Whenever I hear a patient ask about amalgam restorations (usually referred to as mercury fillings), I wonder why this question refuses to go away. For decades, amalgams have been considered the primary restorative material for posterior teeth (the ones in the back) because of their long time success. After enormous amounts of study the World Health Organization, the FDI World Dental Federation, and the American Dental Association continue to endorse the use of amalgam to restore teeth. Yet it continues to be demonized by the public, in particular in urban legends over the internet.
As a result the trend is towards the less and less use of amalgams and the greater use of composite resins to restore posterior teeth. One of our consultants, Tom Limoli of Limoli and Associates notes that US third-party payment data reflects that 65% of direct posterior restorations last year were resin-based composite, while 35% were amalgam. So regardless of the empirical evidence to the contrary, the patient pool is demanding composite restorations.
Every dentist will need an alternative material to use in the restoration of posterior teeth as this trend continues. The challenge for the dentist is that composite resins only have a life expectancy of 5 to 8 years. Given the patient’s desire to be rid of the potential or theoretical health hazards that have been formulated in recent years, amalgam restorations will ultimately be eliminated by the slow and natural death of attrition. While amalgam has been the material of choice for decades and still remains the primary source of teaching in dental schools today, it may not be in the future. Given the patient demand for composite restorations and what appears to be the dentist’s propensity to capitulate, we are going to need a better solution to posterior restorations if we want to achieve the same longevity that is achieved through amalgam restorations.
The internet has continued to create an uncertainty on the part of the lay public about amalgams similar to the controversy that surrounds cell phones and brain tumors. It is interesting to note the dilemma faced by dentists today, when we know that amalgam is the better choice for the restoration, but the popular demand or path of least resistance is a composite restoration. This disconnect creates some interesting food for thought.
Novy Scheinfeld, DDS, PC
290 Carpenter Drive, 200A
Atlanta (Sandy Springs), GA 30328
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Additional sources of information came from Gordon J. Christensen, DDS, James F. Simon, DDS, and Howard E. Strassler, DMD. Compendium of Continuing Education in Dentistry, July/August, 2011.