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What is it about Amalgam fillings that is contentious?


Tooth fillings like amalgam fillings have been a contentious issue in the dental industry, but it never used to be that way.

When I graduated from dental college back in the mid Eighties and started working on the Gold Coast, tooth fillings – specifically amalgam fillings – were offered as the only choice for dentists or patients.

As time went on, the options expanded from amalgam to include white resin fillings for front teeth, while amalgam continued to be used for a back tooth filling. Gold Coast patients, and actually dental patients anywhere, are now more savvy about their oral health and want to understand how amalgam fillings could affect their teeth.

Despite the confidence many of my colleagues had, and continue to have, in amalgam fillings, I felt my enthusiasm for amalgam waning when I started to see a lot of teeth fracturing when filled with this material.

So much in fact, that if I hedged a bet when a tooth fracture, nine out of ten times, it would be a result of an amalgam filling. These aren’t good odds and through my practice, I found resin is much more forgiving to the tooth structure. Let me explain what I meant by that.

Why the argument about amalgam versus resin tooth fillings?

The argument with around 50 percent of dentists in Australia and America is that amalgam fillings are the way to go. Although this percentage is a big drop from what it once was, these dentists are adamant amalgam fillings are the best solution.

The reason they argue amalgam is the best material is because they say resin fillings are more prone to decay developing.

My response? You need to know how to use resin for a tooth filling. Gold Coast dentists like me have become highly skilled at using resin for fillings, even while acknowledging that amalgam does have its advantages.

Amalgam is strong for sure. Actually, as a material it is much stronger than the tooth itself. Believe it or not, this can be a problem, especially when teeth are the hardest material in the human body. But even as strong as teeth are, they are no match for the strength of amalgam.

When the amalgam filling sets, it expands. When it expands, it has the potential to crack the tooth structure. Tiny fine fracture lines can form inside that tooth and those fracture lines can grow, and grow, and grow over time.

Another drawback of amalgam fillings is they shrink and contract with variations in temperature. Significant temperature changes can cause the tooth to split. In the worst cases, a tooth can be lost. This is never the solution a dentist wants, because our philosophy is Teeth. For life.

I’ve seen many examples where this situation has occurred and it’s why I encourage patients to replace their amalgam fillings with resin as soon as they can manage to do this.

If you don’t, here are a couple of very typical scenarios you might experience:

  • A simple amalgam filling can cause a very small fracture and lead to a tooth splitting in two. What then? The tooth literally comes out and must be replaced with an implant.
  • Large amalgam fillings can fracture a tooth right off, leaving the filling – but no tooth. Really? Yes, really. Amalgam fillings can destroy a tooth.

These scenarios occur almost all the time without any ‘pain’ to the patient.

For us, a preventative approach is a no brainer. That’s why when we place our patients on a preventative maintenance program, we recommend replacing amalgam fillings with resin if they want to keep their teeth for life.

There is no silver bullet for tooth fillings, but….

Are resin fillings the answer to every filling?

No, but in their favour is the fact they expand much less than amalgam and they are much kinder to the tooth structure. And that’s what we’re all about at Dental as Anything; kindness and preserving teeth, ideally for life.

In 1999, I made a move to doing only resin tooth fillings. Gold Coast dentist replaces all his own amalgam fillings! Sounds like a fake news headline, right? But I invested in the change and replaced all my own amalgam fillings and all my wife’s fillings. As for my kids,? Well, they’ve never had an amalgam filling; they only have resin. Apart from feeling very strongly about the importance and benefits of resin fillings, I wanted to avoid crowns myself, should the filling fracture the tooth at some point.

Rocking the dental boat with #noamalgam

Having been in dental practice for over 30 years, I’m passionate about people not having amalgam fillings. It’s now 20 years since I’ve performed an amalgam filling and I have no plans to start doing them again either. The main reason? Because I care about the health and wellbeing of my patients.

I know I’m going against a dental trend and I know people will argue otherwise, but really we don’t need something that’s seven times stronger than the tooth structure and has the potential to permanently damage it.

My opinion? We need to think smarter than just using an amalgam filling, and there are now other options available. If you have amalgam fillings, be sure to speak to your dentist about the alternatives that are better for your teeth and health. And if you’re feeling confused and want to learn more, make time to come in for a chat. We’ll show you that your very best oral health is well within reach.

Dr Mark Miller is the principal dentist at Dental as Anything, where he performs Gold Coast tooth fillings by serving the community in Helensvale, Southport, Oxenford, Hope Island, Pacific Pines, Coomera and Upper Coomera. If you have amalgam fillings, now could be time to consider replacing them with a healthier, safe option like resin to give yourself the best chance of keeping your teeth for life. Ready now? Phone 5573 0188 or email us on welcome@dentalasanything.com.au.

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