One Dentist in 4 Supports Banning Dental Amalgam

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Only 1 dentist in 4 would ban dental amalgamIn this survey, we found that most dentists do not support banning dental amalgam as a restorative material.

While previous surveys have consistently shown that about half of dentists place amalgam fillings, the results of this survey were clear-cut. Only 26% of dentists responded, "Yes! It's time for US dentists to stop using amalgam." Fully 74% said, "No! Dentists should be able to make their own choices about restorative materials."

“I haven’t used it for over a decade, but we don’t need more governmental interference," said one dentist. "Let Doctors and Patients decide what is best for any particular case!"

You may be interested in our previous surveys on dental amalgam:

I don't use it, but I defend other dentists' right to choose their materials

  • “It is still the material of choice in some instances. I’ve personally not used it for 30 years, but would guard the right of others to use it when indicated by their ethics and philosophy…” (Washington dentist)
  • “While I do not place amalgams as my first choice of dental restorative material, I do not think a ban is in order.” (Michigan dentist)

Amalgam has been proven safe

  • “All studies demonstrate amalgam is safe and very effective.” (California dentist)
  • “Amalgam has been in use for at least seven generations. Each generation has grown bigger and lived longer than previous ones. Talk about In Vivo testing!!! Where’s the danger? That’s evidence based dentistry in my book.”
  • “Amalgam has been proven to be a practical, durable, economical and safe restorative material for over 50 years.” (Orthodontist)

Who says composite is any safer?

  • “Especially with the questions about composites now. All materials have risks.” (Texas dentist)
  • “Composites are not without their own toxic byproducts.” (General dentist)
  • “Who says resins are safe….?” (Massachusetts pediatric dentist)
  • “Why is it the dentist who wants to ban amalgam do not consider composite toxicity?” (Wisconsin dentist)
  • “With all the controversy regarding composite resins releasing chemicals, why eliminate amalgam, which is the most-researched and proven filling material in existence?” (California dentist)
  • “What happens if the composite filling becomes infamous like amalgam? Or if someone can prove the toxicity of the composite and bonding agent? What do we use?” (California dentist)

Amalgam is old technology

  • “Once the ‘Old Guard’ passes, retires or fades away, there will be no more dental amalgam.” (General dentist)
  • “What other material created in the late 1800s remains used virtually unchanged since its beginning? Would such a material be allowed to be developed today? Did the long-time acceptance of a cheap, mercury-based plastic material unnecessarily delay the development of viable alternatives? So much of earlier dentistry seemed to rely more on feelings about how something 'should' be and 'art' instead of science, and amalgam’s continued use is directly related to that mindset. Sure, the restorations last a long time, but how many teeth have broken as a result? How much extra tooth structure has been lost simply for the retention of this antiquated material? Just because two of the properties of a restorative material are 'easy to use' and 'cheap' does not make it the best material for patients, teeth and the environment.” (Pennsylvania dentist)

Amalgam is a valuable low-cost option

  • “Amalgam is necessary for third world countries where composites can not easily be done. I have seen so many bad posterior composites it is a terrible to think we would be stuck with only one option, especially since nothing has been found to prove amalgam is dangerous.” (General dentist)
  • “For deep, subgingival restorations and large restorations, the option of using amalgam saves teeth and at lower cost than alternatives of composite, gold and porcelain.” (Missouri dentist)
  • “I just travelled to Haiti to do volunteer work in a make shift mission. Composite has its place, Emka silver had its place, but in the end the amalgam was the best material of choice. There was no suction system so each patient had to sit up and spit in a basin. This is the second mission to Haiti and this is the second time I have worked without suction. Each dentist must be given the option of selecting the material of choice for the conditions in which they are required.” (General dentist)

Let's find alternatives to amalgam

  • “Alternative materials to amalgam are readily available and have been shown to have excellent longevity. Let’s get the amalgam/mercury albatross off the back of dentistry once and for all and fully accept advanced restorative materials and techniques.” (Michigan dentist)
  • “It's time to move on. Hopefully the options will get even better.” (New York dentist)

Amalgam works like a charm

  • “Amalgam restorations are superior to composites.” (Arizona dentist)
  • “The safety and benefits of Amalgam fillings far outweigh the attributes of the plastic (combined with 'sand' granules) in the long term and caries prone patients.” (Connecticut dentist)
  • “Most dentists cannot do a decent proximal contacted composite. I would much rather have a mediocre amalgam than an almost perfect composite.” (New Jersey dentist)

