Silver fillings --> Change them to white?

LegacyUser

I have a few silver fillings in my big teeth in my mouth, molars I believe they are called. Anyway, I was wondering if i can get these changed to white fillings?

Supercell

No reason why not, but every time your mouth is drilled a little more tooth is lost, I'd wait till they naturally need replacing (afaik all fillings have a lifespan no matter how well you brush) and then get it done, unless it was for cosmetic reasons only i.e the bottom teeth.

LegacyUser

I just hate them even though you can not see them. But when I clean my teeth, they just look horrible.

DublinWriter

Yes, I know this will open up the whole 'amalgam vs composite' restoration arguement all over again, but here goes.

I had all of my original silver (i.e. mercury/amalgam) fillings replaced with composite fillings in a two year period.

Firstly, there is a *huge* contentious issue among dentists worldwide about the use of 'silver' fillings. These fillings are composed of around 49% Mercury, a known poision, and the big debate has always been around the neurological effects that they might, or might not have, especially in the context of contracting clinical depression and Alzheimers.

You could completely ingest a mercury filling and pass it out southwards without any ill-effect, the issue is around the mercury you absorb through your lungs.

I'm a 'grinder' and have had my 10+ Mercury fillings replaced with composites (white fillings) and to be honest, the white fillings, to me anyway, are more robust.

Mercury fillings basically use pressure after the dentist applies them to swell up a little and sit snugly in the drilled out area. White/Composite fillings are bonded to your tooth issue at molecular level via the application of UV light.

Most of my molars are all composite filled, look natural, and I've been grinding down on them happily for the past 6+ years.

LegacyUser

Right that's it. I'm going to get them done.

luckat

I had mine changed. The dentist was kind of doubtful, because he said the white was more fragile and I grind my teeth.

But since changing them, I'm able to chew fruit and drink hot drinks for the first time in 20 years without going through the roof.

Big_G

There is absolutely NO EVIDENCE supporting a link between mercury amalgams and neurological disease or any other disease for that matter. There is a TENUOUS link between mercury amalgams and increase in degeneration and symptoms in MS sufferers. The evidence is weak and has no bearing or application in people who don't have MS. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=14725374&query_hl=3&itool=pubmed_DocSum
(Yip et al, 2003) is just one article amongst many concerning safety of dental amalgam. Literally billions of amalgams have been placed in teeth. Symptoms of mercury toxicity would have shown up by now in the population after 150 years of use (and modern amalgams are much safer than older hand mixed amalgam). Amalgam is probably the second most studied area of dentistry after flouride (also a controversial issue).

Furthermore, the mercury in silver fillings is held in an alloy state and therefore is not mercury but an inert alloy of mercury with silver and a few other metals. Amalgam (incorrectly called mercury filling - it is not mercury) is chemically inert. The amount of mercury released from amalgam (even multiple amalgams AND in grinders/bruxors) is a FRACTION of your daily dietary intake.

The highest exposure levels (which are still minimal) are during placement and removal, which can be minimised by using rubber dam and suction during placement and removal.

The irony is, people who get mercury fillings removed because they are concerned about mercury exposure are actually INCREASING their exposure level significantly, albeit in a single dose.

As far as durability goes, amalgam is the most durable restorative material available to modern dentistry for intracoronal restorations. http://www.library.nhs.uk/oralhealth/ViewResource.aspx?resID=28984 - is a systematic review of published literature which says that amalgam is still the best.

However, amalgam does have some drawbacks. Post-op sensitivity is one, but can be lessened by use of a base/liner. Development of galvanic currents (did you ever bite tinfoil and get a sharp jolt of pain?) can also be blamed for some amalgam sensitivity and amalgams aesthetics are not as good as some other materials.

I am passionate about this, but only because there is a plethora of misinformation out there (ESPECIALLY on the internet). I am aware that countries like Sweden have banned the use of amalgam but that was because of environmental concerns, not health concerns. Old amalgams from pulled teeth and decaying bodies in graveyards do tend to break down and leech mercury into the ground with the possibility of contaminating underground water supplies.

While replacing sound amalgams with another restorative material for aesthetic concerns MAY be a valid reason (many dentists would have differing opinions about this, and each patient/tooth is different) in my opinion, replacing amalgams over the concerns of mercury toxicity is not. This is just my opinion and other dentists may disagree, but I think the consensus in the profession is that amalgam is the best restorative material available in terms of longevity and cost-effectiveness.

