Sliver-colored dental fillings or dental amalgams contain mercury (Hg) and are known to release mercury vapors. Should you have them removed?
About silver-colored fillings...
Mercury amalgams are silver-colored dental fillings that contain 50% mercury, 30% silver, 14% tin, and 8% zinc. They are called mercury amalgams because mercury is the main component. Historically, it was believed that an oxide layer formed over the amalgam, making it safe. For many years, it has been known that this is not the case.
For each typical amalgam, mercury vapor is released with any manipulation of the tooth. Dry polishing at the dentist releases 600 mcg of mercury vapor per cubic meter of air, while wet polishing releases 500 mcg/m2. People who grind their teeth or have bruxism can expect a release of 350 mcg/m2. Toothbrushing releases 200 mcg/m2, and if done twice a day, that is 400 mcg/m2 total. Chewing releases 36 mc/m2. Released mercury vapor is inhaled and enters the body through the lung. Hot meals and beverages result in a higher amount of released mercury vapor over cold meals.
Currently WHO states that a "safe" amount of long-term daily mercury inhalation is 2 mcg/kg body weight. For a person who weighs 150 lbs. or 68 kg, this would be the equivalent of 136 mcg/day (68 kg x 2 mcg/kg). If this person eats 3 meals and brushes their teeth twice during the day, assuming all of the mercury vapor is inhaled or otherwise absorbed, this is 508 mcg ((36 x 3) + (200 x 2)) and 372 mcg over the WHO recommended safe level. Now, if this same person has two amalgams, that is 1,016 mcg/day. If 3 amalgams, 1,524 mcg/day. Again, this math is with the assumption that all of the vapor is absorbed when in reality, it is likely a lot less but still a concerning amount. Very old amalgams that no longer appear silver and shiny but tend to appear more black are oxidizing and releasing much more significant amounts of mercury.
Should dental amalgams be banned?
In 2011, Sweden, Norway, Denmark, and Germany banned dental amalgams. On 7/1/2018, all European Union countries banned the use of them in children 15 years and younger. By 2019, Ireland, Finland, and Slovakia set timetables to ban them within the next five years. When January 1, 2025, rolls around, they will be banned in all EU countries. As of 2021, 41 countries have banned the use of dental amalgams.
One wonders why dental amalgams are not banned in the US. The American Dental Association (ADA) continues to state that they are safe, affordable, and durable despite acknowledging that vapor is released. When placing an amalgam, more tooth structure must be removed because they do not bond well. On 9/24/2020, the FDA recommended the avoidance of placing amalgams in pregnant women, women who are planning to become pregnant, nursing mothers, children under 6 yrs, people with preexisting neurologic diseases and kidney disease, as well as in persons with allergy/sensitivity to mercury. In response to the FDA, the ADA doubled down and again stated that amalgams are "safe, affordable, and durable ."1
Mercury in the Body
We all know that mercury accumulates in the the brain (Mad Hatter), kidneys, and other tissues. In the kidneys, it causes kidney disease resulting in hypertension and chronic kidney disease. Mercury is absorbed into the body through the local tissues of the mouth, in swallowed saliva, and inhaled vapors. Multiple studies have shown higher blood mercury levels the higher the number of amalgams. In contrast, white composite restoration fillings contain BPA and the urinary BPA level has not been found to correlate with the amount/number of restorations. Composite restorations release high levels of BPA for the first two weeks after placement and then the amount released is very small.
Persons with ApoE4 allele which correlates with a higher risk of Alzheimer's Disease also have reduced mercury detoxifying capacity. Those with ApoE2 allele have the highest mercury detoxifying capisity and also the lowest risk of Alzheimer's Disease.
Several animal studies have shown gut and oral microbiome changes when amalgams are present. Genomic studies have shown that the presence of toxic metals in the body can result in multi-antibiotic resistance as the metals themselves have antibiotic effects that bacteria quickly adapt to, resulting in resistance to other antibiotic substances.2
Further, people with a metal and/or mercury allergy may have chronic mouth inflammation from amalgams.
Removing Amalgams
Unfortunately, getting mercury amalgams removed is not as easy as going to your family dentist. For each typical amalgam with unsafe removal, 1,000 mcg of Hg vapor per cubic meter of air is released into the room. Dentists are aware of the dangers of mercury vapors and airborne particles released when drilling into amalgams. Special precautions must be taken to protect both the patient and dental staff. Staff must wear 3M-type vapor gas masks rated for mercury vapors. The patient will have negative air pressure (suction) and possibly nasal masking, providing clean air.
The cost of removing amalgams is steep and, unfortunately, not covered by dental insurance. Medical tourism may be worth considering but only after verifying that the appropriate precautions will be taken.
2 Wiggins AG, LaVoie SP, Wireman J, Summers AO. Thinking outside the (pill) box: Does toxic metal exposure thwart antibiotic stewardship best practices? Plasmid. 2018 Sep;99:68-71. doi: 10.1016/j.plasmid.2018.08.003. Epub 2018 Sep 4. PMID: 30193909.
3 Photo credit: Hahn, et. al., 1989
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