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Dental Amalgam (Mercury and Silver Fillings) in Seniors

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Concerns about dental amalgam and the toxicity of fillings often worries seniors who may have had their first fillings decades ago. It is important to understand what dental amalgam is and how it is used in fillings. Amalgam is defined as a special type of alloy in which mercury is one of the components. Dental amalgam or silver amalgam is an alloy of mercury with other metals such as silver, zinc and copper, used for dental restorations and fillings. Dental amalgam has been a popular filling material over last few centuries as it is cost effective, easy to manipulate and long lasting.

Why is amalgam used?

When a tooth becomes decayed and the bacteria responsible for the decay causes cavitations on the tooth surface, clinical dental intervention becomes necessary. These cavities are scooped out from the tooth surface and the newly created, free from bacteria cavities are filled with suitable materials such as dental amalgam.

Amalgam is generally used for moderate to shallow decayed, cavitated teeth. As the material has good strength and durability, it can be used in molars, where greater stresses and forces are produced while chewing and grinding of the food. The material is low cost as compared to other dental filling materials. It is easy to insert and has a long lifespan. Dental amalgam is not used in front teeth as the silver color may not be an aesthetic choice.

How are amalgam fillings inserted?

Amalgam is available in the form of a powder containing silver, copper, zinc and a liquid containing mercury. In a dental clinic, the powder and liquid are mixed manually or mechanically. The extra mercury present in the mix is removed by mulling. The prepared cavity on the tooth is thoroughly dried after which dental varnish or cement base is given before amalgam placement. Amalgam is condensed in to the cavity, and burnished thoroughly to achieve a shiny, smooth surface. The minor tooth details are carved on the amalgam surface before the material is completely set.

Where is dental amalgam used?

Amalgam is primarily used in the back (posterior) teeth (molars and premolars) as the material strong and is fracture resistant. It is more commonly used for permanent tooth restorations. It is indicated in the following conditions :

  • Pit like cavities present on the grinding surfaces of molars.
  • Cavities present in between to teeth (on the side walls of the teeth).
  • As restoration material after root canal therapy.
  • Extensively damaged tooth needing cusp coverage.
  • Foundation for metal and ceramic crowns.

When to avoid dental amalgam?

Amalgam is dentist’s choice generally because it is easy to manipulate and has excellent strength. The direct filling restorations are easy to carry out and usually take only one appointment for complete restoration procedure. However, amalgam is to be avoided in certain situations such as :

  • Where aesthetics is a prime concern.
  • Where the tooth is sensitive since amalgam conducts thermal sensations and may increase sensitivity of the tooth.
  • Very small initial cavities requiring conservative fillings.
  • If an existing gold filling is present in the patient’s mouth, there is a risk of galvanism after insertion of an amalgam filling.
  • Patients allergic to mercury should avoid amalgam fillings.
  • Amalgam is associated with the risk of mercury toxicity if not managed properly.

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