Are silver fillings really a health risk for your child?

SILVER fillings have received a lot of bad press in recent years due to concerns about mercury poisoning. However, all the evidence shows there is no reason for such concerns.

It is true that silver fillings - or dental amalgam - have become less common than white alternatives over the past two decades.

The reasons for this are not always clear to the public and sometimes it is assumed that it is because silver fillings are bad for our health.

However, this is not however the case and patients frequently request removal of silver fillings believing they pose a risk to health when this is not supported by scientific evidence.

A major reason why silver fillings have become less common in Europe has to do with the cost of propertly disposing of dental amalgams following the removal of fillings. The aesthetic demands of patients have also driven the need to use white filling materials.

Silver fillings contain a blend of silver, mercury, copper, tin and small amounts of zinc. Because the metals are combined as an alloy the mercury is not freely available which explains why it can be used in the mouth safely. There are numerous sources of mercury in our environment such as contaminated fish, cosmetics, medicinal products and other medical devices.

The main exposure of patients to mercury from dental amalgam happens when these fillings are being placed or when fillings are being removed.

This exposure can be minimised by avoiding dental decay through good oral hygiene and the avoidance of frequent sugary snacks, through the use of good dental techniques such as isolating the tooth being treated using a rubber cover/ dam and through not having silver fillings replaced unless there is a sound clinical reason.

Regulation of the use of dental amalgam within the EU comes under the remit of the Medical Devices Directive 93/42/EEC.

In this context dental amalgams have a long track record of safety and efficacy in dentistry.

A comprehensive assessment by the European Commission Scientific Committees on Emerging and Newly Identified Health Risks (SCENIHR) and on Health and Environmental Risks (SCHER) was updated this year and it has been confirmed that routine placement of silver fillings does not pose a threat to patient health. If it did dental amalgam would banned from use in dentistry across Europe. There are a very small number of individuals who may have allergic reactions to components of dental amalgam such as copper or tin, however this is extremely uncommon.

The other angle for regulation of the use of dental amalgam is that of environmental safety.

The evidence from the report by the SCENIHR is that we do not currently know exactly how much environmental mercury comes from dental fillings. Mercury is already released into the environment through the natural weathering of rocks, fuel and waste combustion. The overall contribution of mercury to the environment made by dental amalgam is considered to be very low. The environmental cost of disposal of dental amalgam is, however, very high.

When it comes to children's teeth there are particular considerations which come into play when deciding to use white or silver fillings.

White fillings have the advantage of requiring less tooth removal. In children's teeth, which have much larger nerves on the inside, this is a significant advantage. Primary molars fall out around the age of 11 years and these teeth require appropriate disposal.

The techniques used for placement of white fillings are more demanding and if children are not co-operative during treatment if can lead to problems with the fillings afterwards.

There is however, no reason for parents to worry about the safety of amalgam placement in children's teeth. The most important thing to remember is that dental decay is preventable through good hygiene and dietary habits.


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