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Toxic Teeth: Are Amalgam Fillings Safe?
By Dr. Jonathan B. Levine
World-renowned NYC aesthetic dentist, oral health expert, author and inventor.
To quote the famous William Shakespeare – had he been a restorative dentist –
“To leave my amalgam fillings or not to leave my amalgam fillings, that is the question.”
Are Your Silver Fillings Making You Sick?
One of the most vexing issues in dentistry today revolves around the use of silver fillings (amalgams) in our mouths. Do we need to take out the old mercury-laden silver fillings for fear of health issues and replace them, or are there better restorative dentistry options that do not pose any potential risk to our health?
Dental professionals in the United States and around the world are currently debating this hot issue.
Amazingly, 72% of those surveyed in the US did not know that silver fillings contain mercury and when they do find out, 92% of the respondents would have wanted to know about the possible mercury issues when the silver fillings were first placed.
Mercury is a powerful neurotoxin and, at certain levels, can cause neurological issues, autoimmune disease, chronic illnesses and mental disorders. The burning question is whether an unknown quantity of mercury vapor in our silver fillings at a constant exposure poses a significant health risk.
Amalgams consist of 50% mercury along with a combination of silver, tin, and copper. Studies have found that the amount of mercury vapor from amalgams varies from 1- 3 ug/day (micrograms/day), at the low estimation, up to 27 ug/day. This translates to 3% to 68% of workplace air quality standards that are allowable by the Occupational Safety and Health Administration (OSHA, our federal environmental agency).
What this means is that at the high level – and with continuous exposure – we could be at levels that OSHA says are unhealthy. The World Health Organization (WHO) has stated that the exposure to mercury vapor can greatly increase beyond this number due to personal habits such as grinding of the teeth, chewing gum, and drinking carbonated drinks. This could lead to a fivefold increase in mercury levels after these activities.
In addition to the problems with mercury vapor coming off of silver fillings in our mouth, there is the issue of water contamination from removing the silver fillings and the ensuing environmental impact as the mercury finds its way into the water supply.
The WHO (World Health Organization) reports that mercury from amalgam and laboratory devices accounts for 53% of total mercury emissions into our environment. The EPA recommends that dentists use amalgam separators to catch and hold excess amalgam waste, to decrease the release of mercury into the sewer system. At this time, these are not mandatory in the US. Let’s all be aware of the environmental issues surrounding amalgam removal and nudge our elected officials to get current on this problem and come up with solutions.
The US is not alone in this conundrum. In 2008, Scandinavian countries took action and banned the use of amalgam fillings for environmental and health reasons.
There are conflicting studies between Sweden and the United States. In Sweden, they have conducted a number of studies where people, with pre-existing neurological and health issues (Chronic Fatigue-type symptoms), had amalgams removed; 78% reported improvement in their health status. In the United States, official studies hired by the FDA and National Institutes of Health (NIH) stated that “the current data is insufficient to support an association between mercury release from amalgams and the various complaints that have been attributed to this restorative material."
By Dr. Jonathan B. Levine
World-renowned NYC aesthetic dentist, oral health expert, author and inventor.
To quote the famous William Shakespeare – had he been a restorative dentist –
“To leave my amalgam fillings or not to leave my amalgam fillings, that is the question.”
Are Your Silver Fillings Making You Sick?
One of the most vexing issues in dentistry today revolves around the use of silver fillings (amalgams) in our mouths. Do we need to take out the old mercury-laden silver fillings for fear of health issues and replace them, or are there better restorative dentistry options that do not pose any potential risk to our health?
Dental professionals in the United States and around the world are currently debating this hot issue.
Amazingly, 72% of those surveyed in the US did not know that silver fillings contain mercury and when they do find out, 92% of the respondents would have wanted to know about the possible mercury issues when the silver fillings were first placed.
