Posted on 1/21/2016 by Dr. Kelsey Ullsmith
|I am asked by patients every day about the relative advantages/disadvantages of silver (amalgam) fillings and tooth colored (composite) fillings. My patients are primarily concerned with price, reliability and relative safety.
The answer is not black and white. There are advantages and disadvantages to both, making the answer a shade of grey. I share with my patients that yes the silver fillings do in fact contain a small amount of mercury. This mercury is what allows the metal alloy to be compressed into the tooth in order to later harden. Mercury is toxic in its aerosolized/inhaled form and is related to neurological disorders and dysfunctions such as Alzheimer’s and Parkinson’s. As dental personnel spend an extraordinary amount of time removing old silver fillings with a dental drill, effectively aerosolizing the previously bound mercury, they are a subject of much interest. Many studies have been completed on this population in order to determine if their incidence of neurological disorders is higher than the general population. Fortunately this has not been demonstrated. However, there is no argument that the incidence of these diseases are increasing in the general population. I believe this to be multi-factoral. In this day and age we are exposed to so many environmental influences both consciously and unconsciously, that it becomes difficult to point the finger at any one causative agent/influence. However, it is always wise to be as well educated and informed as possible and to make a decision that agrees with our individual sensitivities and sensibilities.
On the flip side of the coin, (and there always is a flip side), silver fillings are more economical and can generally last three times as long as a similarly sized white filling. This is important, not just from the point of view of economics and time spent in the dental chair, but from a pulpal health standpoint. Pulpal health refers to the health of the nerve in each and every tooth. Nerves are fragile and susceptible to irreversible damage, necessitating root canal therapy. This damage can be caused by infection (a deep cavity), or inflammation. One source of inflammation is dental work. The more times an individual tooth is worked on through a persons’ lifetime, the higher the chance that the nerve, (which seems to have what I think of as a “cumulative memory”), reaches a point of irreversible inflammation and begins to go through the dying process. Dying teeth require root canals and crown stabilization.
One final thought.
The relative size of the filling needs to be taken into consideration as well. Small cavities are suitable for fillings of either material, whereas larger cavities, (or fractures), that comprise a large portion of the tooth structure, (in a case where a crown or “cap” for that tooth is not financially feasible), can sometimes be better treated by a tooth colored filling. This is due to the fact that tooth colored fillings help bond or “hold” a tooth together, rather than wedge it apart. Again however, the longevity of the filling becomes a consideration, and long term pulpal health enters the picture again.
So you see, there is no real satisfactory answer here. The answer truly is a shade of grey (I have found this to be true of most questions I ask in this life, regardless of the subject…) I believe in making an informed, educated decision that is best for you or the loved ones under your care. There is no right or wrong answer – only what is appropriate for you personally – as you are the very important caretaker of your own mind and body.