Shiny silver tooth fillings in your mouth – who doesn’t know that. For decades, dentists have used amalgam to fill teeth damaged by tooth decay. But this should end by 2025. In order to protect people and the environment from the harmful effects, amalgam should no longer be used in the EU – only if the patient’s medical needs make it necessary. The filler has been banned for children under 15 as well as for pregnant and breastfeeding women since 2018.
Damage to health caused by mercury exposure
This news will please many people, because amalgam is a mercury alloy that has been controversial for a long time. Mercury is a highly toxic heavy metal that, if exposed to too high levels in the body, can cause serious health damage to the nervous, immune and reproductive systems. For example, inhaling mercury vapor can cause…
be permanently damaged.
So far there is no scientific evidence that amalgam is harmful to health
However, it has not been proven that amalgam fillings are actually harmful to health. No study so far has been able to prove anything in this regard. “Since amalgam still consists of 50 percent mercury, the suspicions that it could be harmful to health have never completely disappeared, although the study situation is quite clear,” explains Roland Frankenberger, director of the polyclinic for dental preservation in Marburg, when asked by FOCUS online .
However, people can have allergic reactions to filling materials such as amalgam. It is a contact allergy that manifests itself primarily through complaints in the oral mucosa such as inflammation, sores, burning and a metallic taste on the tongue.
According to “Doccheck” it is extremely rare – it is estimated that only 0.01 percent of the population is affected by it. The allergy can be detected through a test. If the test is positive, the health insurance companies will pay for the replacement of amalgam fillings.
To date, no suitable replacement material for amalgam is available
Even though many may be happy about the ban, Frankenberger is not a supporter of it. “This ban is purely environmental in nature because the aim is to reduce the entry of mercury into the environment,” he says. “But it is not related to dental issues, which is why we would have liked a phase down until 2030 or even better until 2035 in order to have a suitable and clinically tested replacement material available like amalgam,” said the doctor.
There is currently a lack of alternatives to amalgam. “There is currently no classic alternative to amalgam; all potential replacement materials are either very complex (e.g. composites) and therefore much more expensive, or they are as cheap as amalgam but are only suitable for a certain cavity size (glass ionomer cements),” warns Frankenberger.
In fact, amalgam has advantages from a dental perspective: “Amalgam is very robust, which means it is not prone to errors and is relatively tolerant to saliva. It is therefore easy to process even under the most difficult conditions, it is durable and cost-effective,” Frankenberger continues.
Amalgam fillings have been in decline for a long time
In addition to the assumptions that it could be harmful to health, purely cosmetic aspects also speak against the use of amalgam. “For our patients, the focus is often on the desire for invisible fillings; this is not the case with amalgam, which is why its use is declining,” explains the dentist. According to this, amalgam has only been used for around two to five percent of new fillings to date.
Will dental fillings become more expensive in the future?
According to Frankenberger, fears that dental fillings will only be possible with additional payment due to the elimination of amalgam are unfounded: “The National Association of Statutory Health Insurance Dentists (KZBV) must specify a filling material that can be used without additional payment according to health insurance guidelines,” he reassures.
Frankenberger also has clear words for those who still have amalgam fillings and now believe they need to replace them: “Intact fillings – regardless of the material – should not be removed.” The German Society for Dentistry, Oral and Maxillofacial Medicine (DGZMK), of which Frankenberger is also a member, has already commented on this repeatedly.
During amalgam removal, fumes are reduced to a minimum
And what if an amalgam filling is broken? “Then it has to be replaced like any other insufficient filling,” says Frankenberger. Whether an amalgam filling should be done again is ultimately the patient’s decision. “We always have patients who say that they had no problems with amalgam and would therefore like to have the same thing again. Then we do that,” he says. However, the vast majority of patients preferred to continue their treatment with invisible materials.
Dentists exercise caution when removing broken amalgam fillings. Nevertheless, the same standard applies as when removing other filling materials: “You work with maximum water cooling and high-volume suction,” explains Frankenberger. As with removing other metals in the mouth, cut the metal with carbide burs and try to pry it out of the tooth in as large pieces as possible. “This ensures that as little as possible is chipped and that a minimum of fumes are produced.”
For allergic patients, a so-called rubber dam is also used during removal. This is a type of rubber blanket that is placed in the mouth to prevent patients from swallowing parts.
Oral hygiene – How to properly care for your teeth
But it’s best if you don’t need any dental fillings at all. Good oral hygiene is important to maintain dental health and prevent tooth decay and gum disease. The DGZMK therefore recommends:
Brush your teeth at least twice a day. Best after breakfast and before going to bed. Don’t eat anything after that. Clean tooth surfaces with a toothbrush. Clean between your teeth at least once a day with dental floss and interdental brushes. Use toothpaste with fluoride. Don’t scrub back and forth horizontally – ask your dentist about the right technique for you. Under no circumstances should you brush with force.