Mercury/Amalgam Fillings

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Mercury/Amalgam Fillings

We do not use nor recommend mercury fillings.
However, the issue over their use and safety are not clear and is still being debated. Each person has the right to decide what is placed into his or her mouth and each person needs to be informed to make a proper decision. Please read on.

Mercury fillings, also known as silver or amalgam fillings, have been used as a main filling material since the turn of the last century. Although the material has worked "well" for many people and for many years, several health issues have arisen over their safety. This is because the fillings contain approximately 50% mercury. Mercury is known to be very toxic and will cause health problems with excessive or long term exposure. Mercury is also known to accumulate in the tissues and organs (kidneys, brain, lungs, liver and gastrointestinal tract) over long periods of time.

Mercury from fillings is released during placement, removal and during normal eating function. How much is released and absorbed, and is it significant is still in question.
When we remove existing mercury fillings, we follow IAOMT (International Academy of Oral Medicine and Toxicology) guidelines to ensure they are removed in the safest way with the least possible exposure to mercury.

The latest position of the Canadian and American Dental Associations is mercury fillings are safe for most people, provided that they do not have more than four in their mouth. This does not take into account the size, location or age of the fillings and long term exposure. It also appears contradictory to their recommendation to not place mercury fillings in children, pregnant or lactating women. It also does not explain why we can safely place mercury fillings in the mouth, but outside of the mouth it must be handled with the same precautions as hazardous waste! We cannot simply dispose of the excess material in the garbage!

For any who may be interested, we do have copies of the Canadian Dental Associations position on mercury fillings as well as copies of a book titled "Your toxic teeth" by Dr. Murray Vimy D.M.D.

What other choices do you have?
What other choices do you have? Alternatives to mercury fillings are white fillings, also known as composite, or porcelain/ceramic and gold. Each of these materials has their own pros and cons as well, but when it comes to toxicity and biocompatibility there is no comparison.

Filling materials


Besides mercury fillings, there currently are three other choices of materials that can be used to repair and restore teeth. All of the materials are more expensive than mercury fillings, however, two of these materials will last considerably longer. As with most things, we often "get what we pay for."

If you have dental insurance, you will likely find that they may only pay for mercury, as their goal is to provide the most basic of dental services and at the cheapest cost to the insurance company. They are not concerned whether it may be a health risk to you. Please see our insurance page for information about dental plans that may be helpful to you.


Composite fillings
Composite fillings are also known as white fillings or bonded fillings. They are placed directly in the tooth at the same time/appointment that a cavity is cleaned or an old filling is removed. Composite materials were first introduced around 1960 and they have gone through many stages of development. They are made up of microscopic glass particles in a Bis-GMA resin. Their use has increased tremendously, especially in the past ten to fifteen years. Initially they were intended for the front teeth only, but as the concern over mercury fillings has increased, research has brought about newer materials designed for the back teeth.

Advantages: Composite fillings are relatively inexpensive to porcelain and gold and they can be placed in one visit. They bond (adhere) to tooth structure and hence they can be placed in very conservative tooth preparations.

Disadvantages: Composite fillings will only last 7-10 years on average, depending on the size and location of the filling. They are slightly porous and they will become stained in this length of time, and may need to be replaced for esthetic reasons. When placed about 30% of the material does not cure making it weaker and not as wear resistant. For this reason composite fillings are best placed in front teeth or used for smaller fillings only.

They often cause initial sensitivity to cold and pressure that can last from 3 to 6 weeks. This sensitivity is caused by a multitude of factors including the bonding process and shrinkage of the material as it is cured. For this reason, fillings that are very deep or large are more likely to be sensitive and for longer periods of time. Back teeth are more often sensitive than front teeth as there is considerable more biting pressure on the back teeth. We do everything we can to eliminate the sensitivity, but it is still the most common problem associated with the composite fillings. Other problems are the material is not as strong as ceramic or gold, and if it is large it can chip and/or break.

Porcelain/Ceramic
Porcelain has been used to fill teeth for more than thirty years. Porcelain fillings (inlays) are often done by taking a mold or impression of the prepared tooth. A laboratory will then make a custom fitting piece of porcelain that will be inserted approximately two weeks later. In this office, however, we have equipment (Cerec) to provide custom porcelain fillings (inlays, onlays, veneers and crowns) in one appointment.

Advantages: Porcelain can be matched to the colour of your teeth. The fit is very precise and it will seal the tooth better than a filling when done properly. The material is also much stronger and wears better than composites, hence it will last 15 years or longer.

Disadvantages: In most offices this requires two appointments. Porcelain can sometimes chip even though it is much stronger than composite. The initial cost is more than composite, however this is offset in the long term.

Gold
Gold is the standard by which all other materials have traditionally been compared. The reason for this is it has been in use for over one hundred years, it is very biocompatible and is still one of the most durable materials in the mouth. There is some breakdown (galvanic reaction) of the material when it comes in contact with mercury fillings, but by itself it has not been shown to cause any health concerns or risks. Much like porcelain, a dental laboratory will make a custom fitted filling which is placed at a second appointment.

Advantages: Fit, durability and wear of gold restorations is excellent. They will last 15 years or longer, and we have several patients with gold restorations lasting over 25 years.

Disadvantages: The colour can be an esthetic concern if it is visible, and as it requires a laboratory step, two appointments are necessary. The initial cost is greater than composites, but in the long term the overall costs will be less and the benefits much greater.

Summary: Porcelain or gold are both excellent choices and the best material if you prefer durability, minimal long-term problems and the finest quality for your teeth. Composites are good for small fillings and are adequate for larger fillings provided you understand their limitations.