Mercury is a powerful neurotoxin and, at certain levels, can cause neurological issues, autoimmune disease, chronic illnesses and mental disorders. The burning question is whether an unknown quantity of mercury vapor in our silver fillings at a constant exposure poses a significant health risk.
Amalgams consist of 50% mercury along with a combination of silver, tin, and copper. Studies have found that the amount of mercury vapor from amalgams varies from 1- 3 ug/day (micrograms/day), at the low estimation, up to 27 ug/day. This translates to 3% to 68% of workplace air quality standards that are allowable by the Occupational Safety and Health Administration (OSHA, our federal environmental agency).
What this means is that at the high level – and with continuous exposure – we could be at levels that OSHA says are unhealthy. The World Health Organization (WHO) has stated that the exposure to mercury vapor can greatly increase beyond this number due to personal habits such as grinding of the teeth, chewing gum, and drinking carbonated drinks. This could lead to a fivefold increase in mercury levels after these activities.
In addition to the problems with mercury vapor coming off of silver fillings in our mouth, there is the issue of water contamination from removing the silver fillings and the ensuing environmental impact as the mercury finds its way into the water supply.
The WHO (World Health Organization) reports that mercury from amalgam and laboratory devices accounts for 53% of total mercury emissions into our environment. The EPA recommends that dentists use amalgam separators to catch and hold excess amalgam waste, to decrease the release of mercury into the sewer system. At this time, these are not mandatory in the US. Let’s all be aware of the environmental issues surrounding amalgam removal and nudge our elected officials to get current on this problem and come up with solutions.
The US is not alone in this conundrum. In 2008, Scandinavian countries took action and banned the use of amalgam fillings for environmental and health reasons.
There are conflicting studies between Sweden and the United States. In Sweden, they have conducted a number of studies where people, with pre-existing neurological and health issues (Chronic Fatigue-type symptoms), had amalgams removed; 78% reported improvement in their health status. In the United States, official studies hired by the FDA and National Institutes of Health (NIH) stated that “the current data is insufficient to support an association between mercury release from amalgams and the various complaints that have been attributed to this restorative material."
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In 2001, the US National Health and Nutrition Examination surveyed 31,000 adults and found that the number of dental fillings correlated to the incidence of cancer, mental conditions, thyroid conditions, neurological issues (including MS), diseases of the respiratory system, and diseases of the eye. However, the United States, FDA and various Supreme Court justices determined that “the correlations do not sufficiently demonstrate causation.”
What this means is that statistical evidence showing mercury vapor emitting from amalgams does not have a direct causative effect on the various diseases that are being implicated, and correlation does NOT mean causation.
In 2003, the World Health Organization called for further studies to be done. In 2009, the FDA issued a new regulation placing dental amalgams into Class II (moderate risk) from Class I (low risk), allowing them to impose special controls and recommendations surrounding the use of amalgams.
The current ADA and FDA position is that amalgam is a safe restorative material, and any dentist who recommends removing amalgams due to health concerns from mercury vapor is deemed unethical and could have their license taken away. Silver fillings have been used for 150 years; today, around 47% of all dentists still place amalgam fillings.
We do know that mercury vapor is released from silver fillings. But whether amalgam poses a real health risk is still not known for sure. We know there are certain factors that play into more mercury leaching into the body: the number of fillings in the mouth, the age of the fillings, diet, the acid we put in the mouth through carbonated drinks and grinding of the teeth.
Dental amalgams were always considered inert, that little mercury release would occur. With new detection techniques, the measurement of mercury release from amalgam fillings has become possible, down to micrograms per cubic meter. These new detection methods are allowing experts to question previous studies, and new concerns are surfacing from experts.
The highest amount of mercury exposure from silver fillings occurs when they are placed and when they are removed from our mouths. Don’t run to the dentist to have your fillings taken out. But do have your dental team examine your fillings to determine whether or not they are intact, and have a conversation about the potential health risks of keeping or removing amalgams.
