Removing Amalgam Fillings: Procedures, Risks, and Alternatives

Amalgam fillings, also known as silver fillings or mercury fillings, have been used in dental care for a long time. However, since it involves mercury, which is a toxic element, it is not preferred in modern dental clinics. The real challenge of today is the removal of amalgam fillings.
In this guide, you will find answers to many questions about amalgam filling and removal. You will also find some additional details that you should consider if applicable.

What Is Amalgam Filling?

Dental amalgam is composed of silver, mercury, copper, and zinc. Cavities in teeth are filled with this mixture, which has a metallic look that you may already be familiar with. However, this treatment is not followed much these days, mainly because of the mercury content, which makes up half of the composition by weight. It is banned in many European countries, although some dentists still practice this technique in other parts of the world.

Why Is Amalgam Filling Used?

Although tooth-colored composites and gold fillings are the common alternatives of amalgam fillings, they fell back in the market in the past. Tooth-colored composites are more expensive and less durable, whilst gold fillings are durable but highly expensive. On the other hand, amalgam fillings are pretty affordable and durable. However, one big pitfall of them is that they resemble decayed teeth, which is really terrible. The same aesthetic problem also occurs with gold fillings. They don’t look natural, either.

Patients seeking lower prices and longer durability have preferred amalgam fillings, often overlooking aesthetics. However, today, we know that amalgam poses serious health risks.

Are Amalgam Fillings Safe?

The U.S. Food and Drug Administration (FDA)¹ acknowledges that the mercury level in the blood may increase due to amalgam fillings, but they still believe the mercury level is not sufficient to cause serious health problems. However, in 2020, the FDA updated its stance on amalgam fillings, stating that the use of dental amalgam should be avoided whenever possible in certain high-risk groups, including pregnant women, children, individuals with neurological diseases, those with impaired kidney function, and those with known sensitivity to mercury or amalgam components.

In many European countries, the use of amalgam is highly restricted or even banned, as noted by the No Harm Europe Organization².

It appears that there is no conclusive answer to the question. However, many experts agree that removing or replacing the amalgam filling increases the risk of vaporing the mercury. Also, they agree that amalgam filling poses a higher risk for patients under the age of 15, having metal allergies, or pregnant women. Therefore, if you don’t have an amalgam filling, you can avoid it. If you already have an amalgam filling, don’t remove or replace it unless you have a problem with it.

When Do Amalgam Fillings Need To Be Replaced?

An amalgam filling is expected to last approximately 15 years under normal conditions. However, if you grind or clench, the service life of the metal filling may decrease. Additionally, certain urgencies may necessitate replacing the amalgam fillings, such as a new cavity under the filling, a damaged filling edge (open margin), or a cracked or broken tooth surface. Whatever the reason, you should have your amalgam filling replaced by highly competent experts. Amalgam filling replacement needs a thorough examination and utmost care due to the potential mercury evaporation during the treatment.

The American Dental Association (ADA)³ provides guidance on safe removal protocols for amalgam fillings. The ADA recommends that existing amalgam fillings in good condition should not be removed or replaced unless it is considered medically necessary.

Once the removal is done, your dentist can fill in your tooth with a teeth-colored filling. This will be safer for your health.

Are Old Amalgam Fillings Dangerous?

Whether amalgam fillings are dangerous is not clear yet. Mercury in the amalgam is dangerous for health, but the amount of mercury in a dental amalgam filling is similar to the amount of mercury that we take from some seafood. Although they say that it is negligible, some authorities suggest restricting the use of amalgam for some patients with higher risk, such as pregnant/breastfeeding women, children, or people with kidney diseases.

Some recent studies⁴ also found that increased use of amalgam is associated with asthma and arthritis⁵. Therefore, if you want to stay on the safe side and avoid the side effects of amalgam fillings, you can consider other filling alternatives. 

What Are The Amalgam Filling Alternatives?

If you find amalgam filling risky, you can consider other alternatives. An experienced and qualified dentist will explain the other options, as well as their potential advantages and disadvantages, to you. Here is a short takeaway about amalgam filling alternatives:

White Filling:

White tooth fillings are the most commonly used filling materials in dental treatments. They are usually resin-based, and thus they are also called “resin fillings” or” porcelain fillings”. They resemble natural teeth, yet their durability is still inferior to that of amalgam fillings.

Dental Inlay/ Dental Onlay:

Inlays and onlays function similarly to fillings, but they are used for larger cavities. A solid material, fabricated outside, is cemented on the cavity. They are expected to last longer with higher protection against recurrent decay. However, the price of inlays and onlays is higher than direct fillings.

For more information, read our blog post about ‘Composite Inlays and Onlays: A Durable and Affordable Option’

Dental Crowns:

Dental crowns are another indirect filling treatment, similar to inlays and onlays. However, crowns are placed on the tooth surface like a cap, providing better protection. It is usually advised for more severe tooth problems.

Extraction:

This is the final action that your dentist can take against your decayed tooth. The tooth is extracted, and further treatments are followed when needed. Typically, dental implants are applied after an extraction.

Where To Get My Amalgam Fillings Replaced?

Amalgam replacement is a complex job. Many dental clinics can help you with that. Still, you should seek those offering a comprehensive health plan, including an oxygen supply, a rubber dam for shielding your mouth, a suction device, heavy metal detoxification, supplements, and a suitable diet.

The Environmental Protection Agency⁶ (EPA) is concerned about the environmental impact of amalgam waste. The EPA recommends that dental offices properly manage amalgam waste and use amalgam separators. This helps reduce the amount of mercury released into the environment.

You should also ask about the insurance and guarantee options available at any dental clinic you plan to use for replacing your amalgam filling.

Is Replacing an Amalgam Filling Painful?

Amalgam filling removal is similar to many other dental treatments. Local anesthesia is applied to the area, and you feel no pain during the treatment. Only mild discomfort and tooth sensitivity may occur after the treatment.

How Much Does It Cost To Remove Amalgam Fillings?

The amalgam removal involves a great deal of care and organization. Therefore, the cost of removal greatly depends on the materials and quality of the work. You can make a list of the services and types of equipment to be used for your treatment and compare the prices between different dental clinics.

Conclusion

While amalgam fillings have a long history in dentistry, modern dental practices offer safer and more aesthetically pleasing alternatives. If you have amalgam fillings and are considering replacement, it’s important to make this decision in consultation with your dentist. Especially if you’re in a high-risk group or if your filling is damaged, having it safely removed by a specialist dentist can be beneficial for your health.

Maltepe Dental Clinic has a team specialized in the removal of amalgam fillings and can guide you through this process. Contact us for more information.

SOURCE:

1. https://www.fda.gov/medical-devices/dental-devices/dental-amalgam-fillings ↩︎
2. https://europe.noharm.org/news/moving-towards-phase-out-dental-amalgam-europe ↩︎
3. https://www.ada.org/resources/ada-library/oral-health-topics/amalgam ↩︎
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC8532208/ ↩︎
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC8138300/ ↩︎
6. https://www.epa.gov/mercury/mercury-dental-amalgam ↩︎