Whenever I hear a patient ask about amalgam restorations (mercury
fillings), I wonder why this question refuses to go away. For decades, amalgams have been considered
the primary restorative material for posterior teeth (the ones in the back)
because of their long time success.
After enormous amounts of study, the World Health Organization, the FDI
World Dental Federation, and the American
Dental Association continue to endorse the use of amalgam to restore
teeth. Yet it continues to be demonized
by the public, in particular in urban legends over the internet.
As a result the trend is towards the diminished use of
amalgams and the increased use of composite resins to restore posterior
teeth. One of our consultants, Tom Limoli of
Limoli and Associates notes that US third-party payment data reflects that 65%
of direct posterior restorations last year were resin-based composite, while
35% were amalgam. So regardless of the
empirical evidence that refutes these concerns, the patient pool is demanding
composite restorations.
Every dentist will need an alternative material to use in
the restoration of posterior teeth as this trend continues because composite
resins only have a life expectancy of 5 to 8 years. Given the patient’s desire to be rid of the
potential or theoretical health hazards that have been formulated in recent
years, amalgam restorations will ultimately be eliminated by the slow and
natural death of attrition. While
amalgam has been the material of choice for decades and still remains the
primary source of teaching in dental schools today, it may not be in the
future. Given the patient demand for
composite restorations and what appears to be the dentist’s propensity to
capitulate, we are going to need a better solution to posterior restorations if
we want to achieve the same longevity that is achieved through amalgam
restorations.
The internet has continued to create an uncertainty on the
part of the lay public about amalgams similar to the controversy that surrounds
cell phones and brain tumors. It is
interesting to note the dilemma faced by dentists today, when we know that
amalgam is the better choice for the restoration, but the popular demand or
path of least resistance is a composite restoration. This disconnect creates some interesting food for thought.[1]
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200A
Atlanta (Sandy Springs), GA 30328
404-256-3620
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[1] Additional sources of
information came from Gordon J. Christensen, DDS, James F. Simon, DDS, and
Howard E. Strassler, DMD. Compendium of
Continuing Education in Dentistry, July/August, 2011.
