FDA: Mercury fillings are safe

[MattusMaximus]

Good for the FDA! I can't wait to see the backlash from the alt-med woosters on this one...

Mercury in dental fillings not risky, officials say

The U.S. government declared Tuesday that silver dental fillings contain too little mercury to harm the millions of Americans who have had cavities filled with them — including young children — and that only people allergic to mercury need to avoid them.

It was something of an about-face for the Food and Drug Administration, which last year settled a lawsuit with anti-mercury activists by posting on its Web site a precaution saying questions remained about whether the small amount of mercury vapor the fillings can release were enough to harm the developing brains of fetuses or the very young.

On Tuesday, the FDA said its final scientific review ended that concern. Still, the agency did slightly strengthen how it regulates the fillings, urging dentists to provide their patients with a government-written statement detailing the mercury controversy and what science shows. ...

Waiting for the alt-med "government, Big Pharma conspiracy machine" to start up in... 3... 2... 1...

Anti-mercury activists accused the agency of bowing to the dental industry and said they would go back to court to try to force a change.

"FDA broke its contract and broke its word that it would put warnings for children and unborn children," said Charles Brown of Consumers for Dental Choice. "This contemptuous attitude toward children and the unborn will not go unanswered."

Whoops, too late

 

[Eggs Ackley]

I have to say, mercury is a very toxic poison and having it in your mouth where it is being absorbed over an extended period, and in the young, sounds like an inherently risky proposition. I don't doubt there are demagogues who would exploit people's fears but that doesn't preclude that there is some basis for concern. Low-level toxicity is probably difficult to demonstrate conclusively, and there is profit motive potentially involved.

Also, it's an unnecessary risk in the sense that there are superior alternatives without toxic metals. I had all my amalgam fillings replaced with composite plastic a couple of decades ago. The dentist said the plastic fillings wouldn't last but nearly all of them have and now they are much improved anyhow.

With plastic fillings, less of the tooth needs to be removed, and if damaged they can often be repaired without having to dig out the whole thing and make an even bigger hole in the tooth. I've been very happy with mine and of course they look so much better.

 

[Amapola]

@Eggs Ackley: Well, in the article, they do address the reasons why amalgam is still the best choice in certain instances. Also they point out that the mercury used is a different kind, and that scientific studies show no harm from the amalgam.

As far as profit motive, one reason amalgam is used is because it is cheap and more people can afford it.

I'm glad for you if you've found a good alternative. That's terrific! I can't afford to use the alternatives, so I am happy to hear about the results of these tests.

 

[Miss_Kitt]

Eggs -- You get exposed to mercury by walking around and by breathing air. The blanket statement that "it's a very toxic poison" shows a limited understanding of issues of toxicity. Chlorine is toxic, but it's not harmful for you to sterilize clothing or surfaces with a bleach-water solution; in fact, it is often safer than not using the bleach.

Toxicity is a question of doseage, absorption, and retention. Metallic mercury or certain mercury compounds can be toxic in small doses -- but other mercury compounds are stable and readily excreted.

It's exactly that kind of "well, it's poisonous, so we'd better not risk it" thinking that contributes to a lot of fear-mongering, bad risk assessment, and bad public health practices like people refusing vaccines for fear of the (essentially non-existant) risk of damaging their kids' brains.

Just for my curiosity, where did you read that more tooth needs to be removed to install an amalgam filling than a porcelain one? And what kind of plastic is being used in your mouth? Most plastics are not highly resistant to acidity, heat, cold, and shearing stress.

Thanks for the citations, I look forward to seeing them, Miss_Kitt

 

[Tomblvd]

I have to say, mercury is a very toxic poison and having it in your mouth where it is being absorbed over an extended period, and in the young, sounds like an inherently risky proposition.

As already pointed out, chloine is very toxic, yet you ingest table salt with no trouble.

If you are concerned about mercury poisoning, go after the seafood industry and leave us dentists alone.

Low-level toxicity is probably difficult to demonstrate conclusively, and there is profit motive potentially involved.

Please tell me what this "profit motive" is, considering I can charge more for bonded resin ("plastic") fillings than amalgam.

Also, it's an unnecessary risk in the sense that there are superior alternatives without toxic metals.

Are you sure? How do I place a bonded resing filling in an elderly patient with alzheimers, subgingivally in a bloody field? How about a 3 year old thrasing around?

