 Amalgam is highly unpopular in our practice, but silver fillings are still placed by many dentists, particularly in lower income areas. The American Dental Association claims that banning amalgam would increase government spending, while decreasing options for the poor.
My (Vu Le, DDS) official opinion is that amalgams are a safe, if uncosmetic and compromised, treatment option. In some very specific situations, amalgam is still superior to composite resin (white) fillings. In most cases, the adhesive and esthetic properties of tooth-colored fillings make them more desirable than silver fillings.
Amalgam should remain legal for the following reasons:
- After more than 50 years of using them, there's still no scientifically validated study proving adverse health effects of silver fillings. Lots of anecdotal accounts, thousands of anti-amalgam websites, but no peer reviewed, accredited scientific journal published studies. California's Dental Practice Act specifically prohibits a dentist from replacing amalgam fillings for purposes of improving whole body health or curing non-dental diseases such as cancer, fibromyalgia, chronic fatigue syndrome, etc.
- Composite resins require absolute fluid control, or they will fail. If bleeding and/or salivation cannot be controlled, amalgam is the first and best choice for a restorative material.
- For the poor and handicapped, amalgam is a safe and affordable alternative.
- Banning amalgam would drastically increase treatment costs for government health programs, such as California's Denti-CAL. That could lead to reducing benefits for the poor, fewer dentists participating in government programs, or higher taxes for everyone.
- Banning amalgam, if not properly legislated, would create a windfall for trial attorneys. California's byzantine laws sometimes allow lawyers to sue dentists even if they don't have a client. The inevitable landslide of litigation would put many dentists out of business, raise malpractice premiums, and force the remaining dentists to pass on higher dental fees for everyone.
Here's the official release from the American Dental Association:
Banning Amalgam Could Increase US Dental Costs by $8 Billion a Year
CHICAGO (August 10, 2007)—A study in the current issue of the journal Public Health Reports
examines the potential economic impact of a ban or restriction on the
use of dental amalgam, a material commonly used to fill cavities. The
authors conclude that U.S. dental care costs would increase by up to
$8.2 billion in the first year alone—a staggering 10 percent of current
dental expenditures—if amalgam were no longer available as a treatment
option.
Dental amalgam contains a mixture of metals,
including mercury, which combine to form a stable alloy that dentists
have used safely for over 150 years to fill cavities. Numerous
peer-reviewed, scientific studies, including those published as
recently as 2006 in the Journal of the American Medical Association,
attest to amalgam’s safety and efficacy, leading health experts to
recommend its continued availability as an option for treating dental
decay.
Dr. L. Jackson Brown, a dentist, economist,
epidemiologist and former ADA managing vice president for health policy
agrees, saying, “The dental community and public health dentists have
long known that amalgam restorations are a vital component in the
arsenal to manage dental disease. This study documents the large impact
the absence of amalgam would have.”
A small group of
activists has for years called on state and federal governments to ban
amalgam, claiming, with no credible scientific basis, that it causes
systemic diseases. The ADA and numerous state, national and
international health authorities oppose such proposals.
“Dental
care would cost more, and untreated caries (dental decay) is likely to
increase,” said Dr. Brown. “Unfortunately, this impact would fall
disproportionately on the disadvantaged populations.”
The article, "Economic Impact of Regulating the Use of Amalgam Restorations,” can be viewed on the American Dental Association’s Web site.
About the American Dental Association
The not-for-profit ADA is the nation's largest dental association,
representing more than 155,000 dentist members. The premier source of
oral health information, the ADA has advocated for the public's health
and promoted the art and science of dentistry since 1859. The ADA's
state-of-the-art research facilities develop and test dental products
and materials that have advanced the practice of dentistry and made the
patient experience more positive. The ADA Seal of Acceptance long has
been a valuable and respected guide to consumer and professional
products. For more information about the ADA, visit the Association's
Web site at www.ada.org.
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