Are amalgam (silver) fillings safe?

Over the years there has been some concern as to the safety of amalgam (silver) fillings. An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury. Dentists have used this blended metal to fill teeth for more than 100 years. The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth. The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe. Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective. The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling. The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings placed over the decades.

Although studies indicate that there are no measurable health risks to patients who have silver fillings, we do know that mercury is a toxic material when we are exposed to high, unsafe levels of it. For instance, we have been warned to limit the consumption of certain types of fish that carry high levels of mercury in them. However, with respect to amalgam fillings, the ADA maintains that when the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.

There are numerous options to silver fillings, including composite (tooth-colored), porcelain, and gold fillings. We encourage you to discuss these options with your dentist so you can determine which is the best option for you.

How often should I have a dental exam and cleaning?

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for cavities. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health. These include:

Medical history review
Examination of diagnostic x-rays (radiographs)
Oral cancer screening
Gum disease evaluation
Examination of tooth decay
Examination of existing restorations
Removal of plaque and calculus (tartar)
Oral hygiene recommendations
Review dietary habits

What is plaque?

Plaque is a sticky film of bacteria that forms on teeth and gums. Following a meal or snack, the bacteria in plaque release acids that attack tooth enamel. Repeated attacks can cause the enamel to weaken, eventually causing tooth decay. Many of the foods we eat cause plaque bacteria to produce acids. If you snack often, you could be having acid attacks all day long. Plaque that is not removed with daily thorough brushing and cleaning between teeth can eventually harden into calculus or tartar.

Plaque also produces substances that irritate the gums, making them red, tender or bleed easily. After a while, gums may pull away from the teeth. Pockets form and fill with more bacteria and pus. If the gums are not treated, the bone around the teeth can be destroyed. The teeth may become loose or have to be removed. In fact, periodontal (gum) disease is a main cause of tooth loss in adults.

Why is it important to use dental floss?

Brushing alone only cleans approximately 40% of the total tooth structure. Your toothbrush can’t reach the areas in between your teeth that are highly susceptible to decay and periodontal (gum) disease.

Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, which helps prevent damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums. Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar). This will further irritate and inflame the gums and also slowly destroy the bone. This is the beginning of periodontal disease.

How to floss properly:

Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.
NOTE: Your fingers should be close to the tooth you're flossing – almost touching the tooth being flossed. If you work with too big of a piece of floss between your fingers, you will not adequately adapt the floss around the curves of the tooth.

Floss holders are recommended if you have difficulty using conventional floss.

How often should I brush and floss?

Brushing and flossing help control the plaque and bacteria that cause dental disease. Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums. The bacteria in plaque convert certain food particles into acids that cause tooth decay. Also, if plaque is not removed, it turns into calculus (tartar). If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease. Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
Brush the outer, inner, and biting surfaces of each tooth.
Use the tip of the brush head to clean the inside front teeth.
Brush your tongue to remove bacteria and freshen your breath.

Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing is necessary to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

What is tartar?

Tartar, also known as calculus, is calcified or hardened plaque. It forms from plaque that has been sitting on the teeth for more than a day or two. Once plaque sits on the teeth undisturbed, it extracts the minerals from your saliva and hardens up on the teeth forming a crusty deposit that further attracts more plaque. The rate of tartar formation on the teeth varies from person to person. Once tartar forms on the teeth, it can only be removed by a dental professional using special instruments.

What is full mouth debridement?

A full mouth debridement is a procedure performed by a dental hygienist when there is a lot of calculus (tartar) on the teeth and below the gums causing infection in the tissues. When there is too much tartar on the teeth, we cannot accurately determine the health of the supporting structures of the teeth. This tartar on the teeth irritates the tissue, triggers your body’s defense system, and makes it impossible for us to comfortably assess your oral health. Once your body recognizes the teeth are dirty, it will try to fester the teeth out of the gum tissue and jaw bone, much like your body will fester a dirty splinter out of your finger. The full mouth debridement is a means of removing the gross calculus deposits from the teeth, allowing the body to begin the healing process. By removing the tartar, the inflammation in the gum tissue reduces and we can then evaluate how much jaw bone you’ve lost and to see if more advanced periodontal (deep) cleaning is needed to treat and arrest the gum disease.

How often should I replace my toothbrush?

You should replace your toothbrush every three months or sooner if you notice bristles are frayed on the sides of the brush. A worn out toothbrush will not effectively remove the plaque from your teeth. You should only use a soft or ultra soft toothbrush, never a medium or hard! Studies have shown that a medium or hard toothbrush actually contributes to recession, which exposes the softer root surfaces. Root surfaces are more susceptible to decay.

Should I use a rinse?

Antimicrobial mouth rinses can help reduce the bacterial count and inhibit bacterial activity in dental plaque, which can cause gingivitis, an early, reversible form of gum disease. If you are going to use a rinse, follow the instructions on the label, as that is how the rinse is most effective. Rinsing can help reduce the amount of bacteria inhabiting the oral cavity, which then lessens the amount of plaque that might form on your teeth and in your gum spaces.

Should I use an electric toothbrush?

Our office dispenses and recommends the Rotadent One Step plaque control unit. This brush has the softest bristles of the electric brushes on the market and is patterned after the rubber cup polisher we use to professionally polish your teeth at your hygiene visits. Each electric tooth brush unit has specific techniques associated with its use. We dispense the Rotadent with personalized instruction for your needs. Even if you have a different electric brush at home, please bring it with you so we can review proper placement and technique in your mouth, thereby enhancing your personal oral hygiene practices.