously found in the USA Today and other newspapers. It reviewed two more studies that looked at this source of mercury and especially the effects as measurable neurologically in children.My first reaction to the headline was, “Why is this news? No other study has ever found any harm from dental amalgam, news usually means something is “new.” The headline was a little like asking someone “so you deny committing that crime?” When they say yes, I deny it, so is that the same as saying no harm was done for the asking?As a dentist, I am more than interested in any information being passed on to the public about dental care and it’s effect upon your health. I have practiced here the past 30 years, but I claim no special knowledge beyond any other dentist. I too believe I keep up with the scientific literature and believe in the official position of the American Dental Association on this and other filling materials. Can I say that the mercury in amalgam is harmless? I certainly can not, just because it has not yet been shown to have any effects by science. I absolutely find no fault with people who decide to eat only organic food, or avoid other things they believe could harm them. I think studies should continue; they are just not headline-grabbing news until a new conclusion comes from a scientifically valid study. We know elemental sodium or chlorine gas will each kill you, and combining them to make salt does not make it 100 percent harmless, but it is a different compound. The available mercury in fish is different than that absorbed with chewing on fillings, and so the studies are separate. And, I still eat fish and have some amalgam fillings.In response to previous articles about dental amalgam, I have had a few patients ask, “Do dentists even still use that stuff?” When I say yes, these are its advantages and these are its disadvantages, it seems obvious they have never heard that our other materials are not perfect either.Some patients wish to never have amalgam fillings, either over their concern about the mercury in them or for aesthetic reasons. Most dentists are fine with that. Some dentists never place these fillings, with an orientation toward cosmetics that even eliminates other metals from their practice, even gold. They will not usually try and tell you this is an inexpensive choice.Patients should always receive what they want as long as they understand all the options, so I never have trouble with a patient requesting a certain filling material for a tooth that needs work. So why do dentists ever use amalgam, as ugly and dark as it is? Simply, it costs less, lasts longer, is sometimes less sensitive to cold, and is much easier to have tight contracts to protect the gum tissue. In our offices, a small amalgam is $44 less than the same resin and a large filling is $88 less. The larger the filling is, the bigger the difference is in longevity. We can never tell ahead of time how long a filling will last with all variables, but I do see many large resins more than 10-15 years old, and I see 30-year-old amalgams every day. Sometimes with large fillings, the choice is not really between an amalgam and a resin then crown. Suddenly the difference is in the hundreds, which may be why insurances have trouble letting go of our old technology.If you need treatment, ask your dentist what he or she recommends for material and why. There are lots of choices, and we should be able to defend our recommendations. You should have the final say.
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