In the late ’80s and early ’90s, we got a lot of inquiry because there was a big push against metal or amalgam fillings. The reason for that was the mercury. It was the mercury content of amalgam fillings that caused concern. I think that’s a fair call. I think you should be concerned if you’ve got something like mercury floating around in your head. Many interesting things, though, came out of that. There was a stronger association between amalgam fillings and autoimmune diseases. So multiple sclerosis being the most popular, rheumatoid arthritis, and all those autoimmune diseases.
In our practice, we were quite happy on request to remove those based on the fact there was some evidence that could support it. If you’re going to potentially increase the quality of life of a patient, then it was okay. We thought you could, in all good conscience, replace those amalgam fillings. If it’s for aesthetics… Sorry, I should go back. The caveat on removing the amalgam or anything about amalgam. The most exposure you get to a mercury with an amalgam restoration is when you put one in and when you take one out. So in fact, they are actually really stable when they’re in your mouth and they’re quite happily sitting there amalgamated.
It’s when you disturb them that the problem happens. The other negative thing about taking one out is that every time you do something to a tooth, you do inflame the pulp. So the nerve, as lay people would call it, becomes inflamed, and that’s why commonly you get sensitivity, what we call postoperatively.
So it’s not unusual to get that. The danger with that is that potentially that sensitivity could become an irreversible inflammation or Pulpitis. Then you’re looking at root canal treatment and then pretty much a crown. Then you’re on the downhill slide to losing the tooth. You’d say, well, if you’re going to take an amalgam filling out because you don’t like the look of it, think twice because there are potential consequences. Now, it’s not that common, but you still have to be aware that that is a potential risk and a potential reason why you wouldn’t remove amalgam without good reasons, such as autoimmune disease or something like that.
In our practice, our philosophy with amalgam, generally, is that we never put one in, ever. Meaning, if we were to replace one, we would never replace it with another amalgam.
