Whether to replace amalgam fillings

February 20, 2006 11:13 AM

DentalFilter: Anybody else have their amalgam fillings replaced because they're old--NOT because you were worried about their possible harmfulness?

So I've heard both sides of the controversy about whether amalgam fillings cause any harm because of the mercury they contain. My dentist told me that the anti-amalgam people are ridiculous and that no research has proven their claims--but he wants me to get my amalgam fillings all replaced just the same because he says they're too old (most are about 15 years old). I've researched online and haven't found many cases in which people get their amalgam fillings replaced with the white stuff simply because their fillings were old. His argument is that they start to recede and, because bacteria can then enter the cavity, new decay starts. This is going to cost me quite a bit of money (yeah, so I ate a lot of candy as a kid) and gain him quite a bit of money so I'm a tad skeptical. Or maybe I'm just looking for reasons to avoid dreaded dental work. Anybody else had theirs replaced because of age?

posted by lilybeane to health & fitness (18 comments total)

I had an old amalgam filling replaced because there was a cavity forming around it. I had the choice of having it refilled with amalgam or the white composite - I chose the composite only because I'm vain and you could see the amalgam when I yawned or laughed.

It seemed that with my filling, somehow crap had gotten into a tiny crevice and started a new cavity where the old one left off. Apparently it happens, it's not all that uncommon, and lots of people have their fillings replaced. However, my dentist still gives the choice between amalgam & composite fillings at any time - so there's no real reason that your dentist shouldn't give you the same option if your fillings need to be replaced.
posted by tastybrains at 11:18 AM on February 20, 2006

I've had many amalgam fillings replaced (at the 10-20 year range) because they worn, by two different dentists. Most before there was a problem but one after a new cavity formed next to the filling. My insurance covered all the replacements. So if it's a scam it's a well entrenched one.
posted by Mitheral at 11:22 AM on February 20, 2006

My dentist (an anti-amalgam guy generally) has replaced a couple of my old fillings because there was seepage around them; fillings are sealed in away from the tooth material, but the seal doesn't last forever. A good side: current materials are a lot better than the ones being used 10 or 20 years ago, he tells me, so fillings done now ought to last longer.
posted by zadcat at 11:25 AM on February 20, 2006

Oh, and he doesn't mess with amalgam fillings that are stable and not deteriorating. I trust this guy.
posted by zadcat at 11:26 AM on February 20, 2006

I had mine (about a dozen fillings, all on my lower molars) replaced with composite because they were old -- some of them 25 years old, at the behest of my dentist.

Plus they look a helluva lot better and I don't cringe when I accidentally bite down on a piece of aluminum foil. If your insurance covers it, do it. You won't regret it.
posted by solid-one-love at 11:28 AM on February 20, 2006

Amalgam expands and contracts over time, so some people (like me) have had amalgam fillings actually _cleave_ the teeth they're in.

So it's not a scam... it's just good policy.
posted by silusGROK at 11:41 AM on February 20, 2006

When I was nine a dentist decided to fill three of my four back molars. No cavity, just natural pitts that he felt would cause a problem with time. 35 years later I had a horrible pain in one of the molars. Another dentist said pull the tooth. I asked if it was bad. No, but it hurts so pull it. The next dentist I saw had incredible equipment and could
actually show me the damage the original fillings had caused. One tooth had split in three places almost to the root because the old amalgam had expanded. He found another that was splitting in two. Thanks to the dentist of my youth I now sport a crown on the one tooth (dental
insurance is a rip-off as I paid beaucoup bucks) and my
other tooth was ground down and has two fillings. The second tooth is so sensitive I cannot have my teeth cleaned using the sonic methods. I asked my dentist if there was a danger in removing the old amalgam. No.
But then again there are only two places that you are allowed to put mercury. 1. In your mouth. 2. A toxic chemical storage facility. Be aware that you can be allergic to the composite fillings. They can test before actually using them. Oh, yeah. The term "mad as a hatter"
comes from the use of mercury in the millinary trade. Also,
the divorce rate of dentists is twice as high as any other medical professional and they are more likely to develope Psychological problems. Hmmmmm....
posted by CatyDidn't at 11:53 AM on February 20, 2006

I've had mine for 18 years, and I have a really great dentist, and he hasn't recommended replacing them. (He has checked them, more than once.) It seems strange to me to recommend replacing something that hasn't even started to show signs of wear. If he thinks your fillings look okay for now, why not let you wait (and save up the money)?