If they are 20 years and older, causing gum inflammation and preventing you from flossing, and/or have decay underneath, replace them with a non-amalgam restoration. There are terrific restorative options that we currently have in the dental profession other than silver fillings, including direct composite fillings, a cost-effective option, or the more expensive laboratory-fabricated porcelain and/or gold restoration that strengthen the teeth without the potential long-term health risks.
If you are having a silver filling removed, make sure the dentist is using a dental rubber dam that isolates the tooth and minimizes the amount of mercury vapor released.
We must be transparent in the United States about the potential health threat from amalgam fillings. The most critical action point is for more research to be conducted. We need stronger clinical studies funded by our government agencies and research centers to clearly understand the effect of continual release of mercury by amalgam fillings and the cumulative effect on all of us – adults, nursing mothers, newborn babies and children.
With this information, you are now armed with the facts. Discuss the options with your dental professional to make a smart decision.
Learn more about your dental filling options.
What this means is that statistical evidence showing mercury vapor emitting from amalgams does not have a direct causative effect on the various diseases that are being implicated, and correlation does NOT mean causation.
In 2003, the World Health Organization called for further studies to be done. In 2009, the FDA issued a new regulation placing dental amalgams into Class II (moderate risk) from Class I (low risk), allowing them to impose special controls and recommendations surrounding the use of amalgams.
The current ADA and FDA position is that amalgam is a safe restorative material, and any dentist who recommends removing amalgams due to health concerns from mercury vapor is deemed unethical and could have their license taken away. Silver fillings have been used for 150 years; today, around 47% of all dentists still place amalgam fillings.
We do know that mercury vapor is released from silver fillings. But whether amalgam poses a real health risk is still not known for sure. We know there are certain factors that play into more mercury leaching into the body: the number of fillings in the mouth, the age of the fillings, diet, the acid we put in the mouth through carbonated drinks and grinding of the teeth.
Dental amalgams were always considered inert, that little mercury release would occur. With new detection techniques, the measurement of mercury release from amalgam fillings has become possible, down to micrograms per cubic meter. These new detection methods are allowing experts to question previous studies, and new concerns are surfacing from experts.
The highest amount of mercury exposure from silver fillings occurs when they are placed and when they are removed from our mouths. Don’t run to the dentist to have your fillings taken out. But do have your dental team examine your fillings to determine whether or not they are intact, and have a conversation about the potential health risks of keeping or removing amalgams.
If they are 20 years and older, causing gum inflammation and preventing you from flossing, and/or have decay underneath, replace them with a non-amalgam restoration. There are terrific restorative options that we currently have in the dental profession other than silver fillings, including direct composite fillings, a cost-effective option, or the more expensive laboratory-fabricated porcelain and/or gold restoration that strengthen the teeth without the potential long-term health risks.
If you are having a silver filling removed, make sure the dentist is using a dental rubber dam that isolates the tooth and minimizes the amount of mercury vapor released.
We must be transparent in the United States about the potential health threat from amalgam fillings. The most critical action point is for more research to be conducted. We need stronger clinical studies funded by our government agencies and research centers to clearly understand the effect of continual release of mercury by amalgam fillings and the cumulative effect on all of us – adults, nursing mothers, newborn babies and children.
With this information, you are now armed with the facts. Discuss the options with your dental professional to make a smart decision.
Learn more about your dental filling options.
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Amalgam, Mercury Contamination and What You Need to Know
By Gerald P. Curatola, D.D.S.
Oral Health and Wellness Expert, Clinical Associate Professor, NYU College of Dentistry
When considering the history and the polarized positions surrounding the ongoing use of mercury-containing fillings in dentistry, it could be argued that it is time to “stop the insanity.” Dental amalgam is actually comprised of four metals – mercury, silver, copper and tin – with mercury, its most toxic element, also being its most significant component, approximately 50% by weight. Once believed to be “locked into the filling itself,” mercury vapor is now widely recognized to be emitted from the filling surface, but the actual harm of this vapor has been highly contested.
