What is Amalgam?
If you are over the age of 30 years and have received restorative treatment, there is probably a high chance that you have at least one silver filling in your mouth. Silver filling also known as amalgam is a common material used to fill cavities. It is composed of a mixture of silver, copper, tin and mercury, which combines to form a strong, stable and durable material that is resistant to wear. The use of silver fillings dates all the way back to the early 1800s and has come a long way in dentistry and is somewhat still being used today in quite a few countries. Over the years, concerns have been raised about the use of amalgam because it contains mercury however; there is no conclusive research to support the concerns that many people may have.
Is it Safe?
There has been a lot of controversy over the use of amalgam particularly because it contains mercury. Exposure to high amounts of mercury is known to cause irritability, memory loss, headaches, anxiety, and fatigue. Research has proven that the amount of mercury released by an amalgam filling over the course of its lifetime is very low, and in many cases, people are exposed to more mercury in their day to day lives. In 2009 the US Food and Drug Administration (FDA) concluded that amalgam was safe to use in adults and children over the age of 6. Groups have since asked the FDA to reconsider their view, a review is currently underway.
“Nuh Trouble Wah Nuh Trouble Yuh”
During patient consults, concerns are often raised about whether or not silver fillings should be replaced, with many people citing the potential health risks associated with mercury found in these silver fillings. If upon examination, there are no problems with the restoration, I often recommend that there is no need to replace the filling. The unnecessary removal of silver fillings actually results in the loss of tooth structure thereby reducing the overall strength of the tooth. Replacing amalgam restorations can also result in tooth sensitivity and pain. For patients who are concerned with their exposure to mercury, it is important to note that during the removal of amalgam fillings you actually increase your exposure to mercury. So, as the good saying goes, “nuh trouble wah nuh trouble you,” or simply put, if nothing is wrong with the restoration, leave it alone.
When Should I Replace My Silver Fillings?
Regular dental examinations are important because problems with existing fillings can be detected before it is too late. Although you may not be able to tell that your filling is worn, your dentist can any problems with your fillings during a regular check-up. There are certain conditions in which it is recommended that these silver fillings be changed.
Defective Restorations/Recurrent Decay
This happens when there is infiltration of bacteria below and around a filling and is often detected during examination with the help of x-rays. Fillings that have been worn away, chipped, cracked or fallen out may leave gaps between the tooth and the filling, which permits the entry of bacteria. Undiagnosed and untreated decay can progress to the pulp, which often results in the need for a root canal. In this scenario, the filling should be removed in order to permit the removal of the cavity and facilitate other necessary treatments. The dentist will most like opt for a material that looks more like the tooth structure such as composite resin or glass ionomer.
Silver fillings were often used in anterior teeth and still may be seen among the older population. Even if used to fill a small area, silver fillings sometimes cause teeth to appear darker in colour. As time progressed, dental materials were developed with the aim of being more aesthetically appeasing with qualities similar to that of teeth. In these patients with these anterior fillings, if it is of concern, I may advise that they change them to a material that is more aesthetically appealing. If they are not bothered by the presence of the amalgam, I generally would not rush to encourage them to have it changed.
Remember, it is always important to have a conversation with your dentist regarding the options you may have if you are concerned about any of your fillings.
Feel free to ask questions in the comment section below!
Steven Moore is a General Dentist practicing in Jamaica. He graduated from the University of the West Indies in 2015 and completed a Dental Residency (AEGD) with the NYU Lutheran Medical Centre in 2017. He enjoys playing video games and practicing judo.