Feeling Safe With Fillings

Getting ahead and going beyond the FDA’s warning on amalgam.

At Advanced Dental Cosmetic Center, both J. Terry Alford, DMD, and H. Gene Steele, DDS, stand in the forefront of patient safety. For example, out of concern for his patients, Dr. Alford stopped using dental amalgam, which contains mercury, more than 35 years ago.

As it turns out, Dr. Alford was well ahead of the curve.

On Sept. 24, the FDA identified certain groups as being at increased risk for harmful effects from dental amalgam fillings. Those include pregnant women and their developing fetuses; nursing mothers and their newborns; women planning to become pregnant; children, especially younger than 6; people with neurological ailments such as multiple sclerosis, Alzheimer’s or Parkinson’s disease; people with impaired kidney function; and those with a heightened sensitivity (allergy) to mercury or the other components in amalgam, which include silver, tin and copper.

“The FDA stated what some have been saying for a long time, that amalgam releases small amounts of mercury vapor over time,” notes Dr. Steele. “Elemental mercury has long been known to be toxic, and warnings have been issued about exposure.”

Dental amalgam is about 50 percent elemental mercury. In its September 2019 scientific review, “Epidemiological Evidence on the Adverse Health Effects in Relation to Mercury from Dental Amalgam,” the FDA recognized that mercury in dental amalgam can convert inside the body into toxic methylmercury, which is the same type of mercury the FDA warns about in fish. Furthermore, the FDA recognized the bioaccumulation effects of mercury.

“With environmental sources of mercury already exposing patients, dental amalgam is another source that can contribute to toxic levels,” Dr. Steele warns. “Environmental sources include high-mercury fish, occupational exposures and waste incinerators.”

At a scientific advisory committee meeting in November 2019, a group called Consumers for Dental Choice persuaded the FDA to take another look at its amalgam policy. The FDA learned of the bans on amalgam use in children issued by the European Union, Vietnam and Tanzania as well as other changes around the world on amalgam rules. These included phase-out dates set by the Philippines, Ireland, Slovakia, Finland, Nepal, Moldova, the Czech Republic and New Caledonia.

As a result, the FDA advisory committee made recommendations to patients about the risks of dental amalgam, especially in vulnerable populations, and agreed that the use of dental amalgam should end.

“It’s important to note that the FDA does not recommend removal of existing amalgam fillings in good condition unless considered medically necessary, as with hypersensitivity to the amalgam material,” Dr. Steele observes. “Removing dental amalgams may result in a temporary increase in exposure to mercury vapor released during the removal process.

“In our practice, to ensure the safest environment possible when amalgams need to be removed, water is used to suppress mercury vapors and high-speed evacuation is used to capture mercury vapor that may be emitted and capture particles of solid amalgam.”

The FDA also does not find that the available evidence supports a complete ban on future use of dental amalgam.

“Patients can feel safe at Advanced Dental Cosmetic Center because we far exceed the recommended precautions for patient safety,” Dr. Steele assures. “Our choice of filling material is just one of many things we do to keep our patients safe.”

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