In dentistry today, we have materials, that if properly placed, are vastly superior in every way. Dentists who don’t feel comfortable doing these restorations (i.e. bonded composite or porcelain), continue to cite problems that were associated with these fillings years ago. Amazingly, the American Dental Association (ADA) acknowledges in the August 2001 edition of the Journal of the American Dental Association (JADA), “Specifically, failure to understand and use the exacting and more clinically sensitive techniques associated with posterior resin-based composites accounted for nearly all of the clinical problems listed” (JADA, Vol. 132, August 2001, p. 1099). In other words, they work if you do them right!!!
JADA goes on to say, “Resin-based composites eventually will replace amalgam as a direct restorative material because they possess many characteristics not inherent in amalgam. Some of the more important of these properties are esthetics, micro-mechanical bonding to tooth structure, smaller cavity preparations and better sealing potential.” (JADA, Vol. 132, August 2001, p. 1100). This is the first time, that I have seen the ADA print any information that claims amalgam to be inferior to composite resin.
(Note: This is an interesting “crack in the armor”. The ADA is in a bad position. On one hand, they wouldn’t exist without the support of the majority of dentists that are still placing amalgams. On the other hand, they face potentially huge liability issues in supporting the use of a know toxic substance. The general public is going to be very angry when they learn about what has been placed in their mouths! And, unlike the tobacco and asbestos issues, this affects virtually every American.)
I continue to get questions regarding the toxicity of amalgam fillings. This is a tricky issue. Whereas a dentist in Wisconsin can lose his license for informing a patient about the potential health hazards of dental mercury, a dentist in California will lose his license if he doesn’t do so (to learn more about how the California legislature has dissolved the California Dental Board, see our Links).
Actually, all one has to do is look at the positions of the EPA (Environmental Protection Agency) and FDA (Food & Drug Administration) to learn about this issue. Very few dental patients know that the EPA has classified dental amalgam as hazardous waste. And, the FDA has banned all mercury containing product, with the exception of dental amalgam. How will that look in a court of law?
While the two camps argue over how bad mercury is for patients, one thing is certain, it can’t possibly be good. It is indeed sad, that, with all the alternative filling materials available to today’s dentist, we are still debating this issue.