I had all my amalgam fillings replaced with composite plastic a couple of decades ago. The dentist said the plastic fillings wouldn't last but nearly all of them have and now they are much improved anyhow.

Do you realize how much mercury you were exposed to when the old filling were drilled out? It's alot more than if you had just left them be.

With plastic fillings, less of the tooth needs to be removed, and if damaged they can often be repaired without having to dig out the whole thing and make an even bigger hole in the tooth. I've been very happy with mine and of course they look so much better.

If you were given a choice, and made an informed decision, good for you. But if your dentist scared you into having all your amalgams removed because of "toxicity", he was breaking the law. I always give my patients the choice, and the pros and cons. There is nothing wrong with resin or amalgam fillings, but there are too many quack dentists scaring their patients into having all their silver fillings replaced. And that's bad.

 

[Subduction Zone]

I am old enough to have grown up with mercury thermometers, including oral ones. More than once we broke thermometers as kids and played a bit with the mercury balls. Even in chemistry classes in high school we did not have this mercury phobia. Now I would definitely not recommend playing with it every day, but a minor spill in the past would require a hazmat crew today. Today people are way too concerned with the toxicity of mercury. Mercury is the big bad wolf of today's oogie boogie medicine. It causes everything from autism to postpartum depression

 

[Eggs Ackley]

Eggs -- You get exposed to mercury by walking around and by breathing air. The blanket statement that "it's a very toxic poison" shows a limited understanding of issues of toxicity. Chlorine is toxic, but it's not harmful for you to sterilize clothing or surfaces with a bleach-water solution; in fact, it is often safer than not using the bleach.

Toxicity is a question of doseage, absorption, and retention. Metallic mercury or certain mercury compounds can be toxic in small doses -- but other mercury compounds are stable and readily excreted.

The fact that you think you can make an inference that my understanding is limited based on my making a true statement shows a limited understanding of the laws of inference.

Also, it's an obfuscation here to bring in the use of chlorine bleach versus not using it. I am not advocating forgoing dental treatment or drilling out the decay and leaving the holes empty. The question here is what is a safe and reasonable way to fill the cavity and pardon me for being cautious when the historical method is to fill them with an amalgam containing mercury.

I made nor make no special claims to expertise about toxity, but what I said is supported by wikipedia, for example. Mercury is a toxic heavy metal that is fairly easily absorbed and is highly regulated due to this fact. Elemental mercury is not the most dangerous form perhaps, but it is certainly not safe in elemental form, and it is essentially this form that is the type of exposure in amalgam fillings, is my understanding. Please correct me if I'm wrong. An amalgam is more like a solution than a chemical compound, seems to me. The mercury is not so tightly bound to the silver as, say, chlorine is to sodium in table salt. My understanding is that the mercury leaches out over time leaving the silver behind.

I'll stand by to be corrected by more knowledgable individuals.

It's exactly that kind of "well, it's poisonous, so we'd better not risk it" thinking that contributes to a lot of fear-mongering, bad risk assessment, and bad public health practices like people refusing vaccines for fear of the (essentially non-existant) risk of damaging their kids' brains.

Perhaps so but it is not as if either dentistry or medicine have a history of being squeaky-clean with regards to treatment safety. Mercury amalgam fillings are fairly archaic as well so most likely their safety was not well-established prior to their common usage. Some scrutiny is reasonably warranted, seems to me. The relevant question is, at what point should one decide that safety is fully or sufficiently established? So now the studies have been done and that's good news that a new upper limit on the toxicity of mercury amalgam fillings is established and it's not very high. Am I to be faulted for being cautious twenty years ago before the studies were done?

Just for my curiosity, where did you read that more tooth needs to be removed to install an amalgam filling than a porcelain one? And what kind of plastic is being used in your mouth? Most plastics are not highly resistant to acidity, heat, cold, and shearing stress.

Thanks for the citations, I look forward to seeing them, Miss_Kitt

I can't remember where I read that. What's important is whether it's right or not. The dentist above will probably correct me if I'm wrong but I haven't read his post in detail yet. I did not get porcelain fillings so far as I know.
Wouldn't these have to be set and glued into place? The plastic ones are like an expoxy resin that's put in soft and then hardens in place andunder UV light. They have held up very well and have been no more trouble, or less, than when I had various amalgam fillings.

