Is amalgam safe?
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- Responded 15 Oct 2019 · An interesting question one that I doubt you can give a definitive answer to. I expect 'safe' is a relative term. In 2012 Cochrane published “Direct composite resin fillings versus amalgam fillings for permanent or adult posterior teeth”  which touches upon safety: “The current controversy is that amalgam restorations should be banned because of mercury toxicity. In addressing safety concerns, it is important to make the distinction between known and hypothetical risks (Rathore 2012). The truth is that a variety of potentially toxic compounds might be released from restorative dental materials (amalgam and composites) and can diffuse into the tooth pulp or gingiva reaching both saliva and circulating blood (Libonati 2011). Their adverse effects are not yet well known.” They reference Rathore  which is available as free full-text via the link in the Reference section. In 2018 CADTH published “Composite Resin Versus Amalgam for Dental Restorations”  this reports the following key points: “Dental restorations with dental amalgam last longer and cost less compared with restorations with composite resins. The evidence shows no clinically important differences in the safety of amalgam compared with composite resin dental restorations. Whereas the environmental impact of the release of mercury from dental amalgam in Canada is small, the environmental impact of chemicals included in composite resin materials is not known. Shared decision-making between dental providers and patients is encouraged to address the use of the optimal dental material for a given situation.” The FDA report “FDA has reviewed the best available scientific evidence to determine whether the low levels of mercury vapor associated with dental amalgam fillings are a cause for concern. Based on this evidence, FDA considers dental amalgam fillings safe for adults and children ages 6 and above. The weight of credible scientific evidence reviewed by FDA does not establish an association between dental amalgam use and adverse health effects in the general population. Clinical studies in adults and children ages 6 and above have found no link between dental amalgam fillings and health problems.”  Similar messages have been released by the American Dental Association . Finally, the EUs Scientific Committee on Emerging and Newly Identified Health Risks  published “The safety of dental amalgam and alternative dental restoration materials for patients and users” in 2015, reporting: “The SCENIHR concludes that current evidence does not preclude the use of either amalgam or alternative materials in dental restorative treatment. However, the choice of material should be based on patient characteristics such as primary or permanent teeth, pregnancy, the presence of allergies to mercury or other components of restorative materials, and the presence of impaired renal clearance. The SCENIHR recognises that there is a need for further research, particularly relating to (i) evaluation of the potential neurotoxicity of mercury from dental amalgam and the effect of genetic polymorphisms on mercury toxicity and (ii) to expand knowledge of the toxicity profile of alternative dental restorative materials. Furthermore, there is a need for the development of new alternative materials with a high degree of biocompatibility.” References 1) https://www.ncbi.nlm.nih.gov/pubmed/24683067 2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388771/ 3) https://www.cadth.ca/sites/default/files/pdf/ht0021_in_brief.pdf 4) https://www.fda.gov/medical-devices/dental-amalgam/about-dental-amalgam-fillings 5) https://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/statement-on-dental-amalgam 6) https://ec.europa.eu/health/scientific_committees/emerging/docs/scenihr_o_046.pdf Conflict of interest declaration: None
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