Amalgam is toxic

  • “How can the ADA justify placing it in a patient's mouth and mandating that any scrap be hauled away as hazardous waste? And mandate an additional filter on our water lines to pull the waste out of the water?” (General dentist)
  • “If amalgam was safe, OSHA would not require its disposal in hazardous waste. How can anyone deny that? Dentists need to get a better understanding of how the insurance companies manipulate the dentist.” (California dentist)
  • “Mercury is toxic! There are far better materials available to restore teeth that are safe and structurally superior. Stop the insanity and lack of critical thinking ability.” (Pennsylvania dentist)
  • “Poison !!!!!!!!!!!!!” (Texas dentist)
  • "It is inconceivable that dentists should, in this day and age, subscribe to the 'privilege' of implanting the most toxic non-radioactive
    heavy metal on the face of the planet into bodies of their unsuspecting patients.” (Ohio Biologic Dental Practitioner)
  • “It is time to stop defending amalgam. If it is a hazard in the sewage system, how can it be OK in someone’s mouth?” (General dentist)
  • “Just follow the science! There are literally thousands of research articles published in journals of Toxicity, Neurology, Basic Science and even a few in the Dental literature that show deleterious effects of mercury from fillings on every organ and system in the human body. With dozens of books written based on these research efforts, why has not one book been published showing how 'safe' amalgams are??” (Arkansas dentist)

Amalgam helps certain populations

  • “I could not, would not be able to serve the IDD (intellectually and developmentally disabled) population well if I was not given the choice of amalgam. Most of this population has little access to good daily care and amalgam, with its antibacterial qualities, lasts far longer than resin materials. If not given the choice of amalgam restorative materials I would have to stop serving this population whose access to care is already at an all time low.” (Developmental Dentist)

Let doctors and patients decide whether or not to use amalgam

  • “I haven’t used it for over a decade, but we don’t need more governmental interference. Let Doctors and Patients decide what is best for any particular case!” (Colorado dentist)
  • “I personally use amalgam probably less than 5% of the time, but at least I have that choice. Who would enforce this ban? The Government?? Let the dentist decide!!” (Florida dentist)
  • “It’s always the wrong color. Although I don’t personally use it, I don’t think patients require help from Washington or Chicago to make these decisions. BTW, I haven’t 'replaced' all of mine.” (Alaska dentist)

Dentists need many restorative materials

  • “It works well, is very forgiving, seals its own margins. It is not the universal restorative material, but neither is anything else, including resin. Dentists should have the skill, knowledge and option to use a variety of materials.” (Indiana dentist)
  • “Other than for environmental reasons, we should not stop using this very versatile and long-lasting material in dentistry. I can’t tell you how many posterior composites have failed that would probably be perfectly fine if amalgam was used instead.” (Washington prosthodontist)
  • “This absolutely ridiculous. Amalgam is a safe, easy to place, durable and inexpensive restorative. I put in both composites and amalgams in my practice. I inform my patients and let them decide. It is such foolishness that composites are the overall 'superior' restoration. I’ve been replacing a lot of 7 to 10 year old ‘superior restorations’ vs 25 to 30 year old amalgams….hmmm… you do the math. This is another example of junk science, extremist anti-mercury hysteria and self serving practitioners driving public policy.” (Rhode Island dentist)
  • “We clearly need both materials. For those that use only composite – how do you expect it to hold up for a partially subgingival lesion that can’t be kept totally dry – especially if a flap is laid to fully expose the lesion as a specialist friend of mine had to do for one of my teeth just a few weeks ago. He placed amalgam in my tooth, and I thank him for it.” (Colorado dentist)

Amalgam is not a good idea

  • “If this were a new material applying for FDA approval, how long would the process take? How hard would the FDA laugh before saying 'NEXT!'?” (Texas dentist)
  • “Consumer Class Action lawsuit heaven!” (General dentist)

Everything has its dangers

  • “Unless evidence exists – which it does not – a ban is totalitarian. What's next – McDonalds? Pizza? Meat?” (Orthodontist)
  • “There is probably no restorative material out there that one cannot find something harmful about it. Although I prefer composite and recommend it, until there is scientific proof from the ADA, FDA, etc., I will still use amalgam at times. There are some situations that composite will not work, and if you force it, you are not helping your patient.” (General dentist)

