Before and After Replace Amalgams with Composite Resins
Posted on (not posted yet) by Lanier Valley Dentistry
Here is an example of a case where a patient asked to have their amalgam (silver) fillings switched out with composite (tooth colored) fillings. It is quite often that I get a patient in the office who asks me to switch out all of the old amalgam (silver) fillings because they have read something on the internet that says there is some sort of potential health hazard to keeping them in their mouth. If patients insist on the fillings being replaced, I will oblige. However, there is a substantial amount of per reviewed scientific evidence based evidence that supports the efficacy of amalgam fillings.
If there were a time where the amalgam restoration might be dangerous to someone's health it would be when the filling goes in or comes out...but there is no strong evidence to suggest amalgam fillings cause chronic harm if they are already in the mouth. In fact, there is quite a bit of evidence that suggest that removing them for the sake of removing them may cause more damage from the bur required to remove the amalgam resulting in mircrofractues in the tooth. This goes back to the old adage – if it aint broke, don’t fix it.
There are times where the amalgam blue/grey color can leach into the tooth and cause it to look like, what we affectionately call, “a Smurf tooth”. Quite literally the tooth may appear blue (or grey). This can render a tooth aesthetically unacceptable. Sometimes the tooth can be fixed by replacing the amalgam with a tooth colored composite, but there are cases where we need to do a porcelain crown in order to block out the color of an amalgam stained tooth. These are typically issues for front teeth or maxillary premolars and lower teeth that are in the smile line.
I do not make a habit of telling people they need to have their amalgams out if they are serviceable and being well maintained and they do not pose any aesthetic issue for the patient. But I do understand when they want to have them out due to aesthetics. I myself had amalgam fillings removed in dental school by a colleague and replaced with resin composite fillings.
Again, here is an example of someone who had lower amalgam fillings that were visible when the patient spoke, ate or laughed out loud. We use a rubber damn to collect as much of the amalgam as possible and then place the composite fillings that are now tooth colored. Placement of composite fillings is technique sensitive so the rubber damn not only assists in keeping the amalgam from being ingested, but it also keeps the composite dry – a requirement of the material. The rubber damn also keeps a curious tongue away from a very fast spinning dental drill and potential iatrogenic injury.