In Germany there are around 50 million fillings every year. The filling material, which the statutory health insurance companies pay 100 percent, is amalgam. A material that arouses controversy between supporters and opponents.
- Amalgam for dental fillings consists of an alloy of mercury (50 percent) with copper, silver and tin.
- The statutory health insurance companies only cover 100 percent of the costs for amalgam fillings as a standard benefit for the restoration of molars.
- There is currently no clear scientific evidence that amalgam poisoning can actually occur.
- Amalgam fillings should only be removed with special precautionary measures.
Amalgam: from ancient Greek “malakos” = ‘soft’ and Arabic “al-malḡam” = ‘softening paste’. Chemically, amalgam is an alloy with mercury. In an extension of the term, mixtures of substances that cannot be reversed are referred to as amalgams, preferably metal alloys.
Many metals dissolve in mercury, so there are a large number of amalgams. In alchemy, mercury was used in attempts to make gold. The Middle Latin word “amalgama” is documented in alchemical texts from the 13th century.
Amalgam for dental fillings consists of an alloy of mercury with copper, silver and tin. The alloy powder, which consists largely of the three finely ground metals, is mixed in equal parts with elemental mercury. The finished amalgam mixture therefore consists of 50 percent mercury.
Amalgam side effects
Amalgam has been used in dentistry for over a hundred years, making it the tooth filling material that has been in use for the longest time. Because of its high mercury content, there is a controversial discussion about whether amalgam should also have a place in dentistry in the future.
According to the Federal Environment Ministry, mercury is a heavy metal that is toxic to humans and fatal in high doses. The question remains, however, whether amalgam fillings pose an acute risk. What is certain is that when dental fillings are inserted or replaced, mercury is released from amalgam. Grinding your teeth, eating or chewing gum also creates a certain amount of abrasion that gets into the body. According to the German Cancer Research Center, specific side effects for amalgam cannot yet be clearly proven.
The following are discussed as possible side effects:
- Nerve damage
- Chronic headache
- Sleep disorders
- Increase in the risk of cancer
- Triggering Multiple Sclerosis
Is amalgam poisoning possible?
As scary as it may seem to have your teeth filled with a material half of which consists of highly toxic mercury, there is currently no clear scientific evidence that amalgam poisoning actually occurs.
But if amalgam poses no danger, why has the EU passed a regulation according to which amalgam may no longer be used in pregnant women and children since July 1, 2018? Amalgam proponents assume that it is not about the health risks of amalgam in the mouth, but about limiting the use of mercury. Because mercury can get into the environment during its processing, disposal and cremation in crematoria – and from there into food.
Unlike amalgam poisoning, amalgam allergies have been scientifically proven and are recognized by health insurance companies, but they are extremely rare. The triggered reaction of the immune system to amalgam consists in impairment of the oral mucosa. An amalgam allergy can manifest itself, for example, as a burning sensation and sores in the mouth, followed by chronic inflammation, whitening and erosions. If the suspicion of an amalgam allergy is confirmed, the health insurance company pays the costs for the amalgam restoration of fillings.
Amalgam or plastic: advantages and disadvantages of fillings
Amalgam: is an inexpensive, easy to process, very stable material that expands during processing, penetrating even the smallest joints and sealing the filling very tightly. It withstands the stress of chewing very well. However, it is controversial whether or not amalgam fillings pose health risks due to the 50 percent content of the heavy metal mercury. In addition, the silvery fillings are visually not particularly appealing and clearly recognizable as dentures. Amalgam fillings have a shelf life of around eight years.
Plastic: Pure plastic fillings can be easily adapted to the tooth color, but tend to discolour over time and wear out relatively quickly. Because they do not seal very tightly, there is a risk that caries will form on the edge of the filling over time. This risk can be mitigated by more complex processing in several steps, but this also makes the process more expensive. Plastic fillings last around three to five years.
Composites made of around 80 percent ceramic powder and 20 percent plastic are very stable, do not discolour easily and look very similar to natural tooth material. Like pure plastic fillings, composite fillings must be applied in several layers, which is why the costs are higher here than with amalgam. Fillings with plastic-ceramic mixtures last at least eight years.
Which dental fillings are covered by the health insurance?
For the statutory health insurances , the inexpensive amalgam fillings are the standard benefit for dental restorations, which are taken over 100 percent. The more expensive plastic or composite fillings are only paid for by the cash register in the area of the front teeth.
Statutory health insurers only accept non-amalgam fillings for the posterior molar area for pregnant women and children under the age of 18, as well as for amalgam allergies or severe kidney insufficiency. The amalgam restoration of intact fillings is only covered by health insurance in the case of the rare amalgam allergy.
Remove or divert amalgam
According to an expert commission from the Berlin Robert Koch Institute, amalgam fillings should only be removed with special precautionary measures, because mercury can be released in the process. These include mist and saliva ejectors and a water spray cooling system that prevents the amalgam from heating up during drilling. Ideally, the dentist should remove the amalgam without drilling, if possible, and dispose of the waste according to regulations. Other experts are even calling for protective masks for dentists, assistants and patients. Pregnant or breastfeeding women should refrain from removing amalgam fillings.
During a preparatory diversion therapy, the patient is injected with high-dose vitamins, vital substances and trace elements as support.