I would be interested to hear fitzgeme's opinion on this .

delly

Had no fillings at all 6 years or so ago and went to the dentist for an extraction. I then had to get about 7 or 8 over a 2 month period. Dentist was an old timer but had no problem putting the white fillings in, funnily enough though after my dentist retired I went to a new young dentist for another extraction who wasn't too keen on white fillings and said they don't last have as long as the silver ones.

Ethier way I'm glad I went for the white ones even though they cost more and don't last as long. I have often been in company with people laughing and the silver coloured fillings to me don't look too pretty. The mercury poisioning wouldn't worry me too much, but my choice was more for a cosmetic reasons.

Faith

I really wanted to get composite fillings the last time, but I was too much of a wuss to ask my dentist. I hate the look of the amalgam ones too and those "galvanic currents" that Big_G mentioned are a killer!

DublinWriter

Big_G wrote:

There is absolutely NO EVIDENCE supporting a link between mercury amalgams and neurological disease or any other disease for that matter.

What recent clinical trials are you citing there? Here's a link to a many scholarly articles on recent research:
http://www.amalgam.org/#anchor63613

Stuff of a more emotive nature here:
http://www.the7thfire.com/ADApolitics.htm

...and finally here's a link from the UK's Government's Department of Health, advising dentists not to perform amalgam based procedures on pregnant women:
http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4024646&chk=RqdhEo

Big_G wrote:

Furthermore, the mercury in silver fillings is held in an alloy state and therefore is not mercury but an inert alloy of mercury with silver and a few other metals. Amalgam (incorrectly called mercury filling - it is not mercury) is chemically inert.

They're composed of 49% Mercury, and yes chemically inert, but only when oxidised.

The courts would be packed in the morning if the ADA or IDA came out and stated that amalgams weren't a good thing. It would make the Clerical Abuse trials look like a bad day at the Small-Claims Court.

And yes, rubber dams are great, but how many dentists do you know who even make their patients wear protective goggles, never mind gum dams!

The bottom line is composite safe, amalgam controversial. Would you let your own kids have amalgam restorations?

DublinWriter

delly wrote:

funnily enough though after my dentist retired I went to a new young dentist for another extraction who wasn't too keen on white fillings and said they don't last have as long as the silver ones.

From my own experience, I'd totally disagree. I have a pretty big filling on my left upper 6th, which has been basically 50% filling since age 16. From when it was initially amalgam filled to about age 29, the filling was replaced about 4 times.

I had it replaced with a composite (white) filling six years ago, and not a peep out of it since, and I'm a night and day grinder.

delly

DublinWriter wrote:

From my own experience, I'd totally disagree. I have a pretty big filling on my left upper 6th, which has been basically 50% filling since age 16. From when it was initially amalgam filled to about age 29, the filling was replaced about 4 times.

I had it replaced with a composite (white) filling six years ago, and not a peep out of it since, and I'm a night and day grinder.

Well thats just it, I've had them about 6 years myself now and there doing grand. Its gas really, if anything I would have expected the old timer to be againest the white fillings.

xzanti

I want to have this done too... I'm more adament now having read how common it is above... What sort of price would I be looking at per tooth??

delly

Putting them in fresh I think they were around the £40 to £50 quid mark about six years ago. Like everything though, prices have probably gone up since then.

Big_G

DublinWriter wrote:

What recent clinical trials are you citing there? Here's a link to a many scholarly articles on recent research:
http://www.amalgam.org/#anchor63613

You actually have provided scholarly articles that back up the pro-amalgam side of the debate. Articles like this are used in a 'Michael Moore' fashion on these websites. It is not about the content of scientific articles that is important, it is about the interpretation.

In the first article in this link, mercury is mentioned amongst other heavy metals as being of above normal concentration in the brain cells in culture. This is a POST MORTEM observational study. There is no way to establish from this study that mercury or other heavy metals actually cause the symptoms experienced by Alzheimer's sufferers or whether these concentrations actually existed in life. In fact, the altered concentrations could be due to the Alzheimer's disease causing altered brain cell metabolism, as indicated by lower than normal concentrations of rubidium selenium and zinc, which the author also mentions have a protective role against mercury toxicity. The authors state themselves that they could not determine whether the differing mercury levels were a primary (causing Alzheimer's symptoms) or secondary (caused by Alzheimer's) event.

