Should I Get My Amalgam Fillings Replaced?

For almost as long as dental amalgam fillings have been used, there has been some controversy about their health consequences. On one side you have people who state that they are unequivocally safe while on the other side you have people who say that they lead to a whole host of health problems that will resolve if the amalgams are removed. They claim it can cause Alzheimer’s Disease, multiple Sclerosis, fibromyalgia, autism, kidney problems, behavioral problems, and various other health issues. So which side should you believe? As with anything, follow the evidence.

What are Dental Amalgams Made Of?

First, what are amalgams made of? They are a combination of mercury (approximately 50% of the total), silver, tin, copper, and a couple of other trace metals. The type of mercury used in dental amalgams is known as elemental liquid mercury. It is poorly absorbed by the body except in vapor form. The main concern with amalgams is the mercury content. Exposure to certain kinds of mercury is known to cause brain, liver, and lung problems with high exposures enough to cause death. Childhood exposure to certain types and amounts of mercury can cause neurological deficits for a lifetime.

Exposure to Mercury From Dental Amalgams and Other Sources

We do know there is some minimal exposure to mercury vapor from dental amalgams. When amalgams are placed and when they are removed you are exposed to the highest levels. We also know that when you chew, a minute amount of mercury vapor can be released. Interestingly enough, you receive far less mercury exposure over the lifetime of the fillings if you leave them in place vs having them removed. The levels that are released are very minimal as compared to what is considered a safe amount of daily exposure (approximately 1% of the maximum allowable exposure per day). You actually get far more mercury exposure from environmental sources such as eating fish than you’ll ever get from your dental amalgams.

The Evidence

A lot of studies have been done over the years to find out whether this small exposure to mercury can cause any health problems long term. The most well known groups to study this issue have been the New England Journal of Medicine and the Cochrane Collaboration. The New England Journal of Medicine completed a long term study and found that the number of surfaces of amalgams in a person’s mouth did not correlate with any other health problems. The Cochrane Collaboration does reviews of various topics that have been studied in the scientific literature. They took on the dental amalgam controversy and after going through all the literature did not find any evidence to support the claim of health problems associated with dental amalgam.

A lot of different medical groups have also studied this issue and almost unequivocally they have stated that dental amalgam is a safe an effective filling material with no known associated health problems. Some of these groups include The American Dental Association, The Food and Drug Administration of the US Government, The Mayo Clinic, The American Academy of Pediatrics, The Autism Society of America, The US Environmental Protection Agency, The New England Journal of Medicine, and Consumer Reports. Most European countries have also stated that dental amalgams are safe and effective.

You might hear some people say that dental amalgam has been banned in some European countries. While this is somewhat true, it isn’t for the reason you would think. Dental amalgam is known to contaminate water sources when it is removed and it is for these environmental reasons that it has been highly limited. Most dental offices today install a device known as an amalgam separator that removes the amalgam before it can go into the water system.

The Conclusion

I don’t recommend having dental amalgams removed until they actually need to be replaced for legitimate dental reasons. I am perfectly OK with having them in my own mouth or in the mouth’s of my family.

Despite all this evidence, there still continue to be quite a few dentists and people who claim the contrary. They think dental amalgam is a huge cover-up or conspiracy. The important thing to remember is that if we found out tomorrow that all dental amalgams needed to be removed for health reasons, it would be a huge financial boon for dentists. It is not in a dentist’s best financial interest to recommend you leave amalgams in place. The American Dental Association has gone so far as to say that a dentist who recommends they be removed for health reasons is acting unethically. If your dentist recommends you have all your amalgams removed for health reasons, think long and hard about whether it is something that should actually be done.