The Digital Dental Surgeon

Dental amalgam has been around for more than 150 years. I’ve never met a man who lived that long, nor I want to be one. Yes, dental amalgam has developed throughout the years but the content is more or less the same. It still contained mercury, the dreaded word that made dental amalgams feared by some.

The latest (well, not actually THE LATEST as it has been around for some time as well) variation is Silverfil which claims that the dental amalgam do not release excess mercury. Now, I’m not here to blab around about dental amalgam only releases mercury vapours during application and removal bla bla bla. Mercury is toxic period.

I stumbled upon (truthfully, not the company) a blog (http://www.thecosmeticdentistblog.com/) which mentioned that dental amalgam will be classified by the FDA, and that you need to obtain an informed consent from the patient before you could place a dental amalgam in California.

Now, I personally prefer to place composite fillings even for the posteriors. Dental amalgam, although very simple, has low technique sensitivity and sturdy enough to withstand high occlusal loads (chewing forces) the filling do have several major flaws. First of all is the colour, perhaps not really noticeable if placed on teeth at the far nether regions of your mouth, it is still far from being tooth coloured. Secondly, you need quite considerable amounts of the dental amalgam for it to actually be a filling. Having a significantly thick filling (at least 2mm), anything less makes it weak and liable to even light chewing. Thirdly, it doesn’t stick to any tooth structure and wholly dependent on having undercuts to retain it so you could see unlucky patients having part of their dental amalgams falling every now and then. Last, but not the least, the hardness of the filling itself being a double edged sword. It needed to be sturdy to withstand chewing forces which could reach more than 50 Newtons but at the same time, surpasses the strength of the rest of the tooth.

Imagine this, you accidentally bit on a bone with the tooth which had a large dental amalgam on it, chances are the tooth itself fractures off and the filling survives without a scratch.

Now then, I’m prefer not to burden myself with doing a difficult extraction of a badly fractured tooth, nor do I would prefer to do endodontics then face the possibility of having to put posts in the tooth to retain the crown (are you with me on this? I hope you’re not lost). In this instance, I’d do a composite filling anytime, more technique and moisture sensitive but should yield a better outcome.

Although I see that dental surgeons should migrate from dental amalgams to providing tooth coloured and more advanced restorations, I think it would be a problem in Malaysia especially where our GDP is very low compared to say, Singapore. Dental treatments are costly although in reality dental surgeons in Malaysia are charging much, much lower than most of the world. A simple dental amalgam filling may cost between RM40.00 to RM60.00 normally, but this is still a dirt cheap rate. Bear with me, I’m not trying to push for Malaysian Dentist Power or what not, it is a fact that dental treatments in Malaysia is undercharged. Go to a government clinic and you’re only charged RM2.00 per filling, cheaper than dirt itself.

So how could we migrate to more advanced and obviously more expensive composite resin based fillings?

I don’t think we could ever make the move unless Malaysians wake up to the fact that everything’s expensive and we should adapt. Petrol is expensive, yet when compared to our neighbouring countries we still pay our petrol cheaper and we still protest and make a fuss out of it.

Nothing is free is no longer accurate. Nothing is cheap makes more sense in the world today.

In the end I could only say, do not skimp on your dental health. If you have to forego a pack of smokes for a composite filling, by all means go ahead. Besides, the less you smoke, the less staining the expensive composite filling and the rest of your teeth stains.

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