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Winter Park Dentistry- Silver (Amalgam) vs. White (Composite) Fillings




Dr. Ramzi Matar (Winter Park Dentistry): Hello, today's topic for this podcast is silver versus white fillings.  In dentistry, this is definitely a very highly emotional subject amongst dentists, amongst patients.  There's always a significant amount of controversy.  People have very strong opinions and frankly today I'm here just to talk about some of the science that is behind the choice between a silver or white filling if you have a cavity.  At the bottom of this podcast, I'm going to also link a YouTube link to a video, an interview by a Doctor Gordon Christenson who, for non-dentists watching this, Doctor Christenson is probably the most notarized researcher in dentistry.  He is kind of the grandfather of dentistry for when it comes to science and he publishes reports.  He's very well in tuned with what's going on with the science and he was recently interviewed and asked this question about silver versus white fillings.  And he's much more eloquent than me when he discusses it because he has decades of research that he's done that he can back it up with.  I, on the other hand, follow the research and the science, but I'm not a scientist and a researcher myself.  And I do think as dentists, it's our responsibility to follow the science and to make recommendations based on science and not so much our emotional attachment to a decision or not, so I think that's important.  So, let me give you the bottom line for the decision between silver and white fillings.  One looks better and one lasts longer.  You could probably assume by now I'm referring to a white filling, which is also called a resin filling or a composite filling.  They look better--there's no denying it, and there are ways to make white fillings attach to teeth and hence we have white fillings.  Silver fillings are the more controversial ones.  They certainly don't look as aesthetic, but conservatively speaking, they last two times as long as white fillings.  I'm going to get into some of the current controversies for using silver fillings.  Silver fillings are also known as amalgams or alloys.  This is the filling material that common people probably know as the mercury filling because they do contain small amounts of mercury in the material that's used.  It's a mixture of metal, which is what amalgam means--it's a mixture of different metals.  So white fillings, conservatively speaking, last around six or seven years, and silver fillings, conservatively speaking, last fourteen plus years.  I will tell you my rhetorical evidence: in my practice I feel those silver fillings last much more than fourteen years and white fillings are about six or seven years when they start to exhibit failures, but I'm just trying to base it on the current science.  Another advantage of the silver filling is it has been shown to be slightly cariostatic, meaning it blocks decay, it stops it.  I believe it's the zinc inside of it because one of the metals in amalgams is zinc.  I'm not a hundred percent on this, but I do know that silver fillings are slightly cariostatic, meaning they stop decay from progressing and I believe it's from the zinc that has some antibacterial properties in it.  A white filling or a resin or a composite, as most people know it, is effectively like a plastic material and it's glued to the tooth.  We use things called bonding agent and we know this bond between white fillings and teeth tends to break down over time.  White fillings are also very technique sensitive.  Any dentist knows we all have to go through great strides to make sure we do it right.  It's like a chemistry set: there's acid, there's different liquids, and you have to do it a certain amount of time, and you have to rinse it, and you can't over-rinse it, and you can't over-dry it, and you have to put things in certain orders.  And you have to attach the white filling in certain thicknesses and then you have to use the curing light, which people out there have seen as the blue light that's used to harden the material. So there is a number of reasons why the white fillings don't last as long as silver fillings.  One of them is the highly technique sensitive nature of them.  I myself can tell you a silver filling takes me half, if not less than half the time, a white filling does because of all the strides that I have to take to make sure the white filling done as good as it possibly can be.  So, there is a number of factors that make white fillings not last as long.  At the end of the day, they don't last as long; they're about half of what silver fillings are.  During the course of somebody's lifetime, if you're having cavities done in your twenties, you know, six years, you're very quickly leading yourself to several rounds of treatment on a tooth which can lead to more problems, fractures, cracks, things that come up when you're having to treat a tooth over and over.  So let's get into the main controversy for silver fillings.  It's the health disadvantages or the sensitivies or allergies.  People talk about the mercury poisoning.  I think most famously there's a YouTube video that, to me, seems nothing more than a magic show and smoke and mirrors where they take a silver filling and they heat it up and they put it behind some screen.  I'm sure anyone watching this can find it.  And all sorts of smoke is coming out and Doctor Christenson mentions this sort of magic show and he basically states, and I agree, "If you were to heat anything up in your mouth that hot, everything's going to smoke," and you're gong to have all sorts of problems when you start heating things up in your mouth whether it's a silver filling or whatever.  But, my point being, people will suggest that there is health disadvantages and allergies and you're going to die of mercury poisoning from these.  Well, there is some science that suggests that, so I don't want to completely negate that as a problem.  About three percent of the population may have a sensitivity or an allergy to this--metal fillings.  People have allergies to metal.  Women watching this sometimes can't wear jewelry--or men that wear jewelry--if they have earrings that have certain types of metal or gold or nickel.  And they get these allergies in their ear or where ever they put their jewelry.  And so there is genuinely people that have metal allergies.  So you have to put that into effect when you make your decision.  I myself, have never come across a patient--or at least that has told me--or after I've put a silver filling, that they started having allergies.  Now, it's possible they didn't come back to me and I didn't see them again, but I have not experienced that firsthand or I would've removed it and replaced it with a white filling.  I have, on the other hand, had numerous patients come to me, generally as a second opinion, where they went to a dentist who recommended to remove all their silver fillings and replace them with white fillings for health reasons and they started having lots of complications, whether it be the tooth cracked, the tooth needed a root canal, and I don't always think this is the dentist's fault.  The reality is any time you go into a tooth, you risk problems happening with that tooth--that's just the nature of dentistry, using a drill and you're cutting into a tooth, and sometimes these teeth don't react perfectly.  One of my biggest mentors, Doctor John Kois, says, "The best dentistry is no dentistry," and I agree with that, in the right circumstances--that's not for everybody.  That's just a quote that suggests if you can avoid doing anything, and there's good rationale, that's oftentimes a great choice.  And so when somebody has a silver filling that's having no problems--seeming problems--replacing it just for the health benefits, I think, is not indicated.  I would not agree with that and I have told patients I would not do that when they're relying on it.  Now, if the silver filling has decay or a fracture or a problem, then  yes.  Now that decision has to be made whether you replace it with another silver filling or a white filling.  So, ultimately, I don't have a huge allegiance one way or another.  To be honest with you, I present it just like this to my patients.  If you're a patient of mine, you've heard me say this--I say, "One lasts longer, one looks better.  You choose.  I'll do whatever you want."  I probably do about half and half.  In general, on back teeth where it's not very visible, I like silver fillings because I know they hold up better and they are quicker to do, so the treatment time for the patient is faster, I can get a great result, and it's a fraction of the time.  I don't have to numb you up quite as long and the general experience, I think, is just a quicker, nicer appointment.  But I have about half the patients object to that and say, "No, I want a white filling," and I have no problem with that.  So, I will link the video to Doctor Christenson.  I hope you learned something.  You're certainly welcome to comment.  I'm happy to try to have some dialog about it although, again, I don't have a huge allegiance one way or another.  I'm just trying to present some of the facts.  Thank you.