Dental fillings: Amalgam vs Composite

Amalgam Fillings - Pros / Cons

Pros:

• With metal content present, these fillings are stronger and thus able to withstand heavy biting pressure. Because of this strength, they are primarily used for back teeth (molars) where biting force is intense
• Relatively inexpensive

Cons:

• Contains mercury
• Amalgam filling are completely safe and there is no conclusive studies to mercury inside amalgam fillings posing any danger.
  In June 2008, FDA admits that amalgam dental fillings may NOT be safe. Quoted from FDA site:

“Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses. When amalgam fillings are placed in teeth or removed from teeth, they release mercury vapor. Mercury vapor is also released during chewing”

“Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner”

• In light of the above, not all dentist offer amalgam fillings anymore
• More tooth area is lost in the preparation process
• Aesthetically not pleasing (looks like you’ve got black beans stuck in your teeth)

Composite Fillings - Pros/Cons

Pros

• Does not contain mercury, It is basically a plastic with a combination of finely ground particles of silica, quartz, barium,glass, zirconium, and strontium (all dependent upon manufacturer’s unique blend).
• Aesthetically pleasing. Looks like your tooth colour, that explains why it’s sometimes called “tooth-coloured filling/restoration”. Duh.
• Hardens immediately after your treatment (due to light activation), therefore chewing on the site immediately is possible
• Less tooth area is lost in the preparation process

Cons

• More expensive than amalgam ($20-$50 more in Singapore)
• Time taken is usually longer
• Susceptible to staining from staining agents like coffee, tea, tobacco etc.
• Not as strong as amalgam fillings

Conculsion:

In light of the recent health dangers and aesthetics, composite fillings would be a better choice. But due to the inability to withstand large amounts of bite pressure, might not last as long as amalgam fillings in the back teeth.

In any case, ask your dentist for the best solution to your problem.

*Update 27th Dec 2008

Thanks for the emails from concerned Singaporeans that still have amalgam in their mouth or are thinking of doing a filling but are uncertain about which one to choose.

In the Straits Times Fri 11 July 2008, there was an article on the FDA’s announcement where some dentist commented on their findings. Yet again, there are 2 camp regarding this. To view, click here.

Additional resources on this topic:

• America’s Dental Association (ADA) comments on FDA’s settlement on Dental amalgam Lawsuit
• ADA’s stand
• Dental amalgam controversy
• Norway bans mercury fillings
• Norwegien Ministry of Environment: Bans mercury in products
• Reuters: Dental mecury ban in Norway, Sweden & Denmark
• Reuters: US FDA Admits Risks of Mercury Dental Fillings, Settles Lawsuit
• Reuters: Mercury teeth fillings may harm some: FDA
• Philadelphia - First City in Nation - to Pass a Law Requiring Informed Consent
  Before Dentists Use Mercury Amalgam
• Amalgams pose no risk to human health, EU report says
• Asiaone: Silver dental fillings may not harm kids’ brain

And the list goes on….. and on….

However, Singapore’s dental associations continues to state that amalgam filling is safe to be used. That’s why your dentist still offers amalgam fillings as an option to tooth restoration.

This has been and will continue to be a debate. Like many of the other debates going on,

• “excessive usage of handphones is dangerous & affects your brain (mobile phone controversy)”
• “artificial sweeterners causes brain tumors, brain lesions, mental disorders (Aspartame controversy)”

we’ll just have to wait and see…

When it comes to making a decision, you should consult your dentist on his views on this matter. But to many of us, we agree with M.J. when he said “it doesn’t matter if it’s black of white”.