Dental Amalgam, colloquially referred to as 'silver amalgam' due to its appearance, has been routinely used by millions of dentists around the world to fill cavities. Despite years of controversies around its safety and efficacy, it has served the dental industry for more than a century. Amalgam is currently being phased-out or phased down in many parts of the world, not to mention the recently enforced ban on the use of dental amalgam by the European Parliament.
Dental amalgam is regarded as one of the most versatile restorative materials used in dentistry. Its reliable long-term performance especially in load-bearing sites of teeth, low technique sensitivity, and longevity has made it the staple filling material in dentistry. It remains the most cost-effective option making it a viable choice for individuals with limited financial means.
For the aforementioned benefits, amalgam has been used as a yardstick to gauge the efficacy of its successors.
The controversies related to dental amalgam are centered around its principal component- Mercury. Yes, amalgam is a mixture of mercury, silver, copper, tin, and zinc. Mercury has been identified as a neurotoxin that can cause harm to humans especially children, pregnant women, and fetuses. Furthermore, the release of mercury into the environment can escalate environmental hazards. The mercury used in tooth fillings amounts to roughly about 10% of the total global mercury consumption, thus making the field of dentistry the largest consumer of mercury in the world.
It is worth noticing that dentists are at a higher risk as they are exposed to more mercury vapor a work day. This is due to their involvement in the manipulation, disposal, and polishing of dental amalgam. Consequently, it is imperative to observe precautions while handling amalgam in dental surgery.
Arguably, there is insufficient evidence in the scientific literature to conclusively assert that mercury released from dental amalgams causes adverse health effects in the general population.
Reflecting on my college days, when I practiced in a public teaching hospital, I used amalgams on a day-to-day basis. The high patient volume in a hospital setting made amalgams a pragmatic choice, considering their durability and suitability for a large number of cases. In my current dental practice, I have transitioned away from amalgams. I made this change due to evolving preferences, advancements in dental materials, and concerns related to mercury content. Patient preferences have played a significant role, with an increasing demand for biocompatible, aesthetically pleasing, and mercury-free alternatives.Dr. Nirainila Joseph- Junior dentist in Amala Dental Care, Tirunelveli, Tamil Nadu, India
The FDA has identified potential high-risk groups that include women who are pregnant or who are planning to become pregnant, nursing mothers, children (especially those under the age of six), people with a known allergy to mercury, and people with neurological impairment or kidney dysfunction. The agency has recommended against the use of dental amalgam in these susceptible groups whenever possible and appropriate.
In today’s ever-increasing appearance-conscious world, alternative mercury-free materials like composite resins and glass-ionomers that are aesthetically pleasing, have gained momentum. Their enhanced properties over time have rendered them acceptable in indicated clinical scenarios.
“Ultimately, patients have the prerogative to choose what they want in their mouth. It is incumbent upon practitioners to educate patients about the dental materials based on evidence to empower them to make informed decisions.”Dr. Mizba, Chief dentist at Pearl Dental Care, Bengaluru, India
Due to the associated risks, the use of amalgams has declined or been phased out, leading to a shift towards promoting mercury-free alternatives to prioritize safety and environmental responsibility. Undeniably, the transition could pose a conundrum in offering economical options in less affluent regions. Nevertheless, the weaning of amalgams may catalyze the development of new, safer materials that can benefit patients worldwide.
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https://www.fda.gov/medical-devices/dental-amalgam-fillings/information-patients-about-dental-amalgam-fillings