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Why Amalgam Free?
As a practitioner of natural dentistry, your dental awareness and overall wellbeing is Dr. Mafi’s first priority. It is important to her that her patients are aware of the dangers of amalgam as well as their alternatives.
Despite its controversial and toxic nature, amalgam is still used in many dentist offices today in the following situations:
- In people of all ages.
- In stress-bearing areas and in small to moderate-sized cavities in the posterior teeth.
- When there is severe damage to a tooth and cost is an overriding consideration.
- As a foundation for cast-metal, metal-ceramic, and ceramic restorations.
- When patient commitment to personal oral hygiene is poor.
- When moisture control is problematic with patients.
- When cost is an overriding patient concern.
Dr. Mafi’s stance due to her belief in natural dentistry is that her San Diego patients should educate themselves regarding the use of amalgam. Based on the Dental Material Fact Sheet of the California Dental Association, amalgam contains 43 – 54 % mercury. The following is information has been taken from this fact sheet.
Dental Material Fact Sheet of the California Dental Association
The Dental Board of California prepared this fact sheet to summarize information on the most frequently used restorative dental materials.
Reason for the Document’s Conception
Dr. Mafi has included information from this fact sheet on her website to encourage discussion between herself and her San Diego patients regarding the selection of dental materials best suited for her San Diego patients’ dental needs. The most frequently used materials in restorative dentistry are amalgam, composite resin, glass ionomer cement, resin-ionomer cement, porcelain (ceramic, often used for porcelain veneers), porcelain (fused-to-metal), gold alloys (noble) and nickel or cobalt-chrome (base-metal) alloys. Dr. Mafi does not use any amalgam or metal-based materials in her San Diego practice.
When reading this information, patients should be aware that the outcome of dental treatment or durability of a restoration is not solely a function of the material from which the restoration was made. The durability of any restoration is influenced by the dentist’s technique when placing the restoration, the ancillary materials used in the procedure, and the patient’s cooperation during the procedure. Following restoration of the teeth, the longevity of the restoration is strongly influenced by the patient’s compliance with dental hygiene and home care, their diet and chewing habits.
Types of Dental Materials and Their Health risks
Both the public and the dental professionals are concerned about the safety of dental treatment and any potential health risks that might be associated with the materials used to restore the teeth. Materials commonly used to restore teeth do not cause adverse health problems for the majority of the population. However, there exists a diversity of various scientific opinions regarding the safety of mercury dental amalgams.
The research literature in peer-reviewed scientific journals suggests that otherwise healthy women, children and diabetics are not at increased risk for exposure to mercury from dental amalgams. Although there are various opinions with regard to mercury risk in pregnancy, diabetes, and children, these opinions are not scientifically conclusive and therefore the dentist may want to discuss these opinions with their patients. There is no research evidence that suggests pregnant women, diabetics, and children are at increased health risk from dental amalgam fillings in their mouth.
A recent study reported in the JADA factors in a reduced tolerance (1/50th of the WHO safe limit) for exposure in calculating the amount of mercury that might be taken in from dental fillings. This level falls below the established safe limits for exposure to a low concentration of mercury or any other released component from a dental restorative material. Thus, while these sub-populations may be perceived to be at increased health risk from exposure to dental restorative materials, the scientific evidence does not support that claim. However, there are individuals who may be susceptible to sensitivity, allergic or adverse reactions to selected materials.
These are some of the reasons that Dr. Mafi does not use amalgam in her San Diego dentist office.
Amalgam and Mercury
As with all dental materials, the risks and benefits should be discussed with the patient, especially with those in susceptible populations. There are differences between dental materials and the individual elements or components that compose these materials.
For example, dental amalgam filling material is composed mainly of mercury (43-54%) and varying percentages of silver, tin, and copper (46-57%). It should be noted that elemental mercury is listed on the Proposition 65 list of known toxins and carcinogens. Any natural dentist would see this as a red flag. Like all materials in our environment, each of these elements by themselves is toxic at some level of concentration if they are taken into the body. When they are mixed together, they react chemically to form a crystalline metal alloy.
Small amounts of free mercury may be released from amalgam fillings over time and can be detected in bodily fluids and expired air. The important question is whether any free mercury is present in amalgam fillings in sufficient levels to pose a health risk. Toxicity of any substance is related to dose, and doses of mercury or any other element that may be released from dental amalgam fillings falls far below the established safe levels as stated in the 1999 US Health and Human Service Toxicological Profile for Mercury Update.
However, natural dentistry seeks to minimize any levels of toxins and you can be sure - Dr. Mafi will not use any toxic materials in your mouth, including amalgam or any metal-based substance.
All dental restorative materials (as well as all materials that we come in contact with in our daily life) have the potential to elicit allergic reactions in hypersensitive individuals. These must be assessed on a case-by-case basis, and susceptible individuals should avoid contact with allergenic materials.