The second quoted article mentions in its abstract that there were differences in concentration of mercury between study and control groups but it does not even speculate as to whether mercury concentrations were related to behaviour.

The last article contradicts the first and states elevated levels of zinc, iron and selenium in the study group, suggesting that the Alzheimer's cells were
more resistant to mercury toxicity and stated also that the varying levels of concentrations of mercury in the brain cells of both study and control groups meant that there was NOT a statistically significant difference in mercury levels between Alzheimer's patients and non-Alzheimer's controls.

Apart from that, the last study appears to have set out to find higher levels of mercury, stating that "four elements that have been implicated in free radical induced oxidative stress in Alzheimer's Disease (AD)" were studied. This introduces the possibility of study bias. Even with bias, however, a statistically significant result in terms of mercury was not found.

This all constitutes what in the medical/dental world is called equivocal evidence.

Most of the articles on this page are animal studies and giving a cursory glance over them tells me that the concentrations of mercury used in the studies far exceeds anything that exists in the human body, or which would produce obvious symptoms of mercury toxicity such as dementia.

Lastly regarding this set of articles, there is only one study that deals with linking mercury in dental amalgams and neurological disease and it uses subjective neurobehavioural rather than direct objective neurobiochemical or neurophysiological testing.

DublinWriter wrote:

Stuff of a more emotive nature here:
http://www.the7thfire.com/ADApolitics.htm

Absolutely emotive. This man relies on anecdotal evidence (which is not evidence at all in the scientific world) to come up with a treatment regime for 'reversing' Alzheimer's. Alzheimer's by definition is a degenerative disease. That means it is irreversible. Also Alzheimer's is not an acquired disease. It is genetic. This man provides no references whatsoever, other than to his own books. He implies, as you do, that there is a conspiracy amongst dentists. There isn't, and I resent the implication. It is people like this man that bring the profession of dentistry into disrepute. Dentistry is evidence based, we don't do anything without having evidence to say that it is good for the patient.

Equally emotive, but providing references from well-known, reputable peer-reviewed journals: http://www.quackwatch.org/01QuackeryRelatedTopics/mercury.html -written by an MD not a dentist, so no vested interest there. His statements about why certain dentists come out against amalgam are very prudent. Controversy equals publicity.

DublinWriter wrote:

...and finally here's a link from the UK's Government's Department of Health, advising dentists not to perform amalgam based procedures on pregnant women:
http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4024646&chk=RqdhEo

In response to this, I recently did a dissertation on the link between periodontal disease and preterm birth in pregnant women. The conclusion that I made from doing 6 months of study and reading every available piece of literature is that there is not enough evidence to decide whether periodontal disease causes preterm birth, but the theory of the link was sound and that further study should be undertaken. The American Academy of Periodontology published a recommendation that pregnant patients should receive periodontal diagnosis and treatment to prevent this supposed phenomenon (it's called cover your ass). With regard to the BDA's statement on silver amalgam, it relates to the mercury load in a foetus, which does not have the ability to clear toxins as efficiently or as quickly as its mother. The BDA also says in this statement that there is no evidence of any systemic disease caused by dental amalgam.

DublinWriter wrote:

They're composed of 49% Mercury, and yes chemically inert, but only when oxidised.

The courts would be packed in the morning if the ADA or IDA came out and stated that amalgams weren't a good thing. It would make the Clerical Abuse trials look like a bad day at the Small-Claims Court.

And yes, rubber dams are great, but how many dentists do you know who even make their patients wear protective goggles, never mind gum dams!

The bottom line is composite safe, amalgam controversial. Would you let your own kids have amalgam restorations?

1. Mercury composition can vary between 45-50% depending on the type of amalgam. Amalgams do oxidise or 'corrode'. However, the calculated level (as stated in above article) of mercury exposure from one filling is about 0.000001 grams per day, which is as little as one twentieth of daily dietary intake. Most mercury from fillings is not inhaled, it is bathed in saliva and swallowed and passes straight through the digestive tract, which is inefficient at absorbing mercury (1/10th gets absorbed). This lessens over time as amalgam corrodes.

2. I don't think so, and even if it did, the court could only legally instruct the profession to replace the amalgams, not pay damages, because the entire profession was doing what is prudent under the rules of evidence based practice.

3. The patient can and should ask for these protective measures when having amalgams removed. If not available, then it is always possible to go to another dentist. Good suction is more important than rubber dam. Rubber dam prevents swallowing of any material. Good suction can do nearly as good a job.

