The safety of dental amalgam: a state of the art review - nonsystematic review
Conseil d'Evaluation des Technologies de la Sante du Quebec
Record ID 31997008314
The general question explored in this review is whether amalgam fillings pose any significant risk to health. More specifically, does the scientific evidence support restricting the use of dental amalgam, removing existing amalgams, or other measures?
Authors' results and conclusions:
The information available is inadequate to determine whether dental amalgam poses any significant risk to the health of the population (except for relatively rare cases of allergy or hypersensitivity to amalgam), but mercury exposure at higher, occupational levels can produce a number of serious health problems. If low-level mercury does have adverse effects, they are most likely subtle changes in central nervous system functioning, which might cause small deficits in short-term memory, for example. Other health effects- Alzheimer's disease, multiple sclerosis, and the long list of complaints advanced by anti-amalgamists- are, given current evidence, very unlikely to result from amalgam fillings.
Any potential benefit of removing intact amalgams and replacing them with other materials is very uncertain. At least in some instances, the removal procedure itself produces a spike in mercury exposure. More importantly, there is no evidence that individuals who have had amalgams in their mouths for any period of time, and who already have absorbed some mercury from them, would benefit at all from their removal. In addition, the possible adverse effects of alternative materials are not well characterized.
A greater emphasis on preventive and conservative dentistry could play a role in reducing unnecessary exposure to mercury from dental amalgam. Greater use of preventive measures (e.g. fluoride treatments and pit and fissure sealants for children) will reduce the incidence of caries and therefore, the use of all restorative materials. In addition, there is compelling evidence that amalgam is used in cases where other materials would have advantages, either esthetic or for tooth preservation. More appropriate use of existing filling materials would have the side benefit of reducing the amount of amalgam used.
Health Canada's recommendations to reduce the use of amalgam in the primary teeth of children, in pregnant women, and in individuals with kidney disease are consistent with the uncertain evidence regarding possible effects of dental amalgam. If there are effects, these populations are likely to be particularly vulnerable, so, from a public health standpoint, they are logical recommendations.
It is also consistent with good dental and public health practice to minimize patient and dental personnel exposure to mercury during dental procedures, to the extent possible.
English language abstract:
An English language summary is available
- Dental Amalgam
- Dental Care
Conseil d'Evaluation des Technologies de la Santé du Québec
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Conseil d'Evaluation des Technologies de la Sante du Quebec (CETS)