Why Replace Old Amalgam
This is a common and completely plausible question that gets asked frequently and there is no hard and fast answer. Why have a filling replaced when it has been there for years and years and never caused you any problems?? The answer is usually that, just because you don’t have pain, doesn’t mean that you do not have a problem. A lot of problems with your teeth and gums will cause you absolutely no pain until it is too late.
What is amalgam?
Amalgam is a metal alloy consisting of mercury, silver, tin and copper, it has been used in dentistry for over 150yrs and has been a very successful filling material for a long time. It is silver in colour, which often tarnishes to black with time. As a metal it is capable of thermal expansion, contraction and galvanic action. It is not bonded to teeth like todays filling materials, but more packed, locked and wedged into cavities.
Does amalgam leach mercury?
Amalgam fillings do give off a component of mercury vapour during their lifespan in a tooth. Whether or not the volume of this is enough to cause health problems has been debated for decades and there are multiple contradictory studies to prove both sides quite convincingly.
Problems with Amalgam
X-rays can’t see through amalgam.
We use x-rays to see a cross-sectional view through your teeth, showing us in between, underneath fillings, the roots under the gum and into the grooves. Amalgam fillings show up bright white and do not allow us to see through them. This allows decay to exist that is blocked by the amalgam filling. It is difficult to diagnose decay underneath amalgam fillings until it is quite extensive, which is often the difference between having another filling or a root canal on the tooth.
Amalgam contributes to cracks.
When you bit on a tooth with an amalgam filling, the forces are distributed throughout the remaining tooth and cracks form.
This is due to a combination of things:
- Amalgam is not bonded to the tooth and does not reinforce the remaining structure
- It expands and contracts with changes in temperature
- Sharp undercuts, grooves, angles and holes were cut into healthy tooth to lock in amalgam fillings, creating stress points
- Old theories in dentistry lead to over cutting of healthy tooth & a “larger is better” approach to fillings
- The ratio of amalgam:tooth is generally over 30%
Horizontal vs Vertical Cracks.
Horizontal cracks make their way from the inner tooth to the gum-line and will generally result in a corner or wall of healthy tooth fracturing off, requiring a restoration. Vertical cracks propagate towards the root and nerve of the tooth and when untreated, result in root canal therapy or complete splitting of the tooth requiring extraction. Once a crack is visible in an at risk tooth, it is definitely a problem, even if it does not cause you pain.
Inlays & Onlays
I recommend for all medium-large amalgam fillings to be replaced in porcelain.
This is why:
- Same strength as your enamel (EMax porcelain)
- Bonded to the tooth, reinforcing and supporting all remaining healthy tooth structure
- Minimise new cracks/slow growth of existing cracks in teeth
- Look AMAZING, cannot even see them
- Brighten the overall mouth
- It is easier to see problems in xrays
- They are durable & functional
- Stronger than composite resin
- Lasts 2-3 times longer than composite resin
- Maintain the original anatomy of teeth (points and grooves)
- It is simply superior to other filling materials
So, to answer the question, you need to decide which approach you would like to take when it comes to your mouth. If you would prefer to wait until there is a problem, then wait. If you would like to be proactive in preventing problems, then replace them.
Make An Appointment
If you are not sure about your old amalgam fillings, contact Sydney Boutique Dentistry in Waterloo, Sydney on 02 9699 5199 or book online.