Amalgam or Composite

Cincinnati Ohio Dentist: Thomas K. Hedge D.D.S., F.A.C.E.
Published Here For Our Patients

The most common question asked in our practice concerns our choice of filling material that we use to restore small cavities in your mouth.

Amalgam fillings were introduced to dentistry over 150 years ago. At the time, this mixture of silver and mercury was a miracle material. So was the advent of indoor plumbing. Although the American Dental Association has not found any health problems associated with the placement of amalgam, there have been many studies linking amalgam with systemic diseases. The answers are not clear, but we would prefer to side with not placing mercury-containing restorations in our patient's mouths. Mercury is a toxic substance and according to the EPA, must be disposed of in a Toxic Waste Disposal Site. In our opinion, anything that must be disposed of in a Toxic Waste Disposal Site should not be placed in our mouths. Many European countries have either banned or restricted its use. It is against the law in Germany to place an amalgam in the mouth of a woman in her child bearing years. Like everything else, improvements were constant over the last 100 years. It took science until the 70's to develop an alternative, and into the early 90's to perfect it to its current level.

This new material is bonded composite resin. This material is extremely biocompatible and flexes and wears just like natural teeth. A silver amalgam restoration has no bond to adjacent tooth structure. Expansion and contraction of this material over many years will cause teeth to fracture, necessitating that a crown be placed. It is held in by mechanical retention. Amalgams tend to leak after a decade allowing recurrent decay in addition to turning black.

When aging amalgam restorations are replaced by bonded composite resin restorations, the strength of the tooth is increased by over 50% and underlining tooth structure is sealed and decay free. Not to overlook the aesthetic improvement teeth are once again white and the fillings are nearly invisible.

Composite resin restorations are very technique sensitive and are more time consuming place. Special care must be exercised to operate in a clean, dry, and sterile environment. This keeps out bacteria that are the leading cause of tooth pain and discomfort. As a result of this necessary expertise, the cost of placing a composite resin is approximately twice as much. We would not have an amalgam restoration placed in our mouths or in our family's at any cost.

A neighboring county has passed a law preventing amalgam to be passed into the sewer system. Would anyone want a material that has been outlawed in the sewer to be put in his or her mouth?

Insurance companies are slow to embrace new techniques, especially when it could cost them money to provide state-of-the-art care to their customers. Most insurance companies will only cover the cheapest material to restore teeth. Rarely does a patient without the "benefit" of dental insurance ever questions the fees for my care, skill, time, and judgement in the placement of fillings. The only time that we are questioned is when insurance claim sent to the patient states that they would only pay $60 on a $130 restoration and that the Usual Customary and Reasonable fee is $75. What they didn't tell you is that they downgraded the composite resin fee to that of an amalgam fee because they do not cover composite resins on back teeth.

They cite the reason being that they have not been proven to be successful in the long term. We have placed in excess of 1500 of these restorations per year over the last four years. Nearly all of them look like they did the day that they were placed. I would venture to say that these restorations have been extremely successful.

I hope that this helps you to better understand our rational for not placing amalgams, instead placing beautiful, bonded, composite resins.