The Digital Dental Surgeon

Dental amalgams are metallic fillings that has been used in the industry for 150 years. Contents of mercury vary from manufacturers, some containing about 50% of each dose. Dental amalgams are usually placed at the posterior teeth, where high stress during mastication (chewing) occurs. As dental amalgams are very hard once it had set, it would be a good filling material for the posterior molars.

Theoretically, metals in the amalgam will corrode overtime and this also prevents the reoccurence of caries. There are also people who may exhibit allergic reactions towards dental amalgam, which would result in lichenoid reactions. Placement of dental amalgams within soft tissues would sometimes present with amalgam tattoo which do not require treatment.

Lichenoid reaction due to dental amalgam

Amalgam Tattoo

Phase out medical tools that use mercury, says CAP

PENANG: Medical instruments using mercury should be phased out as the risks posed are “very serious,” according to the Consumers Association of Penang (CAP).

Mohamed Idris said that in Malaysia a dental amalgam that has about 50% mercury was identified as an intentionally used mercury-containing product.

“Exposure to mercury vapour could occur during placement and removal of the mercury-containing dental amalgams.

“Mercury-free alternatives to amalgam are making inroads in reducing the risk of mercury contamination in patients and Malaysia should move towards these alternatives,” he said.

For more of the article from The Star, click here.

The British Dental Association has a written policy on the use of dental amalgams.

The British Dental Health Foundation does not consider that the use of dental amalgam containing mercury poses a significant health risk.

It also supports the view of the UK Department of Health that it is sensible to minimise health interventions during pregnancy. For this reason, and because mercury can be passed through the placenta and breast milk, it is prudent to avoid placing or removing amalgam fillings during this period.

Minute amounts of mercury from dental amalgam do escape from dental amalgam and are absorbed into the body, some of it into the central nervous system. Everyone has a small amount of mercury in their system, measurable through their blood and urine. On average a UK adult absorbs about 9 millionths of a gram of mercury a day from all environmental sources – about a sixth of which comes from amalgam fillings.

Most people with dental amalgam fillings containing mercury show less than 5 micrograms per litre of urine. Nearly all dentists have levels below 10 micrograms per litre. Compared with this, the maximum permitted level of exposure to mercury for industrial workers in the US will produce levels around 135 micrograms per litre, which is still considered safe by medical authorities.

In my view, dental amalgams are perfectly safe. Vapourisation and exposure of mercury is minute and occurs only during placement of amalgams. Once set, release of mercury is insignificant. What worries me is the disposal of residual amalgam products which if released into the environment would be dangerous. The American Dental Association has a Best Management Practices (BMP) article in PDF form which includes topics regarding dental amalgam waste handling and disposal that can be downloaded here.

Although dental amalgam fillings are widely used in public hospitals and clinics throughout the country, I’m moving towards alternative materials such as special posterior composite resin based fillings. These composite resin based fillings are made out of larger fillers that would stand better to higher stresses compared to the normal composite resin fillings. Colour conscious patients would also be happier as it is tooth coloured compared to the metallic colour of dental amalgams. One downside to the usage of the composite resin based fillings is that the composite resin based fillings are technique sensitive and needing good moisture control during placement.

I would encourage the used of these composite resin based posterior fillings as it also binds to the tooth structure, dental amalgams do not and more often than not risk tooth fracture.

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