Are amalgam tooth fillings dangerous?

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Are amalgam tooth fillings dangerous?

Many of us can likely still remember it – the uncomfortable sound of the dentist’s drill followed by careful dabbing and the placement of a silver-colored filling. For a very long time, the amalgam filling was the gold standard for dentists to seal off decayed teeth after removing all damaged dental matter. Over the past few years, the potential harmfulness of amalgam fillings due to their high mercury content (up to 50%) has become a hot discussion topic across all of Europe given that excessively high doses of mercury can cause or exacerbate a wide variety of illnesses. Doesn’t this just make any future dentist visit doubly concerning – especially when you’re already suffering from toothache?

How harmful are amalgam fillings?

Nowadays, many warnings about the supposedly extremely dangerous tooth filling material amalgam are circulating in the press and some even say that it can lead to lasting damage to the mental and physical development of children. However, to date, none of the many clinical studies that the global medical community has run on this subject has produced any evidence for the supposedly damaging effects of amalgam. It is also worth noting that mercury is the only one of amalgam’s ingredients that is harmful to the body and that it has to take the form of vapor to potentially have any damaging effects. Therefore, the usual amalgam fillings that can be found in many patients’ oral cavities are most likely not poisonous and, thus, do not have to be replaced proactively unless they are damaged.

Despite all of this evidence (or lack thereof), to protect against all eventualities, on July 1st, 2018, the European Parliament passed a ban on the use of amalgam tooth fillings on pregnant women, women who breastfeed their children, and children up to the age of 15. Additionally, going forward, dentists may only apply amalgam in a pre-dosed state (i.e., a set amount per filling) and will also have to install so-called “Amalgam Filters” in their practices to prevent amalgam residuals from dripping into the sewage water. In the meantime, all eyes will be directed at a new study which by 2020 aims to finally determine whether or not mercury-containing amalgam tooth fillings are dangerous and whether they should be banned completely from the field of dentistry by 2030.  

Empty dentist chair ready for treatment with a filling


Why are amalgam fillings still used?

Irrespective of whether amalgam fillings are finally proven to not be harmful, many people still ask themselves why this silver-colored filling material is still used despite the availability of newer white filling materials (e.g., composite). Well, for once, amalgam is still in use because no newer material has yet been covered by Austrian health insurers (meaning, insurers do not pay for other materials). As a result, many leading dental medicine experts in Austria have heavily criticized the currently active health insurance contract which dates back to 1957 and which has not been updated since then. So far, this criticism has not been successful in getting newer filling materials covered. However, the recently passed EU-wide amalgam ban may just bring a little more movement into this situation.

Child receiving treatment from a female dentist via an amalgam filling
What are the advantages and disadvantages of amalgam fillings?
Besides the potential toxicity of amalgam, patients should also make themselves aware of its other downsides. Though amalgam is a very potent filling material, it does get worn out over time which can result in the formation of fissures and additional decay over the years. To prevent this from happening, amalgam fillings have to be replaced from time to time, which is always accompanied by the abrasion of additional dental material.

With all of that said, the two key advantages that amalgam has over other newer filling materials are its durability and its relatively lower cost. While composite fillings tend to break after 2-5 years, amalgam fillings can last for a decade or even longer without needing to be replaced. Also, while amalgam fillings are covered by insurance in Austria, newer composite fillings can cost a patient up to  EUR 150 out of pocket (though they also look better due to their white color).

Net-net, it looks like patients can leave their existing amalgam fillings inside their mouths and, if necessary, they could even get new ones without having to worry about longer-term adverse effects. Still, most dental experts cheekily say that the best filling remains no filling at all.

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