mercury amalgam fillings

Every once in a while, I have a patient ask me if they should have all of their amalgams (dental mercury fillings) replaced.

Dental amalgam is an alloy made up of liquid mercury and a powdered mixture of silver, tin and copper.  Most of the filling composition is elemental mercury (approximately 50%).  This type of mercury releases mercury vapor and has been the cause for concern with amalgam fillings.  It was first used in the 19^th century in France.  For many years it was the dental material of choice because of its strength, workability and low cost. 

Over the years, there have been claims that the mercury in dental amalgam leaches out, enters the body and contributes to a wide variety of ailments such as depression, epilepsy, multiple sclerosis, lupus, leukemia and more.  While dental amalgam does release mercury, in the words of 16th century Swiss physician Paracelsus, “The dose makes the poison.”

According to Dr. Rod Mackert, professor of dental materials at the Medical College of Georgia School of Dentistry Department of Oral Rehabilitation, “a person would need between 265 and 310 amalgam fillings before even slight symptoms of mercury toxicity could be felt.”  A person with seven fillings, which is average, absorbs only about one microgram of mercury daily. About six micrograms are already absorbed daily from food, water and air, according to the Environmental Protection Agency. 

In other words, people are exposed to more total mercury from food, water and air than from the minuscule amounts of mercury vapor generated from amalgam fillings.  The American Dental Association (ADA) continues to support the use of amalgam as “a safe restorative option for both children and adults.”  In 2009, the U.S. Food and Drug Administration (FDA) deemed amalgam fillings a “safe and effective treatment option for the general population.”  

Granted, in Europe, Denmark and Sweden have completely banned the use of dental amalgam.  Germany and Norway have restricted its use.  Note that this is not because of safety concerns for amalgam itself but as a very small part of an overall effort to decrease environmental levels of mercury.  In fact, the European Union also continues to support amalgam as a safe restorative material.

Still, the reality is that amalgam use in both the United States and Europe continues to decrease.  Look for my next article where I will tell you why I haven’t placed a dental amalgam in over 15 years.

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Woman’s Day Magazine may not be a scientific journal but in this December’s issue, a friend of my wonderful wife Amy found an article that piqued her interest.  The article entitiled “Take care of your teeth and protect your health” by Sara Reistad-Long addresses a health topic that continues to get exposure.  Your dental health affects your overall health.

There’s no escaping the fact that the health of your mouth affects the health of your entire body.  As my staff and I have professed to our patients, research indeed indicates a link between dental disease and your systemic health and in particular four of the top ten leading causes for death according to the Centers for Disease Control.  These include heart disease, stroke, diabetes and Alzheimer’s disease. 

Your mouth houses a lot of bacteria, which cause cavities and periodontal (gum) disease.  If you have inadequate dental health, the gum around each tooth can be weakened and thinned, thus allowing bacteria to seep from the mouth and into your body.  The bacteria then settles in susceptible areas of the body including your heart and blood vessels and leads to what can be pretty major problems.

 Woman’s Day is but one of several magazines that have had articles on this important topic.  Some of our new patients are coming to us specifically because of concerns they have for their overall health and not just their dental health.  

For example, we have known for many years that diabetics are three times more susceptible to periodontal (gum) disease.  But research is now showing that periodontal (gum) disease increases one’s susceptibility to diabetes!  It’s a vicious cycle. 

We pay particular attention to the “oral-systemic connection” and when red flags come up regarding a patient’s periodontal (gum) health, we may bring the patient’s physician into the loop just to make sure there aren’t any other systemic problems going on. 

So when you are brushing and flossing, you are not only saving your teeth, you may very well be saving your life!

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This is a great case where my patient “Joe” wanted his front teeth fixed and looking better.  Joe felt that he had neglected his teeth over the years.  He was concerned not only for the appearance but also the health of his teeth.  He just didn’t like his smile.

An unsightly smile

 In transforming his smile, he wanted a very natural look that not necessarily matched but “blended” with his natural teeth.  Joe wanted an authentic look – one that was believable. For many patients this comes down to color or shade of the teeth.  Certainly there are many options when it comes to color.  I find that most patients tend to want a good  color match of their existing teeth or a slightly lighter color that still blends in with their natural teeth. 

Beautiful porcelain veneers!

 Occasionally we will whiten teeth first and then match the crowns or veneers to the new color of their natural teeth.  It all comes down to the patient’s personal preference.

 An interesting thing about “Joe” is that he’s 80 years old, which again is proof positive that one’s chronological age doesn’t necessarily coincide with one’s biological or real age.  I don’t even think it occurs to Joe that he is 80 years old.  He doesn’t allow his chronological age to limit him.

 Joe was very pleased with the end result.  He now has a more youthful smile that may even knock a few years off of his biological age!  Asking him how he likes his new smile, Joe replied, “I love it.”

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Undersized lateral incisor tooth

Matching a single veneer or crown on a front tooth to the adjacent natural teeth is one of the most difficult procedures to do in dentistry.  This patient had recently finished wearing braces for a few years but found himself dissatisfied because of an undersized lateral incisor tooth.  He wanted the gap filled but wanted the treatment to be long lasting.  Together we decided that a porcelain veneer would fit the bill.

Whenever we do a case like this, we carefully evaluate the adjacent teeth first.  We don’t just look at the color or shade, but also the size and shape and even little nuances such as the white splotching on the teeth so that the veneer seems to disappear when it is placed.

Porcelain Veneer to fill the gap

Using our CAD/CAM technology, we made the actual porcelain veneer in our office and then color-matched the veneer to the patient’s natural teeth.  We have the technology that allows us to do that as well.

The result was awesome, the patient was happy and it was all done in one appointment.  I love it when a plan comes together!

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