Are Amalgam Fillings Safe?

| September 1, 2016


Global Coalition Takes Aim At A Common Dental Practice

By Judy Latta

This summer, the United Nations announced that a coalition of international non-governmental organizations (NGOs) has launched a global campaign to end what some consider a longstanding health and environmental hazard – the use of mercury in dentistry.

This announcement was met with mixed reactions from dental and healthcare professionals around the world. The use of dental amalgams (those silver colored fillings made from a mixture of tin, silver, mercury and copper) is one of the most contentious issues in the field of dentistry today. Critics of amalgams argue that these fillings are unsafe because they contain mercury, a known toxin that harms the human body as well as the environment. Supporters, on the other hand, argue that amalgam fillings, the most common cavity treatment over the past century, are safe and effective, providing patients with the most durable and affordable remedy available for treating tooth decay. They contend that the amount of mercury vapor contained within the metal mixture is so miniscule that it is benign.

Potential Dangers of Mercury

As far back as the mid-1800s, some dental and medical professionals have expressed concern regarding the wisdom of using amalgam in the mouth due to its potential toxicity. Most healthcare and public health experts agree that mercury is a toxin linked to neurological issues, autoimmune disease, chronic illnesses and mental disorders. According to the Occupational Safety & Health Administration (OSHA), “High mercury exposure results in permanent nervous system and kidney damage.” There are also concerns regarding how exposure to mercury could adversely affect fertility, fetuses and breastfed babies.

In addition to the potential impact on individuals, the World Health Organization (WHO) warns that amalgam fillings also pose a more macro public health hazard because when amalgam fillings fall out or are taken out to be replaced, the disposal of the used metal can lead to leakage of mercury into our environment and ultimately into our food supply. In 2009, a multi-national panel of WHO experts concluded that each year the use of dental amalgam results in at least 180 metric tons of mercury being discharged into the atmosphere, soil and water. Thus, in 2011, the organization advocated for a world-wide reduction in the use of amalgam by dentists with the goal of reducing the amount of mercury polluting the environment. The report, however, stopped short of recommending an outright prohibition of the substance.

Thus, there is little doubt among experts across scientific fields that mercury is toxic for both individuals and the environment. Where professional opinions on this issue diverge sharply, however, is regarding whether the small amount of mercury vapor in silver amalgam fillings could actually pose significant risks.

Critics of Amalgam Treatment Call for a Ban

Some healthcare and public health professionals, adamant that mercury at any level cannot be safe when it comes to the human body and our food supply, do not think the WHO went far enough with its recommendations, and applaud the recent international initiative to curb the use of mercury in dentistry. According to the International Academy of Oral Medicine and Toxicology, this issue is simple and straightforward. “The scientific evidence has established beyond any doubt two propositions: that amalgam releases mercury in significant quantities, creating measurable exposures in people with fillings, and that chronic exposure to mercury, in the quantity released by amalgam, causes physiological harm.” Some countries such as Denmark, Norway and Sweden, have banned amalgam fillings altogether. Here in the United States, dental amalgams are still legal and widely accepted, but watchdog and public service organizations, such as the Washington-based World Alliance for Mercury-Free Dentistry, Moms Against Mercury and the Cooperative Food Empowerment Directive, are pushing for legislation to ban mercury in dentistry.

Supporters of Amalgam Treatment Urge a Rational Approach

Many significant organizations, however, downplay the danger of such a tiny amount of mercury in fillings. In a 2009 study, the U.S. Food and Drug Admin­istration (FDA) determined that amalgam poses no serious health concerns for consumers. “FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages six and above. The weight of credible scientific evidence reviewed by FDA does not establish an association between dental amalgam use and adverse health effects in the general population.” The Council on Scientific Affairs of the American Dental Association (ADA) published a review of scientific literature on dental amalgam which concluded that “based on available scientific information, amalgam continues to be a safe and effective restorative material. There currently appears to be no justification for discontinuing the use of dental amalgam.” Some experts worry that given that amalgam continues to be the most durable, long-lasting and inexpensive option for dealing with tooth decay, an unnecessary ban of what they believe to be a safe and effective product will prevent the economically disadvantaged from receiving the dental care they need.

A Measured Approach

Despite these assurances and concerns, the case related to this matter in the United States is far from closed. A panel of FDA scientists and dental health professionals revisited the issue in 2010, and while they upheld the findings of the organization’s earlier report, the panel encouraged experts to continue to study this issue.

Given the fact that there are adequate functional alternatives to amalgam in the dental industry, such as porcelain and composite resin, researchers at the University of Illinois at Chicago School of Public Health have taken a practical, better-safe-than-sorry stance on this issue. This group recommends that since there are questions regarding the safety of amalgam fillings, the logical approach would be to phase them out, even if the research on their safety has not yielded definitive findings. This is the approach the Council of Europe took in 2011 when it passed a resolution calling on member nations to start restricting the use of amalgam for dental fillings.

Going Forward

Because alternative, more aesthetically appealing dental filling treatments have been improving in regard to durability and dependability in recent years, and there are no real questions regarding their safety, the use of these newer treatments in the U.S. now exceeds that of amalgam, and each year an increasing number of dentists across the country set up “mercury-free” offices. Thus, regardless of whether the U.S. moves to ban silver fillings, it seems they will eventually be phased out.

The critical question now is whether we need to remove and replace existing mercury-laden silver fillings. According to the FDA, if yours are in good condition with no decay, it is not advisable to have your amalgam fillings removed or replaced. “Removing sound amalgam fillings results in unnecessary loss of healthy tooth structure, and exposes you to additional mercury vapor released during the removal process.” This is an issue you should discuss with your dentist and/or healthcare professional if you have concerns.

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