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Should Silver-Mercury Amalgam Fillings Be Replaced?

By Dr. Randall LeDuke, DDS

Should Silver-Mercury AmalgamMuch is written these days about the dangers of the elemental metal, Mercury, in our environment. We are frequently warned about mercury contamination in our rivers and lakes and the danger of eating fish or shellfish that have high concentrations of mercury compounds. The source of these contaminates come from industrial chemical runoff, agricultural fungicides and consumer products including jewelry, antiseptics and mercury thermometers. Another widespread use of mercury in our society is the dental filling material known as amalgam.

Dental amalgam is a mixture (an amalgamation in chemistry jargon) of powdered silver, copper and tin with metallic mercury, which is a liquid, at room temperature. When these materials are mixed, the resulting paste is packed into the cavity that is left after tooth decay has been removed. The paste is carved and smoothed to reproduce the contours of the tooth and it soon hardens. Amalgam has been used in dental therapy throughout the world for over 150 years. Its success as a dental restorative is undeniable. It is relatively inexpensive, relatively easy to use and is durable in function. However, it does possess a few drawbacks. Amalgam begins to oxidize after its placement so our fillings soon acquire an unattractive dark appearance after a few days. Amalgam does not bond with tooth structure so it must be locked into the cavity preparation in a way that weakens the teeth. And, of course, one of its main ingredients is mercury, a significant neurotoxin.

Advocates of the use of dental amalgam point out its long history of use as proof of its safety. The compound of dental amalgam is extremely stable once it sets and although it wears with chewing function over time, and certainly some mercury and mercury vapor ingestion results, scientifically verified damaging health consequences have not yet been demonstrated. The American Dental Association’s position states, “dental amalgam has an established record of safety and effectiveness which the scientific community has extensively reviewed and affirmed.” Critics of the use of dental amalgam, on the other hand, maintain that there is no safe level of mercury ingestion and its use in humans should be banned.

An Effective Alternative
The development of composite resin filling materials has provided an effective alternative to the use of dental amalgam that will, eventually, lead to the demise of the use of silver-mercury restorative materials in the future. Composite resin dental restoratives are plastics with particulate silica fillers that provide functional strength and a tooth-like appearance. They possess the advantage of chemical-mechanical bonding with the structure of tooth material that provides a huge advantage over amalgam material. Instead of weakening tooth structure, their placement actually strengthens the tooth, lessening the probability of cracks or fractures under function. And they provide a highly esthetic alternative to metal restorations. However, the use of composite materials in dentistry is more costly than amalgam due to the combination of higher material costs and the fargreater technical challenge to the proper use of the material. Composite is a much more difficult and time-consuming material to place than amalgam.

Removal of existing silver-mercury amalgam restorations based on fear of mercury poisoning is probably unwarranted based on current scientific evidence. The ADA position is, “the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical.”

Supported By Most Dentists Today
However, the choice of the alternative of resin restorative materials over the use of amalgam is one supported by most dentists today and the request of any patient desiring to have unsightly amalgam restorations removed and replaced by esthetic alternative materials is a completely appropriate cosmetic choice. If you have questions about the use of amalgam materials in your mouth, please contact our office for consultation at 731-885-0497. We are always happy to answer your questions.

Dr. Randall LeDuke is a graduate of the University of Memphis and the University of Tennessee College of Dentistry. He is a past president of the Tennessee Academy of General Dentistry, (www.AGD.org) and has achieved AGD Master status, one of only 48 AGD Master dentists in Tennessee.

Dr. LeDuke holds his permit to administer Limited Conscious Sedation, having received training in this area through the Dental Organization for Conscious Sedation. Cosmetic Dentistry is a passion with Dr. LeDuke. He is a member of the Tennessee Academy of Cosmetic Dentistry and serves on its Board of Directors. Dr. LeDuke is a general dentist, not an Orthodontic Specialist. However, he has treated hundreds of children and adults within his dental practice over the past twenty-five years. Conventional braces, clear ceramic braces and clear aligner orthodontics (ClearCorrect.com and invisalign.com) are available at our office. Dr. LeDuke has a special interest in interceptive therapies for achieving improved development and alignment of the jaws of young, growing patients.

Please visit our website Smile Gallery at www.smilesbyleduke.com for some examples. Most dental services can be accessed within our office, eliminating the need for out-of-town referrals. Our patients appreciate Dr. LeDuke’s depth of experience and advanced training through years of continuing dental education.

For more information or a consultation appointment with Dr. LeDuke, please call:

214 West Church
Union City, TN 38261


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