In certain cases. amalgam works best

  • “I do not use amalgam very often, but there is still a use for it. I prefer it in second molars, on people who are high risk caries, in people who are VERY apprehensive so the restoration does not have to be replaced so often, and in restorations that are subgingival where isolation is a problem.” (Maryland dentist)
  • “I don’t care how good you are with your hands. Their is always some where posterior that you cannot control bleeding and need something to build up a tooth or use as a filling, and amalgams are it !” (New York dentist)
  • “In a situation where it is impossible to get a dry field, amalgam is a better choice and absolutely should not be banned.” (General dentist)
  • “It's the only material that you can place successfully in areas where moisture control is is less than ideal.” (New York dentist)
  • "There are places where amalgam has a value.” (General dentist)
  • “There are some locations that are nearly impossible to restore with composite, i.e. interproximal cervical caries. If composite were the only choice, the tooth would have to be crowned.” (Florida dentist)
  • "Amalgam has less wear, less leakage, less toxicity than an occlusally placed composite." (California pediatric dentist)
  • “You can’t do repairs under crowns with anything other than amalgam.” (General dentist)

The role of dental insurance in amalgam use

  • “I would vote to ban it only if insurance companies raise their crown allowances. They must realize that dentists would have no choice but to do more crowns, because composite, as good as it is, is very technique-sensitive and without proper isolation, has a high failure rate when used improperly. These companies will be paying towards more crowns and I personally think they will not raise their allowances which will put us dentists in a difficult situation as far as treatment options go when things get deep and wet.” (Pennsylvania dentist)
  • “1) If it were banned, then insurance companies would not be able to down code my composites to amalgam. It would mean less business for dentists in the future, because less teeth would be fractured, therefore, less major restorative work to do! 2) OSHA does not let my employees touch the stuff, so why should I put it in peoples’ mouths?” (Texas dentist)
  • “Mostly amalgam is used to treat low-income patients and is justified in that way, rationalizing that they would otherwise not get treatment. Of course, PPO dentists might use it for the same reason as well since they are accepting very low fees.” (California dentist)

The place for amalgam

  • “It is safe or the Dental School would not be teaching it. They cover themselves every possible way. RESEARCH, primarily, is their tool of evidence-based dentistry. Researchers are SKEPTICS, first. So does the ADA. They have made a statement of amalgam’s safety. I respect BODY of
    EVIDENCE conclusions. Many people in the U.S. need the least expensive fillings to have teeth. It is arrogant to think of banning amalgam and ignoring that need. We are way over-legislated anyway, and do not need another law. It is the science that is my deciding factor to vote against banning amalgam.” (General dentist)
  • “Amalgams give good service for many more years than resins even if they are not as attractive. Popular demand and witch-hunts about mercury limit their use any how, but I feel they still have a valuable place in dentistry. Probably they will go the way of gold foil, except they never killed any teeth.” (General dentist)
  • “All dental offices should have amalgam/mercury separators or filters either chairside or at suction unit.” (Georgia dentist)

Dental amalgam is not an environmental hazard

  • "Minnesota Pollution Control Agency reports that about 6,000 lbs floats down on us from above annually. What the hell has dental amalgam mercury got to do with this problem?” (Minnesota dentist)

I don't use it

  • “I haven’t regularly used amalgam since 2000.” (Michigan dentist)
  • “I have not used it since 1997. My own personal boycott – any patients wanting it would have to leave the practice, and you know what, no one has left because of it.” (General dentist)
  • “I wouldn’t use it on myself or my family. So I haven’t used it on my patients in 17 years.” (Texas dentist)

Amalgam is safe

  • “Amalgam works fine. Never seen a negative effect of amalgam use.” (Prosthodontist)
  • “Not so fast. I rarely use it, but it’s sometimes the ONLY thing that will work in a given clinical situation. And I dare say, it hasn’t killed anyone yet and unless someone chokes on a huge buildup that’s fractured off, it’s not gonna–ever."
  • “While I don’t use it much due to esthetics, I want to know who these dentists are who complain about possible toxicity. They seem to be no better educated than the general public about amalgam, which has been one of the most studied dental materials and found to be safe.” (General dentist)

 

Note: Survey sample included 253 respondents. Posted
9/28/2010

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