Revisiting Your Story About Amalgam Versus Composite

Regarding the October 2014 “Mouths of Mercury” column by Kate Madden Yee in the East Bay Medical Guide.


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Regarding the October 2014 “Mouths of Mercury” column by Kate Madden Yee in the East Bay Medical Guide: Perhaps a bit more inquiry might have been in order. I am not an amalgam-filling proponent, as I have never placed a silver filling in my 20-plus-year career, but amalgam fillings last a hell of a lot longer than 12 years. In my practice, the vast majority of patients that have amalgam fillings have had them over 50 years, and the vast majority of my patients’ composite fillings last 10 to 20 years. Heck, I have perfectly good silver fillings that were placed in the late 1960s and early ’70s and composite fillings that were placed in the early 1980s. Amalgam and composites fillings have no expiration date. They fail due to recurrent decay, fatigue of the tooth, or faulty placement.

Both are good filling materials. Done correctly, composite fillings are better, in my opinion, because instead of weakening the tooth as amalgam does, it can strengthen it. The hazard of mercury is not so much having the filling in one’s mouth; it is at the time of placement and at the time of removal when mercury is in the liquid form or the aerosol form. In between, they are fairly inert. Using the analogy of a grape and an amalgam filling, over time, as water leaves the grape it becomes smaller and turns into a raisin, losing much of its mass. If amalgam fillings leached significant amounts of mercury, the filling would get smaller and eventually fall out of the hole that the filling was placed in. This does not happen. Not in 12 years, and not in 50 years.

Unfortunately, many dentists still use amalgam, not because they believe it to be better, but because third-party insurance carriers will only cover amalgam fillings on back teeth. One needs to educate the public that the dentist generally wants to do the best for the patient; the insurance company wants to pay out the least. Their term is, “the least costly alternative treatment.” Since the advent of dental HMOs and PPOs, in-network providers have to comply with the desires of the insurance companies that dictate the treatment. One does not place composite fillings simply in lieu of amalgam fillings. Amalgam fillings can be placed very easily, without much effort. Composite fillings are very technique-sensitive, and much more difficult to do. Amalgam fillings are to cooking pasta in boiling water as composite fillings are to making a souffle.

I hope that helps. Cheers!

Whitney Johnson, D.D.S.

Berkeley

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