4. The bottom line, in fact, is amalgam safe, comosite safe. Dental professionals have a higher exposure to mercury than someone with fillings in their mouth (we are dealing with amalgam all day). If amalgam was unsafe, we would be the first to stop using it in order to protect ourselves from mercury exposure. I personally have a few amalgam fillings and I would have absolutely no qualms about putting mercury in any of my family member's mouths (I don't have kids yet ).

I don't think I will change your mind DublinWriter, and everyone is entitled to ask their dentist about this. I just want people to be aware of both sides of the debate. I googled amalgam and the first 10 sites were all about the supposed detrimental effects of dental amalgam. Not one extolling its virtues of safety, cost effectiveness, longevity, excellent wear properties, ease of handling and use, etc.

I think people should read as much as they can about both sides of the opinion with eyes open to sensationalism and the evidence base.

DublinWriter

Big_G wrote:

2. I don't think so, and even if it did, the court could only legally instruct the profession to replace the amalgams, not pay damages, because the entire profession was doing what is prudent under the rules of evidence based practice.

Nope, and that's the nightmare scenario for the entire dental profession and it's partly the reason they are so defensive about amalgams.

Say for example, it was proven beyond all reasonable doubt that amalgams cause manic depression and/or Alzheimer’s. Could you image the legal repercussion for all dentists?

Controversy aside, do you consider it to be good dentistry that in the 21st century people are still having their mouths filled with metal?

Composites not only look better, but are bonded to the dental material at molecular level. Amalgams are held in place by the benefit of the fact that they expand after being put in place and 'wedge' themselves into the drilled area.

Big_G

DublinWriter wrote:

Nope, and that's the nightmare scenario for the entire dental profession and it's partly the reason they are so defensive about amalgams.

There is nothing to be defensive about, as outlined above. Also, the attacks on amalgam (unfounded) far outweigh the defenses in the popular media.

DublinWriter wrote:

Say for example, it was proven beyond all reasonable doubt that amalgams cause manic depression and/or Alzheimer’s. Could you image the legal repercussion for all dentists?

I cannot honestly say what would happen in a legal sense, as I am not trained in the law. In cases of negligence or malpractice, a practitioner is judged in his actions by what is considered reasonable practice by his professional peers. If all his peers are doing it, it cannot be considered malpractice or negligent, and therefore the practitioner could not be considered liable.

DublinWriter wrote:

Controversy aside, do you consider it to be good dentistry that in the 21st century people are still having their mouths filled with metal?

I am disappointed that you not only have not read my previous posts, but that you fail to realise that my opinion has little bearing on this debate, the body of EVIDENCE (multitudes of studies over 150 years in a multitude of peer reviewed journals - search pubmed.org) is in favour of using amalgam in terms of cost effectiveness, longevity, ease of use, tooth substance wear, etc (see my first post for systematic review link).

DublinWriter wrote:

Composites not only look better, but are bonded to the dental material at molecular level. Amalgams are held in place by the benefit of the fact that they expand after being put in place and 'wedge' themselves into the drilled area.

Composites use micromechanical retention as their main retentive feature. Amalgams use macromechanical retention. There is no molecular bond between composite and tooth structure. An adjunct is used to achieve this micromechanical bond when filling cavities involving dentine. It is called dentine bonding agent and takes several forms.

In fact, polymerisation shrinkage in composites causes gaps to form between the edge of the composite and the tooth. Layering techniques and use of a bonding agent can help, but not fully eliminate the problem. This is one of the reasons that composite is inferior to amalgam in back teeth.

Amalgams are not held in place by wedging forces developed from corrosion expansion, but by the properties of retention (parallel walls of cavity preparation, grooves or other features lock the filling in place, preventing its movement in any direction). Corrosion expansion can be both beneficial and detrimental, providing a measure of seal and at the same time increasing the possibility of fracture of weakened tooth structure by wedging forces.

Wight

DublinWriter wrote:

I'm a 'grinder' and have had my 10+ Mercury fillings replaced with composites (white fillings) and to be honest, the white fillings, to me anyway, are more robust.

White/Composite fillings are bonded to your tooth issue at molecular level via the application of UV light.

Most of my molars are all composite filled, look natural, and I've been grinding down on them happily for the past 6+ years.

Lot of wooly science here:

Firstly Composites are NOT more robust. they have lower abrasion resistance, lower compressive strength, much lower shear strength, (which is how most of them fail) and study after study shows a lifespan of about 2/3 that of amalgam.