 

[Toke]

I read of that discussion a few years ago in denmark, I think the conclusion was that dentists and their assistants may have been poisoned and needed better protective equipment.

 

[thull]

I need a little clarity on the issue, as i don't know much of the practices in dentistry.

Within the article they single out young children and fetuses. Since being pregnant has a very short list of drugs that have been shown to cause no damage to the unborn baby and a huge list of "we don't know and it's probably unethical to find out". I have no qualms about adding certain fillings to that big list. However my confusion is over the children claim. Are fillings even used with baby teeth or are they just pulled out and the kids live without that tooth for a few years?

 

[Tomblvd]

I need a little clarity on the issue, as i don't know much of the practices in dentistry.

Within the article they single out young children and fetuses. Since being pregnant has a very short list of drugs that have been shown to cause no damage to the unborn baby and a huge list of "we don't know and it's probably unethical to find out". I have no qualms about adding certain fillings to that big list.

Actually, it's been on "the list" for quite a while now. I recall my father, many years ago, holding off on doing work on pregnant women, but it was, like most things, purely CYA. If you notice, they also recommend pregnant women avoid certain seafood for the same reason.

However my confusion is over the children claim. Are fillings even used with baby teeth or are they just pulled out and the kids live without that tooth for a few years?

As I stated in my first post, amalgam is used a lot on small kids when you don't have a lot of cooperation from the patient. Seeing as how a 3 or 4 year old would have to go without the tooth until they are around 12, pulling the tooth just for a cavity isn't even an option.

 

[Eggs Ackley]

As already pointed out, chloine is very toxic, yet you ingest table salt with no trouble.

If you are concerned about mercury poisoning, go after the seafood industry and leave us dentists alone.

With this level of argumentation you are not making me more comfortable that amalgam fillings are safe. It is reasonable to consider sodium chloride part of what we are made of and of couse it is essential to our survival. Mercury is not such. Also, if the mercury levels in seafood are clearly dangerous (and I am not granting that is true but perhaps you are?) then please explain how that should reassure me that the exposure from amalgam fillings is of no consequence?

Please tell me what this "profit motive" is, considering I can charge more for bonded resin ("plastic") fillings than amalgam.

You are not giving dental services including amalgam fillings away for free, I don't think. If you can't do them it seems it will not clearly help your business. Plus, they've been in use for a long time and so it's not unreasonable to expect some resistance to stopping their use just on that account, even if they cannot be proven safe.

Are you sure? How do I place a bonded resing filling in an elderly patient with alzheimers, subgingivally in a bloody field? How about a 3 year old thrasing around?

Also not a sound argument for the safety of amalgam fillings.

Do you realize how much mercury you were exposed to when the old filling were drilled out? It's alot more than if you had just left them be.

I don't know but I'd be interested to know if the new studies addressed this. Certainly it would be a reasonable trade to consider among those who already have them. Is your claim that the exposure would be more by removal substantiated in a study somewhere or is that just your belief?

It's not relevant to the question of whether they should be used in the first place, in any case.

If you were given a choice, and made an informed decision, good for you. But if your dentist scared you into having all your amalgams removed because of "toxicity", he was breaking the law. I always give my patients the choice, and the pros and cons. There is nothing wrong with resin or amalgam fillings, but there are too many quack dentists scaring their patients into having all their silver fillings replaced. And that's bad.

My dentist was dead against it, as I hinted at above. I read a book that seemed convincing and sincere enough at the time. Like I said it was about
20 years ago and I didn't have the benefit of any studies that have happened in the meantime or the internet for researching it. Some or all of my childhood amalgam fillings were needing replacement and I think I had also read about advances in composite plastic fillings. Anyhow they have been great and since you make more money off them perhaps we can agree that they are a viable option for anyone who can afford them and wants to reserve judgement or forego an extensive investigation into the absoluteness of the safety of mercury amalgam fillings.

 

[Tomblvd]

I'll stand by to be corrected by more knowledgable individuals.

See post #5.

Perhaps so but it is not as if either dentistry or medicine have a history of being squeaky-clean with regards to treatment safety. Mercury amalgam fillings are fairly archaic as well so most likely their safety was not well-established prior to their common usage. Some scrutiny is reasonably warranted, seems to me. The relevant question is, at what point should one decide that safety is fully or sufficiently established? So now the studies have been done and that's good news that a new upper limit on the toxicity of mercury amalgam fillings is established and it's not very high. Am I to be faulted for being cautious twenty years ago before the studies were done?

