Many patients come to us with at least 1 amalgam (silver filling) restoration if they're middle age and above. In the dental community you may see a wide array of opinions, from people removing dental amalgam in HAZMAT suits to dental offices still placing amalgam daily. Our philosophy based on our experience and research is that dental amalgams do not need to be automatically removed, but we no longer place these types of restorations.
To begin, there are some positives of dental amalgam. When compared to white composite fillings, they are less techniques sensitive to place. Where a white filling needs a completely dry field (difficult to achieve in the mouth), a silver filling can be placed with the presence of some saliva. It is soft when it is first mixed, then solidifies over minutes, while fully set after about 24 hours. Amalgam in comparison to composite seems to last slightly longer, though not statistically significant depending on the study.
The negatives to amalgam are that they require an undercut in the tooth in order for them to stay in place. Over time, we see the cusp overlying the undercut start to crack and sometimes it can actually fracture completely. When you visit our office, we may take photos to document this process. If the cracks begin to stain or darken, we may suggest a new restoration for that tooth to prevent a full fracture. There are times that the fracture can propagate down to the root, deeming the tooth non-restorable. Other negatives are that when amalgam is removed there is mercury vapor released and the amalgam must go in hazardous waste. The thought that something touching the food you eat everyday, ends up being a hazard can be unsettling. However, the research is not clear that amalgam has any true negative effects on people other than a small amount with true amalgam allergy. The amount of mercury vapor released is suctioned through the high volume suction to minimize exposur.
In summary, at Mason Elite Dentistry we will not blanket recommend amalgam removal. We prefer to take a personalized approach with these restorations and determine case by case if the amalgam is holding up well- to leave it, or if is starting to break down, has a secondary cavity under it or the tooth is already broken- to replace it with a crown, inlay or possibly a white filling if enough tooth remains. We no longer place these restorations due to esthetics, having to remove more tooth structure to achieve an undercut and the time it takes to harden. If you have questions about any amalgam fillings in your mouth, please give us a call!