Secondly they are not bonded at molecular level. They are bonded at micro-mechanical level, and are cured by visible blue light, NOT ultra-violet.

Thirdly, the amount of mercury you are exposed to by amalgam fillings is less than one third of the typical Japanese person's exposure via dietary mercury from fish consumption. They do not show a higher incidence of ANY ill=effects you describe.

Fourthly EVERYTHING is poisonous, it's all to do with dose. Oxygen will kill you in minutes if you're given enough. Do you suggest everyone stop breathing??? :eek:

Finally, have you ever looked at what is in your lovely "safe" composite? It's a bis-GMA resin, a kind of epoxy. This material is a known carcinogen for over twenty years.

Dammed if you do, dammed if you don't, eh?

DublinWriter

Wight wrote:

Lot of wooly science here:
...
Thirdly, the amount of mercury you are exposed to by amalgam fillings is less than one third of the typical Japanese person's exposure via dietary mercury from fish consumption. They do not show a higher incidence of ANY ill=effects you describe.

True, because you can ingest a mercury filling and pass it out southward without much ill-effect.

Mercury is most effectively absorbed via your lungs. This is where all the contentious issues arise about using it in dental restoration.

Comparing...

a) having material comprised of 49% Mercury permanently in your mouth, constantly being eroded and oxidised as you bite and erode the surface, vapours of which being absorbed via your respiratory system 24 X 7

...with...

b) Japanese people eating fish and absorbing through their digestive system

is nonsense for the reasons I mentioned.

lomb

composite is useless in damp conditions with blood saliva etc, so needs meticulous placement. there are numerous cases of secondary decay under large composite due to margin flex, bad bonding, moisture etc.
the main problem however seems to be wear meaning teeth start moving over time as contacts wear. this may be more of a concern with new compomers many dentists are mis using like dyract or fuji lc where ive seen gross wear. i reakon whats needed in large multisurface cavities is bonded compressed ceramic inlays or crowns. i think the research would agree. cost and other factors mean people generally dont get the ideal.

Wight

DublinWriter wrote:

True, because you can ingest a mercury filling and pass it out southward without much ill-effect.

Mercury is most effectively absorbed via your lungs. This is where all the contentious issues arise about using it in dental restoration.

Comparing...

a) having material comprised of 49% Mercury permanently in your mouth, constantly being eroded and oxidised as you bite and erode the surface, vapours of which being absorbed via your respiratory system 24 X 7

...with...

b) Japanese people eating fish and absorbing through their digestive system

is nonsense for the reasons I mentioned.

No it's not nonsense. You DO absorb through the digestive tract. You are correct that vapour is more readily absorbed (around 50 times more readily) than through the digestive system. Japanese people recieve an ABSORBED dose that is higher than pretty much anybody will ever receive from dental fillings. That's allowing for the "vapour versus solid" aspect. (The only people who imght receive more are dental care workers, as we're around the stuff in potential vapour form all the time.)

Paulie82

I'm the same. I have three fillings altogether one big one on my molar on the left side of my lower jaw, all are silver, I will wait until I have to get them changed naturally and then I will ask for white fillings, simply because they look better but I watched a couple of videos that kinda shocked me into getting white fillings also, one thing I have to say for big corporations like dental organisations and the such, I take almost everything they have to say with a pinch of salt and dont't forget some countries have already banned Mercury fillings, here is one video that I watched, it was convincing enough for me.

http://www.youtube.com/watch?v=4qvNf4NVZvI&feature=related

flahavaj

Paulie82 wrote: »

I'm the same. I have three fillings altogether one big one on my molar on the left side of my lower jaw, all are silver, I will wait until I have to get them changed naturally and then I will ask for white fillings, simply because they look better but I watched a couple of videos that kinda shocked me into getting white fillings also, one thing I have to say for big corporations like dental organisations and the such, I take almost everything they have to say with a pinch of salt and dont't forget some countries have already banned Mercury fillings, here is one video that I watched, it was convincing enough for me.

http://www.youtube.com/watch?v=4qvNf4NVZvI&feature=related

Did you look in those countries' reasons for banning amalgam?

Paulie82

Yeah apparently it was due to the toxicity to humans and Mercury pollution, Denmark and Sweden say that most Amalgams end up in the sewers and as Amalgams are around 50% Mercury they are classed as toxic to the environment.