Are Your Silver Fillings Making You Sick?
While the use of mercury-free fillings, such as tooth-colored composite resins and ceramics, are becoming more prevalent and better performing, approximately 46% dentists in the United States still use mercury-containing dental amalgam. Since the Civil War, mercury-containing fillings (often called “silver” or “amalgam”) continue to be used extensively to fill dental cavities.
A 2006 poll of 2,590 US adults found that 72% of respondents were not aware that mercury was a main component of dental amalgam, and 92% of respondents would prefer to be told about mercury in dental amalgam before receiving it as a filling. This could be compared to being given a drug today by a pharmacy without the mandated FDA prescribing information (contents, possible side effects, etc.). Unfortunately, many dentists continue to place mercury-containing fillings, with many patients remaining uninformed of its mercury content.
Complicating the matter of mercury-containing fillings is the important fact that the greatest exposure of mercury vapor to the patient (and dentist) is when dental amalgams are first placed in the tooth and when they are removed.
Mercury use in health, consumer, and industrial products has declined precipitously in all products over the past 30 years, but in dentistry, this decline has only been slight, such that dental fillings jumped from 2% of all mercury products two decades ago to over 20% in 2001. In 1991, the World Health Organization (WHO) confirmed that mercury contained in dental amalgam is the greatest source of mercury vapor in non-industrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and for air.
WHO also went on to state that mercury contained in dental amalgam and in laboratory and medical devices accounts for about 53% of total mercury emissions – and about one-third of the mercury in the sewage system comes from dental amalgam flushed down the drain. The Association of Metropolitan Sewerage Agencies (AMSA) studied seven major waste-water treatment plants and found that dental uses were "by far" the greatest contributors of mercury load, on average contributing 40%, over 3 times the next greatest contributor. The Environmental Protection Agency (EPA) also declared that dental amalgam is a major source of mercury contamination in waste-water.
The health debate surrounding mercury-containing fillings is equally concerning and confusing. Peer-reviewed scientific studies have come to opposite conclusions on whether the mercury exposure from amalgam fillings causes health problems. While it would be appropriate that any medical device should be proven 100% safe BEFORE being placed in the human body, and all potential health concerns from a known toxic environmental hazard be fully investigated, dental amalgam continues to be used until enough ongoing research is accepted proving it is unsafe and unsuitable.
By Gerald P. Curatola, D.D.S.
Oral Health and Wellness Expert, Clinical Associate Professor, NYU College of Dentistry
When considering the history and the polarized positions surrounding the ongoing use of mercury-containing fillings in dentistry, it could be argued that it is time to “stop the insanity.” Dental amalgam is actually comprised of four metals – mercury, silver, copper and tin – with mercury, its most toxic element, also being its most significant component, approximately 50% by weight. Once believed to be “locked into the filling itself,” mercury vapor is now widely recognized to be emitted from the filling surface, but the actual harm of this vapor has been highly contested.
Are Your Silver Fillings Making You Sick?
While the use of mercury-free fillings, such as tooth-colored composite resins and ceramics, are becoming more prevalent and better performing, approximately 46% dentists in the United States still use mercury-containing dental amalgam. Since the Civil War, mercury-containing fillings (often called “silver” or “amalgam”) continue to be used extensively to fill dental cavities.
A 2006 poll of 2,590 US adults found that 72% of respondents were not aware that mercury was a main component of dental amalgam, and 92% of respondents would prefer to be told about mercury in dental amalgam before receiving it as a filling. This could be compared to being given a drug today by a pharmacy without the mandated FDA prescribing information (contents, possible side effects, etc.). Unfortunately, many dentists continue to place mercury-containing fillings, with many patients remaining uninformed of its mercury content.
Complicating the matter of mercury-containing fillings is the important fact that the greatest exposure of mercury vapor to the patient (and dentist) is when dental amalgams are first placed in the tooth and when they are removed.
