Read also the previous summary on tooth filling material (2008)
Safety of dental amalgam and alternative dental restoration materials
Context - In light of recent scientific studies on dental amalgam, the SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks) revisited its 2008 opinion on the safety and performance of both dental amalgam and possible alternatives (i.e. resin-based composites, glass ionomer cements and ceramics).
Mercury, which is the metallic element used in dental amalgam fillings, has well-documented and well-known health effects. Do dental amalgam and alternative materials pose any risks?
- What is dental amalgam?
- What are the alternatives for amalgam fillings?
- Are there any health risks associated with amalgam fillings?
- When is the exposure to mercury from dental amalgam the highest?
- Are there any health risks associated with the use of alternative materials?
- Are some dental filling materials preferable?
1. What is dental amalgam?
Dental amalgam is an alloy of mercury (about 50%) with other metals, usually silver, tin and copper. Dental amalgam has been used for over 150 years for the treatment of dental cavities. It has long been and still is considered the material of choice because it is durable, very hard and inexpensive. However, dental amalgam is not tooth-coloured and does not adhere to remaining tooth tissues. It is held in the tooth mechanically and, in comparison with some alternative materials, requires drilling a relatively large cavity and therefore the removal of more healthy tooth substance.
A reduction in the use of dental amalgam is occurring across the European Union. This is in line with the concern about the exposure to mercury from the environment and with the general aim to reduce mercury use. More...
2. What are the alternatives for amalgam fillings?
The current trend in dentistry is towards techniques that use minimal intervention and materials which adhere to the tooth structure. The use of alternative materials such as ceramics and adhesive composite resins and cements is increasing. Some alternative materials have been offered in dentistry for over thirty years. However, many of the alternative materials have only recently been developed and put into use. More...
3. Are there any health risks associated with amalgam fillings?
The way how mercury is currently used in dental amalgam is not considered to endanger the health of the majority of patients. In some cases there are direct effects in the mouth such as allergic reactions. However, these are relatively rare and could be resolved by removing the amalgam fillings.
Available studies do not indicate that in general dental personnel suffer from adverse effects from mercury, even though they are more exposed to it than patients. More...
4. When is the exposure to mercury from dental amalgam the highest?
The highest exposure to mercury occurs during placement or removal of dental fillings. Accordingly, there is no justification for unnecessarily removing amalgam restorations when they do not cause an allergic reaction. As with any other medical or pharmaceutical intervention, caution should be exercised for pregnant women when considering the placement or removal of dental fillings. More...
5. Are there any health risks associated with the use of alternative materials?
The alternative materials have clinical limitations and may pose toxicological hazards. However, limited data are available on exposure of patients and dental personnel to substances that are used in alternative restorative materials. The available data revealed little evidence of adverse effects. It is important to note that the composition of resin materials has changed substantially in recent years and improved polymerisation processes result in a smaller amount of material released.
As the scientific data on possible adverse effects of alternatives are very limited, the Scientific Committee notes that it is not possible to provide a scientifically sound statement on the overall safety of these materials. Further research is needed. More...
6. Are some dental filling materials preferable?
The opinion of the SCENIHR is that for the general population, current evidence does not preclude the use of either amalgam or alternative materials in dental restorative treatment. From the perspectives of longevity, mechanical performance and economics, dental amalgam is still considered the material of choice. The dentist should base the choice of material on patient characteristics such as primary or permanent teeth, pregnancy, presence of allergies to mercury or other components of the restorative materials, and eventual decreased renal functioning.
The reasons for this choice should be explained to the patients to help them make informed decisions. More...