Your overall health and wellbeing is Priority One on Dr. Mafi’s list. She seeks to greatly reduce the potential for allergic reactions in her San Diego patients, which is why she takes the extra time needed to give a thorough initial examination and explanation to every one.
Documented reports of allergic reactions to dental amalgam fillings exist (usually manifested by transient skin rashes in individuals who have come into contact with the material), but they are atypical. Documented reports of toxicity to dental amalgam exist, but they are rare. There have been anecdotal reports of toxicity to dental amalgam and as with all dental material risks and benefits of dental amalgam should be discussed with the patient, especially with those in susceptible populations.
Comparison of Restorative Dental Materials
The Dental Material Fact Sheet compared the traits of four different kinds of Direct Restorative Dental Materials: Amalgam, Composite Resin (used of direct and indirect restorations), Glass Ionomer Cement, and Resin-Ionomer Cement. Here we list the comparisons between amalgam and porcelain (which is listed in the Comparisons of InDirect Restorative Dental Materials, buy it is used for several of the same procedures as those compared in the Direct Restorative Dental Materials list).
Porcelain (Ceramic)
Porcelain, or ceramic, is a glass-like material formed into fillings and crowns using models of the prepared teeth. Its principle use is for porcelain inlays, porcelain veneers, crowns and fixed-bridges. Porcelain veneers have a good resistance to further decay if the restoration fits well. It is the material of choice in Dr. Mafi’s natural dentist practice.
Porcelain is classified as moderately durable. It is a brittle material that may fracture under high biting forces. It is not recommended for posterior (molar) teeth. A good-moderate amount of the tooth can be preserved when using porcelain. Little removal of the natural tooth is necessary when using porcelain for veneers. More removal is necessary for crowns because strength is related to its bulk.
Porcelain veneers are resistant to surface wear, but abrasive to opposing teeth. It has a poor resistance to fracture. However, its resistance to leakage is very good. Porcelain can be fabricated for very accurate fit of the margins of the crowns. Its resistance to occlusal stress is moderate. Porcelain is brittle material susceptible to fracture under biting forces, which is it is predominantly used for porcelain veneers.
Porcelain toxicity was rated excellent in that there are no known adverse effects on the patient’s health when using it. There are also no known allergic or adverse reactions to porcelain veneers. Furthermore the susceptibility to post-operative sensitivity is not material dependent. Porcelain does not conduct heat and cold well – so sensitivity for the patient is very low.
Porcelain’s appearance was rated excellent. The frequency of repair or replacement to porcelain dental work varies. It depends upon biting forces, which is why the material is used for work such as porcelain veneers. Fractures of molar teeth are more likely than anterior teeth. Porcelain fractures may often be repaired with composite resin. The relative cost to the patient is rated high because it often required at least two office visits and laboratory services. The number of visits to the office for porcelain dental work is normally two – minimum. Matching appearance of teeth may require more visits.
However, Dr. Mafi’s San Diego patients have the luxury of a high tech 3D CEREC, which means they can be in and out of her dentist office in a single visit with a ceramic crown, onlay or veneer.
Amalgam
Amalgam is a self-hardening mixture in varying percentages of liquid mercury and silver-tin alloy powder. Amalgam is used for fillings and sometimes for replacing portions of broken teeth. It has a high resistance to further decay, but recurring decay around amalgam is difficult to detect in its early stages.
Amalgam is classed as durable, but relatively speaking, only a fair amount of the healthy tooth can be preserved. Using amalgam requires the removal of healthy tooth to be mechanically retained. There is also no adhesive bond of amalgam to the tooth.
Amalgam has a low resistance to surface wear – and is compared to dental enamel. Amalgam is a brittle metal. Amalgam may also fracture under stress. Furthermore the tooth around the filling may fracture before the amalgam does. Amalgam’s resistance to leakage was classified as Good because it is self-sealing by surface corrosion. But, the margins may chip over time. Resistance to occlusal stress is high, but amalgam’s lack of adhesion may weaken the remaining tooth.
The toxicity of amalgam was classified as generally safe. However, occasional allergic reactions to metal components do occur. Furthermore, amalgams contain mercury. Mercury in its elemental form is toxic and as such is listed on prop 65.
Allergic or adverse reactions to amalgam are rare. But it is recommended that dentist evaluate each patient to rule out metal allergies. Susceptibility to post-operative sensitivity is minimal when using amalgam – but high thermal conductivity may promote temporary sensitivity to hot and cold. Contact with other materials may cause occasional and transient galvanic response.
Amalgam’s appearance was classified as very poor. Amalgam is not tooth colored. Initially amalgam is silver-gray, but it becomes darker and eventually turns black as it corrodes. Amalgam may also stain teeth dark brown or black over time.
Amalgam has a low frequency of repair or replacement, which is usually due to fracture of the filling or the surrounding tooth. Cost to the patient is also low, depending on the size of the filling. A single visit is required to put in an amalgam filling.
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