Dental amalgam has been used for over 150 years. In that time there has been literally thousands of studies looking at safety. It is known as one of the most studied compounds (healthwise) in history. And in study after study, no adverse effects have been shown. It is actually sad that they had to throw good money after bad in order to study something that has been studied to death already. But be that as it may, it has been shown to be safe for many decades, but that won't quiet the critics.

In addition, this isn't a new study done by the FDA, it is a review of over 200 older studies done. IOW, the evidence has always been out there.

 

[Eggs Ackley]

See post #5.

Here is what I said:

I made nor make no special claims to expertise about toxity, but what I said is supported by wikipedia, for example. Mercury is a toxic heavy metal that is fairly easily absorbed and is highly regulated due to this fact. Elemental mercury is not the most dangerous form perhaps, but it is certainly not safe in elemental form, and it is essentially this form that is the type of exposure in amalgam fillings, is my understanding. Please correct me if I'm wrong. An amalgam is more like a solution than a chemical compound, seems to me. The mercury is not so tightly bound to the silver as, say, chlorine is to sodium in table salt. My understanding is that the mercury leaches out over time leaving the silver behind.

I'll stand by to be corrected by more knowledgable individuals.


What part(s) of that paragraph are false, specifically?

 

[Tomblvd]

Posts crossed, here is a reply to my first:

With this level of argumentation you are not making me more comfortable that amalgam fillings are safe. It is reasonable to consider sodium chloride part of what we are made of and of couse it is essential to our survival. Mercury is not such. Also, if the mercury levels in seafood are clearly dangerous (and I am not granting that is true but perhaps you are?) then please explain how that should reassure me that the exposure from amalgam fillings is of no consequence?

You misunderstand, I said nothing about mercury levels in seafood being dangerous. They aren't. But the levels in seafood are MUCH higher than any residual levels given off by vapors in the mouth. And whether NaCl is essential is beside the point. A component of salt is also highly toxic at certain levels, that doesn't make salt toxic. The same goes for amalgam.

You are not giving dental services including amalgam fillings away for free, I don't think. If you can't do them it seems it will not clearly help your business. Plus, they've been in use for a long time and so it's not unreasonable to expect some resistance to stopping their use just on that account, even if they cannot be proven safe.

Why would I fight the ban of a filling material if the replacement is more expensive? I can make more money. Also, in cases where I can't use bonded resin, there are other alternatives, but they don't hold up well at all and need to be replaced often. I'm sure some dentists would love to say "well, the gov't says I can't use silver anymore, so I have to use this stuff, but we'll have to replace it next year".

Also not a sound argument for the safety of amalgam fillings.

I isn't meant as an argument for SAFETY. You said there are "superior alternatives". What are they?

I don't know but I'd be interested to know if the new studies addressed this. Certainly it would be a reasonable trade to consider among those who already have them. Is your claim that the exposure would be more by removal substantiated in a study somewhere or is that just your belief?

It always helps to read the article:

"Removing the fillings actually releases more mercury vapor, FDA said."

It's not relevant to the question of whether they should be used in the first place, in any case.

It. wasn't. meant. to.

You were the one crowing about having all your silver filling removed. I was just pointing out how counter-productive that was.

My dentist was dead against it, as I hinted at above. I read a book that seemed convincing and sincere enough at the time. Like I said it was about
20 years ago and I didn't have the benefit of any studies that have happened in the meantime or the internet for researching it. Some or all of my childhood amalgam fillings were needing replacement and I think I had also read about advances in composite plastic fillings. Anyhow they have been great and since you make more money off them perhaps we can agree that they are a viable option for anyone who can afford them and wants to reserve judgement or forego an extensive investigation into the absoluteness of the safety of mercury amalgam fillings.

As I said earlier, as long as it isn't sold as a cure for a disease, or ridding the body of "toxins", there is nothing wrong with it. But amalgam remains a good option for many people and many situations.

 

[Tomblvd]

Here is what I said:




What part(s) of that paragraph are false, specifically?

This:

My understanding is that the mercury leaches out over time leaving the silver behind.

