The 80th element of the periodic table is no stranger to controversy. A unique and bizarre substance, it maintains a metallic liquid state under ordinary conditions and vaporizes upon contact with only moderate heat, earning it the alias quicksilver, not to mention a considerable measure of awe. Throughout history it has at turns been venerated and feared: In ancient China it was regarded as a giver of eternal life, and it was used by the Greeks in ointments and by the Egyptians in cosmetics. It takes its very name from the Roman god of speed and agility.
But as more is learned about mercury’s highly toxic properties and its harrowing effects on the environment and human health, its modern reputation is rife with infamy. Pregnant and breastfeeding women are issued dire warnings not to eat fish that may contain high levels of mercury. Parents agonize over whether to have their families immunized with mercury (thimerosal)-preserved vaccinations. And increasing consumer awareness, coupled with the widespread speculation that mercury exposure can trigger copious systemic health problems including neurological developmental disabilities like autism and ADHD, have led to escalating, often passionate debates on the practicality of the metal’s current applications.
In recent years, one of mercury’s most common uses—as the primary component in dental amalgam fillings—has come into focus as an easily preventable source of exposure, despite the longevity and benefits of the material’s employ and its unwavering support by nearly every national professional dental association, along with the Food and Drug Administration (FDA) and the Centers for Disease Control (CDC). In fact, for over 150 years, dental amalgam has been the most preferred solution of dentists for cavity fillings and restorations, but with continued development—and constant improvement—of alternative materials, more dentists and their patients are weighing the risks and benefits and saying no to amalgam.
Quicksilver, not silver
Those metal fillings in your mouth might look like silver, but in truth, the material commonly referred to by dental professionals as silver amalgam is an alloy made up of a whole gang of ingredients. Along with a small amount of silver, there may be tin, copper, zinc, and other metals, but highest on its list of ingredients (roughly half of the recipe, in fact) is liquid mercury. When those components are combined, what results is a highly durable, particularly low-cost, and—its proponents claim—stable material that is easy to handle and well suited for repairing our mouths, a claim they say is backed by 150 years of continued use and a lack of scientific evidence to the contrary.
Indeed, according to the American Dental Association (ADA), dentists place more than 100 million amalgam fillings every year. The widespread acceptance of dental amalgam, however, may have more to do with a general lack of awareness than consensus—or even evidence—of its safety: Despite its highly prevalent use, polling as recent as 2006 indicates that nearly half of Americans are unaware that mercury is the primary metal in amalgam. And more than 90 percent think dentists should be required to inform patients of alternatives, which in many places is not current practice. As well, a large body of evidence has called into question the safety of the constant exposure to mercury-based metals, not only for patients but also for dentists, their technicians, and their staff.
Across the country, a growing number of practices have renounced the use of amalgam altogether. In the Hudson Valley, a handful of dentists who are way ahead of the curve haven’t relied on use of the material in cavity restorations for decades, following their convictions in spite of at-times tremendous professional pressure to tow the amalgam line.
Why mercury-free dentistry?
“If you got a hundred dentists in a room and brought up the question of mercury safety,” says Bruce Kurek, DDS, founder of the Center for Advanced Dentistry in Highland, “you would see a very passionate and emotional debate. I don’t offer mercury fillings here under any circumstances, and I haven’t in over two decades. The reason I stopped [using amalgam] is simple: Mercury is toxic.”
While concern over the dangers of mercury-based amalgam stayed his conviction, what’s important to Kurek is that his patients have the information to make a knowledgeable decision about their own care—even, he says, if that means referring them to a practitioner who will repair their teeth with amalgam. But, he adds, that has never happened. “Over the course of many thousands of patients that I’ve treated, I’ve never had anybody say, ‘No, doc, I prefer mercury.’ Even when they know the alternative will cost a little bit more, when people understand how toxic mercury can be, it’s a no-brainer.”
And toxic it is. Exposure to certain forms of mercury have been known to cause permanent damage to the brain, nervous system, kidneys, and immune system, leading to gastrointestinal problems, sleep disturbances, concentration problems, tremors, memory disturbances, depression, restlessness, bleeding gums, and plenty of other systemic diseases. It has also been speculated that mercury poisoning can be implicated in cases of Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, Lou Gehrig’s disease, and autism. The contention of the ADA, FDA, CDC, and other agencies condoning the use of amalgam is not whether the element itself is toxic, but that, they say, in its amalgamated form the mercury becomes stable.
A growing number of studies and even public policy, however, suggest otherwise. It has been proven that mercury-based fillings emit trace amounts of mercury vapor, even after decades in the mouth, and that chewing, drinking hot liquids, and otherwise agitating mercury fillings can increase the off-gassing substantially. Still, the ADA maintains that the amount of mercury vapor released by dental fillings is not enough to pose a significant threat.
