One of the most serious and prolonged controversies among the dental society is the use of dental amalgam. Patients, dental practitioners, and legislators have split into two conflicting parties for over than 150 years, one which claims that dental amalgam fillings are toxic and an unnecessary taken risk, and another refuting that by reassuring that there is no root for such claims. Both sides have strong arguments and convincing studies backing up their claims about this widely used material. Following are the details of the controversy, the arguments, and the claims.
The main cause after the controversy of amalgam is derived from mercury use in preparing an amalgam filling. A certain amount of mercury has to be mixed with silver to produce a proper amalgam filling. Mercury being toxic and considering that fillings are subjected to teeth pressure, wear factors and leaking risks, the possibility of mercury leaking into teeth sockets and poisoning patients had to be taken into consideration more seriously. All together spurted the controversy. Many more factors are integrated into and are affecting this controversy. These factors include mercury properties, the affects of different amounts of mercury on patients, whether fillings leak mercury or not, and whether long term exposure to small mercury amount can lead to poisoning or death. Each of these factors has to be studied and monitored on the long term to conclude a correct result and judgment about the use of mercury-included amalgam fillings.
It is a fact that the element mercury in general is a toxic Metal and one that causes allergic reactions. It is classified as a mercuric chloride, due to that nature, and on the long term exposure mercury leads to many complications. For example: chronic diseases, such as, high blood pressure, active sweating, night sweats, loss of libido and male sexual dysfunction; neurodegenerative diseases, like, concentration difficulties, and memory disturbances  ; birth defects; and mental disorders, that include, Alzheimer’s and schizophrenia in rare severe cases. Considering the hazardousness of this metal, it appears that there is no margin to be doubtful about whether it should or should not be used in dental applications.
It is also a fact that dental fillings of all kinds leak certain amounts of the materials used. Because no matter what the materials are, what the circumstances are, and how well the fillings are protected and improved, the forces of biting and the environment inside the mouth affect the filling in a way that sooner or later will cause leakage. That for sure includes amalgam fillings.
Despite that fillings leakage and the toxicity of mercury both being proved scientifically and by clinical trials, the question remains, are the leaking amounts of mercury into the mouth enough to cause mercury poisoning? No study or clinical trial has managed to prove that yet, because mercury poisoning, and poisoning of all kinds, is relative. It depends on the patient’s age, build, gender, bone strength, eating habits, and blood regulation. That means an amalgam filling may be poisonous to a 12 years old female, but not a 35 years old male in an athletic shape. Due to that, and add the fact that no other material has properties that match amalgam’s properties in fillings, prohibiting amalgams became a very hard decision to take. Instead it became a matter of personal conviction and orientation.
Proponents of amalgam prohibiting, that includes environmentalists, conservative dentists, and concerned parents, believe it is better be safe than regret not taking any precautions later. They rather avoid all contact with amalgams and all procedures linked to their use. Some went as far as removing present amalgam fillings and replacing them with other less effective but safer kinds of fillings. They have their own activities and groups concerning spreading the awareness about the dangerous effects of amalgam fillings. For instance, there is The CFMR, the Canadians for Mercury Relief; and the EPA, the Environmental Protection Agency.
Opponents of the amalgam prohibition mostly include amalgam and mercury companies, amalgam and mercury suppliers, and dentists financed by them. It also includes unbiased parties such as: the ADA, American Dental Association, and the FDA, Food and Drug Administration. Who both conducted their own long term studies and clinical tries and found out that despite mercury toxicity, amalgam fillings cause no toxic effect on the patients. All those believe there is no need for replacing amalgam with another material, and believe removing present dental amalgam fillings is an unprofessional and an unethical thing to do.
I personally believe that in such issues there can be no decision that works for all sides or cases. There should be no amalgam use prohibition or limitations, nor should it be considered ultimately safe for everyone. Every patient is supposed to be taken as an individual case. Each case has to be studied from all the different aspects, and after all options and choices are properly weighed and evaluated, the dentist can take a decision whether the amalgam filling is appropriate or not. Another Solution is that for amalgam fillings to be administered whenever they are needed, and for follow ups to be scheduled for these patients to check whether the mercury caused any poisoning to their bodies. Until a new better material is found, only these two ways can resolve the amalgam controversy.
