Whenever I hear a patient ask about amalgam restorations
(usually referred to as 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 less and less use of
amalgams and the greater 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 to the contrary, 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. The challenge for the dentist is that 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.
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