Mercury use in health, consumer, and industrial products has declined precipitously in all products over the past 30 years, but in dentistry, this decline has only been slight, such that dental fillings jumped from 2% of all mercury products two decades ago to over 20% in 2001. In 1991, the World Health Organization (WHO) confirmed that mercury contained in dental amalgam is the greatest source of mercury vapor in non-industrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and for air.
WHO also went on to state that mercury contained in dental amalgam and in laboratory and medical devices accounts for about 53% of total mercury emissions – and about one-third of the mercury in the sewage system comes from dental amalgam flushed down the drain. The Association of Metropolitan Sewerage Agencies (AMSA) studied seven major waste-water treatment plants and found that dental uses were "by far" the greatest contributors of mercury load, on average contributing 40%, over 3 times the next greatest contributor. The Environmental Protection Agency (EPA) also declared that dental amalgam is a major source of mercury contamination in waste-water.
The health debate surrounding mercury-containing fillings is equally concerning and confusing. Peer-reviewed scientific studies have come to opposite conclusions on whether the mercury exposure from amalgam fillings causes health problems. While it would be appropriate that any medical device should be proven 100% safe BEFORE being placed in the human body, and all potential health concerns from a known toxic environmental hazard be fully investigated, dental amalgam continues to be used until enough ongoing research is accepted proving it is unsafe and unsuitable.
The Food and Drug Administration (FDA) has stated that,
“There is limited clinical information about the potential effects of dental amalgam fillings on pregnant women and their developing fetuses, and on children under the age of 6, including breastfed infants.”
In 2002, the FDA also issued a statement on dental amalgam, which asserted that "no valid scientific evidence exists that has shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy.” Nevertheless, a 1991-1997 study of 3,162 patients in Sweden and Germany found that 719 of those with mercury fillings, or 23%, tested positive for systemic allergic sensitivity to inorganic mercury on the MELISA lymphocyte proliferation test.
A paper published as part of a 1991 National Institutes of Health (NIH) conference on side effects of dental restorative materials also reported a 22.53% incidence of allergy in subjects who had amalgam fillings for more than five years. A 2003 monograph on mercury toxicity from the World Health Organization (WHO) concluded that studies on humans and animals demonstrated that dental amalgam contributes significantly to mercury body burden in humans with amalgam fillings, and dental amalgam is the most common form of exposure to elemental mercury in the general population.
In 2008, the FDA issued an advisory, warning pregnant women and children (the most sensitive population to mercury) about dental amalgam containing mercury, and posted this warning on their website. However, after significant debate, in addition to reclassifying dental amalgam as a Class II (more risk) medical device, this warning was amended in 2009 to: “Pregnant or nursing mothers and parents with young children should talk with their dentists if they have concerns about dental amalgam."
Most recently, the American Public Health Association (APHA) issued a policy statement, in conjunction with the American Dental Association (ADA), affirming that “dental amalgam is safe and effective in treating cavities.” It pointed out that since amalgams are less expensive, easy to place and extremely durable, it also argued that curtailing amalgam’s availability could have “negative health effects” in low-income areas that need low-cost fillings.
All this brings to mind the expression, “The operation was a success, but the patient died.” While the continued use of dental amalgam has strong support as a restorative success, shouldn’t we also continue to be concerned if the patient and our planet could be negatively impacted by a known toxic element? If that is true, then the debate should continue and the retirement of this old standard in dentistry should be considered as we look toward safe and stable restorative alternatives.
Until then, here are five top considerations for those who should speak to their dentist about having their amalgam fillings removed, and five top considerations for the best protective measures and nutritional support before and after amalgam removal and replacement. As I mentioned, the greatest exposure of mercury vapor to the patient (and dentist) is when dental amalgams are first placed in the tooth and when they are removed. If you are concerned about your silver fillings, have your dental team examine your fillings to determine whether or not they are intact, and have a conversation with your dentist about the potential health risks of keeping or removing amalgams.
