Hi Dr. Connolly,
I hope this finds you well. This is [Patient's Name], long time patient.
I was writing to ask your opinion about mercury used in amalgam fillings. I'm 31, and had a few fillings put in over 20 years ago.
Should I be worried or consider having them replaced?
My best to you and your family.
This is a very common question, and if you ask ten dentists about this issue, I wouldn't be surprised if you heard ten different responses. While the use of mercury-filled amalgam restorations is a controversial topic, a dentist's opinion on the "amalgam debate" should ultimately stem from the most current scientific literature. The American Dental Association is constantly reviewing this literature and modifies its stance on the subject accordingly. Currently, the ADA claims "Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness" in an official statement that also summarizes the results of the most credible scientific literature on the topic. However, this is a complex issue dealing with very personal subject matter, so there tends to be varying philosophies regarding amalgam and its use. Consequently, I was pleased by Dr. Connolly's response, since it is exactly what I tell my own patients. Quite a coincidence since we have never discussed this issue with each other:
Dear [Patient's name],
We don't place amalgam fillings in our practice. That being said, probably 50% of the dentists in the United States do continue to use the material.
Mercury Toxicity is generally the focus of concern about Dental Amalgam. The greatest amount of Mercury released from Amalgam occurs when the amalgam is placed. The second greatest release of Mercury occurs when the Amalgam is removed. All Dental Restorations have a lifetime. It makes sense to me to replace your Restorations when they fail, with another material. I would not recommend that you replace them before they fail.
Finally, while concern is justified, it's important to put concern in context. Billions of Amalgam Fillings have been placed over the last century. Where are the hospitals full of patients suffering from Mercury Toxicity? If you have any other questions feel free to call.
Dr Joseph Connolly
4/14/10
I agree with everything Dr. Connolly has stated. However, though Dr. Connolly does not place amalgam in this practice, I will...on rare occasions. You can count on one hand the number of amalgam restorations I have placed in the last year.
The reason I place them? Amalgam fillings are better suited than composite resin fillings (white fillings) for very large cavities. When I say large, I mean replacing a cusp of a tooth or more with filling material:
Using silver fillings in this situation is a last resort, though, because these large cavities are best treated by a laboratory fabricated inlay, onlay, or full coverage crown. So, if a patient declines my suggestion of using one of these stronger restoration options, I will have a frank discussion with him/her about the advantage of an amalgam restoration (silver filling) for the long-term prognosis of the tooth. If the patient refuses the silver filling after our discussion, I will happily place a white one, knowing the patient understands the risk for future problems with this particular tooth.
As always, it is important patients are informed enough to weigh the risks/benefits of their treatment. I believe the benefit of a stronger, mercury containing silver restoration outweighs the risk of future decay or tooth fracture associated with placing a large white filling. Not everyone has the same risk/benefit philosophy though, so it's important each patient has the facts so he/she can make the decision.
I hope this post helps clarify the concerns patients have regarding silver fillings. Even if you don't agree with my philosophy on the matter, at least you now know the reasoning behind it.
-DRS
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