Mercury fillings: plenty of bucks to pass around

Kathleen McGee’s oped, “Mercury mouthful” (BDN, Feb. 7), is a timely commentary concerning the use of the element mercury in dentistry. Mercury is a toxic element, and rightly should be eliminated from everyday use. That being said, the facts surrounding the continued use of mercury in dentistry should be accurately understood to gain a fuller perspective.

As a child growing up in East Millinocket, we played army outside – shooting our toy guns at the biplanes flying overhead dumping DDT to kill the mosquitoes (and everything else, it turns out). The refrigerator repairman would pump Freon into the fridge to keep it working properly – oblivious to the holes he was creating in the ozone. My father would use asbestos gloves to hold the copper tubing he was soldering. And old Dr. Civiello would fill my cavities with amalgam fillings when I needed them fixed.

Amalgam is a compound formed by the chemical reaction of silver and mercury. This is no different than the chemical reaction of deadly chlorine and combustible sodium to form sodium chloride – everyday table salt, absolutely necessary for sustaining human life.

This is simple high school chemistry – that elements that would be individually toxic to humans combine in chemical reactions to form completely different, harmless compounds. In dentistry for decades we have fought to have fluoride added to municipal water systems over the objections of well-intentioned people who confuse sodium fluoride (which has reduced the incidence of cavities by over 50 percent in people) with fluorine gas used in World War I as “mustard gas” to kill soldiers.

To call amalgam fillings used in dentistry “mercury fillings” is at best a misnomer, and at worst is alarmist and Kathleen McGee does her Maine Toxics Action Coalition a disservice as she aligns her coalition with Chicken Little.

Having said that, organized dentistry does no better when we refer to amalgam fillings as “silver fillings.” They are no more silver than they are mercury. Dentists seem to prefer to coin them out of popularity’s sake more than for accuracy.

DDT, Freon, asbestos – all are things of the past. The same is happening in dentistry as we move away from amalgam fillings to other restorative materials – primarily resin-bonded ceramics, which for simplicity are called “composites.” Composites are the so-called “white fillings” and are presently being used with more and more frequency by the profession. Other alternatives to amalgam include gold or porcelain.

As an individual dentist, I personally believe amalgam filings are better than what we had to use many years ago. I prefer not to engage in all this finger pointing as to whether amalgam fillings are good for you or bad. The simple fact is that there are hundreds of millions of people out there walking around with literally billions of amalgam fillings. Hundreds of millions of people are not dropping dead in the street daily from amalgam filling disease.

So why do dentists continue to use amalgam fillings? I personally switched to “white fillings” back in 1984 and have watched their evolution from a new technology to an established protocol.

The simple truth to why amalgam fillings are still used is that there is plenty of “passing the buck” in this instance. Take insurance reimbursement, for instance. The insurance industry – always eager to retain its profit and please its stockholders – considers composite fillings of molar teeth “cosmetic” and refuse to pay more than the amalgam rate. So, the dentist must a) place an amalgam on molar teeth to please the insurance industry or, b) place a composite filling and make the patient responsible for reimbursement. Either way, the insurance company wins because it has received money from the employer and doesn’t have to pay out all or any of its benefit for the patient. Believe me, dental insurance reimbursement is a national scandal waiting to be exposed.

There is good reason why many of my colleagues refuse to accept dental insurance reimbursement – “benefit” maximums (normally $1,000 per calendar year) have stayed constant for nearly 30 years. When was the last time you saw any price stay constant for nearly 30 years? Buy a car recently? A home? Have a filling? As the cost of living creeps along upward, all that cost-of-living allowance increase goes directly to the insurance company as gross profit and not to the people it purports to benefit. Dental insurance is a national joke and all the insurance companies are laughing (at the expense of the employer and the patient) all the way to the bank.

Another buck passer with the amalgam-filling situation is the government. There are no clear state or federal statutes or regulations regarding the dentist’s obligations or responsibilities towards placing amalgam fillings. The new brochure that the state of Maine has mandated to be available this year is a good first step in informing patients, and dentists too, concerning amalgam placement. But, like other areas of protocol, the issue is murky at best.

Did you know that as a dentist

I cannot ethically recommend that you have all your amalgam fillings replaced with white fillings? The government says that there is nothing wrong with amalgam fillings. I could have my license to practice restricted or suspended for making such a comment. You can, however, go into any dentist’s office and request such a procedure be done. That’s your personal choice and

is acceptable.

It is my personal belief as a practicing dentist that amalgam fillings are anachronisms, and the newer restorative technologies should be embraced. Do I think that amalgam fillings are full of mercury and are toxic? Certainly not. I believe, however, that it is best for us as a profession if we move away from their use because of their tainted reputation. While patients may receive an amalgam a few times a year, the dentists and his assistant are constantly exposed to the elemental mercury prior to the mixing procedure.

A patient hazard? Possibly. A workplace hazard? Certainly. The government, through new workplace safety and insurance regulation, should motivate the use of newer restorative techniques and relegate the use of amalgam to fringe or specialty uses. Don’t be surprised, however, if the state government or the insurance agency somehow empties your wallet to fill these cavities.

Frank Dentremont, DMD is a native of Maine and has been a practicing dentist in the Greater Bangor area for 21 years.