Considerations for dental amalgam removal:
Protective measures and nutritional support for dental amalgam removal:
“There is limited clinical information about the potential effects of dental amalgam fillings on pregnant women and their developing fetuses, and on children under the age of 6, including breastfed infants.”
In 2002, the FDA also issued a statement on dental amalgam, which asserted that "no valid scientific evidence exists that has shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy.” Nevertheless, a 1991-1997 study of 3,162 patients in Sweden and Germany found that 719 of those with mercury fillings, or 23%, tested positive for systemic allergic sensitivity to inorganic mercury on the MELISA lymphocyte proliferation test.
A paper published as part of a 1991 National Institutes of Health (NIH) conference on side effects of dental restorative materials also reported a 22.53% incidence of allergy in subjects who had amalgam fillings for more than five years. A 2003 monograph on mercury toxicity from the World Health Organization (WHO) concluded that studies on humans and animals demonstrated that dental amalgam contributes significantly to mercury body burden in humans with amalgam fillings, and dental amalgam is the most common form of exposure to elemental mercury in the general population.
In 2008, the FDA issued an advisory, warning pregnant women and children (the most sensitive population to mercury) about dental amalgam containing mercury, and posted this warning on their website. However, after significant debate, in addition to reclassifying dental amalgam as a Class II (more risk) medical device, this warning was amended in 2009 to: “Pregnant or nursing mothers and parents with young children should talk with their dentists if they have concerns about dental amalgam."
Most recently, the American Public Health Association (APHA) issued a policy statement, in conjunction with the American Dental Association (ADA), affirming that “dental amalgam is safe and effective in treating cavities.” It pointed out that since amalgams are less expensive, easy to place and extremely durable, it also argued that curtailing amalgam’s availability could have “negative health effects” in low-income areas that need low-cost fillings.
All this brings to mind the expression, “The operation was a success, but the patient died.” While the continued use of dental amalgam has strong support as a restorative success, shouldn’t we also continue to be concerned if the patient and our planet could be negatively impacted by a known toxic element? If that is true, then the debate should continue and the retirement of this old standard in dentistry should be considered as we look toward safe and stable restorative alternatives.
Until then, here are five top considerations for those who should speak to their dentist about having their amalgam fillings removed, and five top considerations for the best protective measures and nutritional support before and after amalgam removal and replacement. As I mentioned, the greatest exposure of mercury vapor to the patient (and dentist) is when dental amalgams are first placed in the tooth and when they are removed. If you are concerned about your silver fillings, have your dental team examine your fillings to determine whether or not they are intact, and have a conversation with your dentist about the potential health risks of keeping or removing amalgams.
Considerations for dental amalgam removal:
- Patients who have recurrent decay and/or defective margins around their dental amalgam fillings.
- Patients who have 8 or more dental amalgam fillings.
- Patients who have exhibited an allergy or sensitivity to dental amalgam (lymphocyte proliferation test).
- Patients who have bruxism (grind their teeth).*
- Patients who consume high quantities of acidic foods and carbonated beverages.*
Protective measures and nutritional support for dental amalgam removal:
- Your dentist should always use a proper isolation technique with a dental rubber dam to minimize exposure to mercury contact and/or swallowing amalgam debris.
- Check that the dentist is using a high-speed and low-speed suction device to rapidly remove amalgam, and ask for an oxygen nose mask if available to reduce the risk of inhaling mercury vapor during removal.
- Take chlorella (fresh water algae tablets or powder), a chlorophyll-rich nutritional supplement shown to assist with mercury (and heavy metals) excretion from the intestines, before and after amalgam replacement.
- Vitamin C has also been shown to be effective in assisting with mercury elimination. Take after meals and apart from chlorella.
- Cilantro is the most celebrated herb to assist with intracellular mercury elimination.
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