To quote the famous William Shakespeare – had he been a restorative dentist – “To leave my amalgam fillings or not to leave my amalgam fillings, that is the question.”
One of the most vexing issues in dentistry today revolves around the use of silver fillings (amalgams) in our mouths. Do we need to take out the old mercury-laden silver fillings for fear of health issues and replace them, or are there better restorative dentistry options that do not pose any potential risk to our health? Dental professionals in the United States and around the world are currently debating this hot issue.
Amazingly, 72% of those surveyed in the US did not know that silver fillings contain mercury and when they do find out, 92% of the respondents would have wanted to know about the possible mercury issues when the silver fillings were first placed.
Mercury is a powerful neurotoxin and, at certain levels, can cause neurological issues, autoimmune disease, chronic illnesses and mental disorders. The burning question is whether an unknown quantity of mercury vapor in our silver fillings at a constant exposure poses a significant health risk.
Amalgams consist of 50% mercury along with a combination of silver, tin, and copper. Studies have found that the amount of mercury vapor from amalgams varies from 1- 3 ug/day (micrograms/day), at the low estimation, up to 27 ug/day. This translates to 3% to 68% of workplace air quality standards that are allowable by the Occupational Safety and Health Administration (OSHA, our federal environmental agency). What this means is that at the high level – and with continuous exposure – we could be at levels that OSHA says are unhealthy. The World Health Organization (WHO) has stated that the exposure to mercury vapor can greatly increase beyond this number due to personal habits such as grinding of the teeth, chewing gum, and drinking carbonated drinks. This could lead to a fivefold increase in mercury levels after these activities.
In addition to the problems with mercury vapor coming off of silver fillings in our mouth, there is the issue of water contamination from removing the silver fillings and the ensuing environmental impact as the mercury finds its way into the water supply.
The WHO (World Health Organization) reports that mercury from amalgam and laboratory devices accounts for 53% of total mercury emissions into our environment. The EPA recommends that dentists use amalgam separators to catch and hold excess amalgam waste, to decrease the release of mercury into the sewer system. At this time, these are not mandatory in the US. Let’s all be aware of the environmental issues surrounding amalgam removal and nudge our elected officials to get current on this problem and come up with solutions.
The US is not alone in this conundrum. In 2008, Scandinavian countries took action and banned the use of amalgam fillings for environmental and health reasons.
There are conflicting studies between Sweden and the United States. In Sweden, they have conducted a number of studies where people, with pre-existing neurological and health issues (Chronic Fatigue-type symptoms), had amalgams removed; 78% reported improvement in their health status. In the United States, official studies hired by the FDA and National Institutes of Health (NIH) stated that “the current data is insufficient to support an association between mercury release from amalgams and the various complaints that have been attributed to this restorative material.”