I have seen fillings that are 50 years old and have never seen one that the mercury "leached out leaving the silver behind". The mercury is tightly bound in the amalgam (see where the word comes from?). Various quacks and unscrupulous trial lawyers have been trying to measure elevated mercury levels in people with amalgams forever, and haven't had much luck. As I said earlier, there aren't many health items that have been studies more, and no ill effects have been proven.

 

[Tomblvd]

??

I'd say the delay in answering can only mean he comes up with the "smoking teeth" video as proof that mercury "leeches" out of the filling.

 

[Eggs Ackley]

This:



I have seen fillings that are 50 years old and have never seen one that the mercury "leached out leaving the silver behind". The mercury is tightly bound in the amalgam (see where the word comes from?). Various quacks and unscrupulous trial lawyers have been trying to measure elevated mercury levels in people with amalgams forever, and haven't had much luck. As I said earlier, there aren't many health items that have been studies more, and no ill effects have been proven.

Well I am not saying you are certainly wrong, but it didn't take too long to find an academic paper that directly contradicts your claim.

http://www.ripublication.com/ijpapv2/ijpapv2n3_1.pdf

'Jones et al. [1] proved that Mercury leaves dental amalgam
continuously throughout the lifetime of the filing. Mercury vapor is the main way that
mercury comes out of amalgam and is absorbed at a rate of 80% through the lungs
into the arterial blood [2, 3].'

Care to substantiate your claim beyond your say-so?

Edit: here is an interesting paper concerned with release of mercury into the environment from dental uses. It does say this:

Mercury in dental amalgam exists in a fairly
stable equilibrium, with only minute amounts
released into the surrounding environment.8-12

I would be interested to know how big is "minute" but it's unlikely I'll be able to get to those papers online.

http://www.dentalmercury.com/pdf/papers/JADA-Disinfectants.pdf

 

[Eggs Ackley]

I want to mention also, fillings routinely need to be replaced after some decades in your mouth, it seems. In my case keeping at least most of the ones I replaced wasn't an option.

And again, I have had composite plastic for I think 20 years and can only recall one needing maintenance. It turned out to be patchable in place. This I think is never the case with amalgam. The whole thing would have to be drilled out and replaced, correct?

 

[Tomblvd]

Well I am not saying you are certainly wrong, but it didn't take too long to find an academic paper that directly contradicts your claim.

http://www.ripublication.com/ijpapv2/ijpapv2n3_1.pdf

'Jones et al. [1] proved that Mercury leaves dental amalgam
continuously throughout the lifetime of the filing. Mercury vapor is the main way that
mercury comes out of amalgam and is absorbed at a rate of 80% through the lungs
into the arterial blood [2, 3].'

Care to substantiate your claim beyond your say-so?

Nowhere in that paper does it make your claim that mercury is leeched out of the filling, leaving the silver (and other metals, I presume) behind. There is no doubt that the body absorbs mercury as the fillings wear, but, as you paper makes painfully clear, these levels are measured in the ppm or ppb range.

If mercury were "leeching" into the bloodstream, it would be a simple enough study to take urine samples from people with and without fillings and show highly elevated levels of mercury.

 

[Eggs Ackley]

Nowhere in that paper does it make your claim that mercury is leeched out of the filling, leaving the silver (and other metals, I presume) behind. There is no doubt that the body absorbs mercury as the fillings wear, but, as you paper makes painfully clear, these levels are measured in the ppm or ppb range.

If mercury were "leeching" into the bloodstream, it would be a simple enough study to take urine samples from people with and without fillings and show highly elevated levels of mercury.

It was something less than a claim of certainty on my part. Regardless of how I put it precisely I meant that this was something I had read. And I read it again just now while searching around about it, with the word "leaching" used. So I think my recollection is accurate here.

There are many of these kinds of claims out there, of course, on the web. I don't consider them reliable either but they are certainly earnest and some of the people behind them claim to have credentials.

It's part of the argument on these sites that mercury that's absorbed in the body isn't excreted well through the urine.

Seems to me it should be easy to test the mercury content in old fillings by removing a sample. Then assuming the mercury content was known initially one could determine the rate of leaching or evaporation. Also it seems to me that if the mix is too mercury rich there would be some substantial initial release.

Well it just goes to show that it's a complicated subject and I think it's a good use of my tax dollars to do a meta-study of what the situation is. I continue to think it needs to be assessed by disinterested parties and I only hope the FDA can be relied on to remain so.