On preview, er...reading CatyDidn't's tale I'm inspired to suggest you get a second opinion from another dentist (assuming you can get an inexpensive consultation, which may not be possible).
posted by Gator at 11:56 AM on February 20, 2006

I've also had most of mine replaced, but like others have said, it was because they were wearing out, not because I was scared of a health risk. This was by two different dentists, over the course of about five years, to fillings that were about 15 years old. The last go round I had two replaced, and my dentist asked which material I wanted- composite or amalgam. I told him which ever would last longer. He said the amalgam, so that's what I went with.
posted by kimdog at 11:58 AM on February 20, 2006

The search term you need to add to amalgam is 'leaking.' Dentists will also replace older crowns that are "leaking at the margins." You really don't want to wait until there are more signs of decay, the tooth is already compromised and your dentist's main goal is to keep all of your teeth in your head for your whole life. If they can't be kept, he'll tell you what to do then. Don't make his job harder. He'd much rather do these replacements now than half a dozen crowns down the road. He doesn't want to see you in the pain (and sticker shock) that often accompanies the need for emergency care.
posted by bilabial at 12:08 PM on February 20, 2006

My dentist is gradually (like, over a five or six year period) replacing my old amalgam fillings with composite. Like the other posters, I trust my guy and I'm really pleased with the results. My insurance covers it.
posted by rdc at 12:16 PM on February 20, 2006

His argument is that they start to recede and, because bacteria can then enter the cavity, new decay starts.

I've had amalgam fillings fall out for basically this reason, and the dentist needed to drill a bit more to clear out the new decay.

Also, (for what this is worth), my dad is a physical chemist who has many many amalgam fillings, and as a result has done a fair amount of research into whether they are stable over the long term or not. He tells me that they are.
posted by advil at 12:23 PM on February 20, 2006

My dentist is gradually (like, over a five or six year period) replacing my old amalgam fillings with composite.

Why over such a long period of time? I had a dozen replaced in one 90-minute sitting.
posted by solid-one-love at 12:44 PM on February 20, 2006

One of my molars, that was amalgam-ly filled at least ten years ago, split right in half (on a veggie burger of all things) I had to have the tooth shaved and filed and then crowned. Would have much rather just refilled it a year before that atrocious pain. I can't definitively attribute the cracking to amalgam shrinkage, but if I had replaced the filling with a stronger bonding substance, who knows...I might still have a tooth there...just saying.
posted by iurodivii at 12:48 PM on February 20, 2006

Last year I had the fillings in my top teeth replaced due to age. Now the sides of both of the teeth have a heavy furrow in them. The edges of the furrows are somewhat rough. They're rough enough that maybe once every month I'll get a sore spot on my tongue after rubbing it against one of the teeth in my sleep.

Is this par for the course?
posted by Hubajube at 1:01 PM on February 20, 2006

Hubajube, that is not par for the course. Go see your dentist and tell them about this sore spot on your tongue. It's too late to pin it on the fillings, but they can fix it now, either with bonding material or by smoothing the surface of your tooth out, depending on what they did in the first place. (By the way, I manage a dental practice)
posted by bilabial at 1:20 PM on February 20, 2006

In the past three years or so, I've had all my amalgam fillings replaced by composites. Like everyone else, it was a matter of their just getting old - in my case, generally older than 30 years.
posted by WestCoaster at 1:53 PM on February 20, 2006

Any type of filling can be imperfect and it's only as good as the dentist who puts it in. I recently had two amalgam fillings replaced with composite because they were old and the dentist noticed a crack in one and a shadow (which probably indicated more decay) on another. Fillings will wear out and there is nothing you can do about it. It's no big deal. Either material is fine.
posted by FergieBelle at 4:28 PM on February 20, 2006