I decided to tackle a behemoth in dentistry since it’s in the news again: amalgam fillings (also called silver fillings due to the color).
Released early this month was this news: three EU institutions (European Parliament, European Commission and the Council of the European Union) have come up with a provisional agreement to ban amalgam use in children and pregnant women to go into effect July 1, 2018. As with most things political, things move very slowly, but seemingly the EU is moving toward a full ban of amalgam at some point. The momentum is definitely there. Some countries such as Sweden have already banned amalgam. So it brings forth the question: should I remove my silver fillings? Should I refuse to have one placed? The answer is not simple.
I started with a document released in 2015 by the SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks) which is essentially a panel of experts in Europe who looked at the safety of amalgam and alternatives (white fillings). This document only goes into health risks directly involved in placing, having and removing silver fillings. It does not address the environmental impacts of amalgam waste, which is another reason that the EU is moving towards a ban. However, this environmental effect is relatively small compared to other sources, such as car emissions. But any toxin release into the environment isn’t good for it. (Obviously)
There are two types of mercury exposure: organic mercury (the kind in fish) and inorganic/elemental mercury (the kind in silver fillings). It is generally accepted that organic mercury is worse for your health. Since it is organic, it can go more places in the body more easily. For instance it has been shown to cross the blood brain barrier.
I’ll focus on inorganic mercury since that is what is in silver fillings. There has been evidence of silver fillings causing a localized response (like a rash in the mouth) but the incidence is low and it is usually not severe. As far as harm to the whole body, inorganic mercury has been shown to harm the developing brain and the kidneys. There are studies that have suggested a link between diseases and silver fillings, but the evidence is weak and therefore unreliable. Does this mean that silver fillings are safe beyond all doubt? Of course not, but unfortunately not much in our chemical laden world is safe beyond all doubt. (Think cell phone radiation and pesticides) The question we should be asking is if silver fillings are more or less toxic than alternatives? And if the difference in toxicity is negligable between the alternatives (white and silver) which will work best in the mouth?
So how do we know if something is toxic? The best way to know if a product is safe (best, not perfect, not even close) is time and breadth of use in the public and vigor of scientific study. Amalgam has been in use for over 150 years and has been placed in over 100 million Americans. If there were something acutely related to having amalgam placed, it probably would have cropped up by now (think about cigarettes and cancer or asbestos and mesothelioma). Is it fair that these people were unwittingly guinea pigs? No, but we all are…GMOs, pesticides, cell phone radiation, etc. I digress.
Another thing to consider is that the dentist and the dental workers are getting the highest exposure. This is due to the highest amount of mercury vapor being produced in placement and removal of amalgam. I know some older guys who literally hand mixed mercury into the other metals before it came packaged in capsules. Yet even in this population, there has been little documented adverse effects. For example, if dentists were getting the highest exposure, wouldn’t a correlation be found by now? There may be a correlation between tremor and dentist mercury exposure, but it wasn’t found for MS and mercury exposure by this Journal of the ADA study.
Also, on a personal note, I work at a dental school where amalgam is taught to students. During one session, 130 students are placing giant amalgams in their manikin teeth. And then inevitably when they mess it up, they take it out and place another. Let’s just say it’s a lot of mercury vapor happening. I actually had my urine tested once after this session out of concerns for my health. It came back normal.
So the next issue to tackle is if white fillings are less toxic. One thing to note is that they are newer, which means they are less tested by science and by use in the public. The SCENIHR document even states that “information on the toxicological profile of alternative materials and clinical data on possible adverse effects of alternatives are very limited.” Which basically means “we have no idea”. I have multiple white fillings in my mouth and I place them at work all the time. They are essentially plastic, which doesn’t make them safe, but when you think of the deluge of plastics in our lives, the toxins from a filling is most likely small in comparison. But essentially we have no idea exactly. (This is true, by the way, about most things, not just fillings) So this gives us more data to consider.
The next thing to ask when determining whether to place a new silver filling is whether it out performs white fillings. And in a lot of cases they do. White fillings are more technique sensitive and can be more difficult to place correctly. This means if a good seal isn’t achieved, a cavity can form around the filling. This is why I use a LOT of isolation and am crazy about getting the filling just right. If placed correctly, they perform the same.
When asking whether to remove an existing silver filling when there is no cavity or problem with it, it will create more mercury vapor to remove it. As of right now, it is safer to keep it in. I am following some interesting research coming out about MRIs and WiFi interaction causing more everyday vapor released, but the evidence isn’t very strong yet.
I respect whatever my patients decide on what they wish to do with their mouths, including silver fillings. It is your mouth, not mine. My job is to provide you the best information I have so you can make the best decision for yourself.
The best way to avoid a filling of any type is to prevent cavities, which is why I’m so into prevention!