“The ADA says it’s safe,” says Michael Tischler, DDS, of Tischler Family Dentistry in Woodstock. “But we’re also regulated by state agencies that say when we remove mercury from the mouth, we have to put it in a special container and dispose of it as toxic waste.” The Tischlers, who incorporate holistic approaches including acupuncture in their patients’ dental care, have not used mercury amalgam in their practice in over 15 years.
“New York State has now mandated that all dental offices have a special sedimentation filter on their waste water line so we do not allow mercury to enter the sewer system,” adds Jeffrey Viglielmo, DDS. “So it is illegal to flush it down the drain for its effects on the environment, but we can put it in your mouth and let you leave our health care offices? Something is wrong with that picture, isn’t there?”
Viglielmo, who practices mercury-free dentistry in Kingston, is a member of the International Academy of Oral Medicine and Toxicology, a professional association whose mission it is to “continually examine and compile scientific research relating to the biocompatibility of oral/dental materials,” including mercury amalgam, and to act as a network of dentists and specialists who share that aim.
“Way back when I started this, dentists were actually persecuted by the dental societies for acquiescing to patients’ requests to remove mercury,” agrees Kurek. “There are dentists who have lost their licenses, who have had disciplinary action or had suspensions. It was a real knee-jerk reaction, a threat that the profession perceived. But,” he says, “things have changed since then.”
Should it stay or
should it go?
While it may be disconcerting to have mercury-based amalgam fillings in one’s mouth, having them removed is not without risks. Nor will doing so promise improved or sustained health, stress dentists. “When patients come to me and ask about this, I let them know about mercury and its toxicity,” says Kurek, “but I’m always very careful not to imply to them that they’re going to benefit in any specific way as far as their health is concerned. They can be the judges of that. But dentists have to be very careful not to offer hope that you don’t know will be there.”
“If a patient wants to have it done, that’s their right,” agrees Bruce Jay Milner, DDS, of Transcend Dental in West Hurley. “On the other hand, I don’t say to them, ‘If you have your 20 silver fillings removed you’re going to feel better and you’re going to lose the chronic disease that you have.’ No one can make those guarantees.”
It is important to minimize the risk of mercury exposure when removing existing amalgam restorations, and most dentists take a similar set of precautions. “When fillings are drilled out, they create a very, very fine particulate dust that is easily aspirated into the lungs, where it enters the blood stream,” explains Kurek. “And mercury has the ability to permeate the blood-brain barrier. The most effective way to prevent mercury from entering the patient’s respiratory system when fillings are being removed is to apply a rubber dam to the patient’s mouth. We also use a lot of water irrigation that keeps the dust down, and we use very high-speed suction” to remove mercury particulate from the site. Additionally, some dentists incorporate nutritional supplements like activated charcoal to help support the body in excreting any mercury that may have been ingested in the process.
Guarantee of health or not, among patients who have had their amalgam fillings removed, there is plenty of anecdotal evidence to support the advantages of doing so. “Have we seen people improve their health after removing mercury fillings at a physician’s request? The answer is yes, absolutely,” says Tischler. “That’s an important thing.”
Adds Viglielmo, “Many [patients] have told me that they just feel better knowing that there is no more mercury out-gassing in their mouths. Most recognize that like most things with one’s health, what you do today most likely will show its effects many years hence. I had mine replaced over eight years ago with gold inlays. I had no idea at the time that my minor hand tremors were an early symptom of mercury toxicity.” Since the removal of his amalgam fillings, he says, the tremors have disappeared.
Life without mercury
“The argument that many of us dealt with in the early days,” says Kurek, “was that you could use a tooth-colored resin filling, but it wasn’t going to hold up well. And they were right. We’re into seventh-generation materials now, and if they’re used correctly, they have excellent durability functionally and aesthetically, and they represent excellent value. I have them in my own mouth, my staff’s, my family’s, and certainly all of my patients’ mouths.”
In addition to a tooth-colored composite of glass or quartz filler in a resin medium, porcelain and gold-based metal fillings present alternatives to mercury-based materials. “I think the storm clouds are building,” says Kurek. “It’s just a matter of time before it’s going to be very difficult for organized dentistry to defend the use of amalgam. In Europe we’re already seeing legislation to limit or to completely ban its use… When it comes to the way I practice every day, I just had to ask myself, ‘What could possibly be the justification for putting this in somebody’s body?’ There just isn’t any.”
RESOURCES
Center for Advanced Dentistry
494 Rt. 299, Highland; (845) 691-5600
www.thecenterforadvanceddentistry.com
Tischler Family Dentistry
121 Rt. 375, Woodstock; (866) 359-5743
www.tischlerdental.com
Transcend Dental
269 Rt. 375, West Hurley; (845) 679-4000
www.transcenddental.net
Jeffrey Viglielmo, DDS
56 Lucas Avenue, Kingston; (845) 339-1619
idealhealthdds@aol.com
This article appears in May 2008.
