Community Magazine October 2009

50 Community magazine JACQUES DOUECK, DDS I personally haven’t done a silver filling in 16 years and I wouldn’t have one done in my mouth. Many other dentists, however, swear that silver fillings are better. In fact, one hundred million silver amalgam fillings are done in the United States every year. White fillings, for the back teeth, have always been considered less enduring than, and hence inferior to, silver amalgam fillings, but new materials are now available with properties comparable to silver amalgam, and these are proving to be very successful. The life expectancy of a white filling depends, to a large extent, on its location in your mouth and how heavily your teeth come together when you bite. Your dentist can advise you on the life expectancy of your fillings. The history of white fillings on back teeth goes way back to the 1970s, well before the technology was available to do them well. In the mid-‘80s, the materials were improved thanks to new technology which was developed to bond to dentin. I started placing these restorations in 1984. While it is true that in the ‘80s, these composite restorations were functionally inferior to the old silver amalgam restorations, that is no longer the case, provided that they are placed with proper technique by an experienced practitioner. With what we already know about mercury, if silver amalgam was a new treatment discovered yesterday, it would have virtually no chance of gaining FDA approval. Indeed, in the interest of protecting their citizens’ health, Sweden, Norway, Germany, Denmark, Austria, Finland and Canada have recently taken steps to limit and phase out the use of silver amalgam restorations. Dental amalgam fillings consist of 50 percent mercury. Mercury, which is highly toxic, can leak from the fillings, and low grade chronic mercury intoxication can give rise to symptoms such as anxiety, irritability, fatigue, outbursts of temper, stress intolerance, decreased simultaneous capacity, loss of self-confidence, indecision, headaches, depression and a metallic taste in the mouth, among others. Higher doses of mercury can cause serious damage to the brain, central nervous system and kidneys. While we don’t know if the amount of mercury released from dental amalgam is enough to cause illness, I don’t feel it’s something to take chances with. My personal advice is not to be overly assertive with your dentist about how you want your back tooth restored. Listen to the options presented; ask what your choices are and what the dentist recommends. If your dentist is not offering the option of white fillings for your back teeth, there is probably a good reason. Many dentists do not feel comfortable using these composites on back teeth, which requires special training. Pressing your dentist to place a specific restoration – even if he or she feels uncomfortable performing the procedure – is almost certainly more dangerous than accepting their advice to use an alternative material. Are Silver Fillings Better than White Advantages of WHITE Fillings Restores tooth strength: Since they bond to the  tooth, composite fillings restore most of the original strength of the tooth. Silver weakens the teeth, making them more susceptible to breaking. Broken teeth are very expensive to restore, and thus composites can save a lot of expense over the long run. Natural look: Composite fillings restore the natural  appearance of the tooth. Tooth sensitivity: Teeth restored with white fillings  are less sensitive to heat and cold than teeth restored with amalgam, if correct techniques are used. Non-toxic material: Composites are mercury-free.  Mercury in the fillings could be toxic. Minimal invasion: Composites require less removal  of tooth structure. Especially with new cavities, the size of the hole made for the filling can be dramatically smaller with composites. Advantages of SILVER AMALGAM Fillings Cost: Composite fillings, when done correctly, take about  60 percent longer, require special expertise and expensive materials, and are more difficult to place, and so they cost considerably more than silver. General Dentist can do it: Composite requires the use of  special bonding technology that many dentists don’t have the training for or are uncomfortable with. The proper placement of a white filling requires that the site for the filling be kept totally isolated from saliva while it is being placed. More comfortable procedure: With some patients, it is  difficult to keep a tooth in the very back of the mouth isolated for the duration of the procedure. This can also be uncomfortable for some patients. A silver amalgam filling does not require this strict isolation of the tooth. Stronger material and proven: Although silver is a  stronger material, it weakens the tooth. Silver fillings have a longer history of use than mercury-free fillings, thus some feel that they are more tried and tested.