No more amalgam fillings: invest in porcelain inlays

by Matthew D. Wittmer
Last updated June 2016

In 2005 I began reading up on the history of dentistry to better understand why and how metals have been used for filling material in teeth. What I found was that there has been a divided opinion of the use of “silver amalgam” fillings for quite some time, basically since the formation of the American Dental Association. The long-term cumulative effects of metals in the oral cavity have been debated ever since their first use in America (Wentz 2004). I found that there are alternative dentists, cosmetic dentists, mercury-free dentists, and of course what I had always utilized—traditional dentists. The dentists I grew up visiting in Missouri had given me several silver amalgam fillings and had not ever offered alternative filling materials. I had not asked for alternatives at the time either – I had blindly trusted their clinical judgment with my health. Upon moving to California, I began to see that dental offices there post warnings about filling materials as required by Proposition 65 (Brown and Hansen 2000, p. 50). I saw these warnings posted in dental offices in Glendale and Pasadena, California. They were always framed and hanging next to the patient dental chairs in clinics using silver amalgam filling material.

I read an insightful book by Dr. Myron Wentz, called A Mouth Full of Poison: The Truth about Mercury Amalgam Fillings. Wentz reveals the history of amalgam metals in dentistry in that book; he is a microbiologist who runs an alternative health clinic in Rosarito, Mexico called Sanoviv. I consulted many other dentists in California about alternatives to metal fillings and asked each one about their filling materials and protocol in removal and restoration procedures. This research revealed sharply divided opinions from dentist to dentist.

I found that the process of removing these fillings from my teeth could be harmful unless safety protocol is taken. Most sources report that amalgam fillings are typically comprised of about 50% mercury. Mercury is stated to release fumes when it’s temperature increases, which occurs when eating hot foods or drinks, as well as the through friction resulting from simply chewing food. Dental drilling or polishing causes the most friction (Brown and Hansen 2000; Wentz 2004). The International Academy of Oral Medicine and Toxicology has a complete safety protocol for amalgam removal; however, finding dentists who recognize or are even aware of this protocol remains a challenge. Is it bologna? You be the judge. Some dentists will use slower drills with cool water to reduce friction. Some also use a vacuum system to divert fumes away from the patient and completely out of the office altogether. A rubber dam also prevents material from going into the mouth and being swallowed. The Missouri dentist who placed most of my amalgam fillings advised me against removing them; however, other dentists were happy to perform the procedure with and without any degree of the IAOMT safety protocol. Removal protocol validity appears to be based on your own (and your dentist’s) core belief about the whether or not the materials are harmful to begin with.

As far as finding alternative filling materials, the one I found most frequently offered is a composite, white material that has aluminum in it. Estimates on this material’s longevity stretch only two to five years before beginning to break down (a dentist in Pasadena told me this when he gave me one). Porcelain was the strongest material I felt was the most biocompatible, as it closely mimics tooth enamel (various California dentists told me this in personal consults to discuss filling materials in the summer of 2005, but, it can only be used on large fillings). Recent developments in porcelain have increased its core strength as a filling material.

Traditional dentistry tends to employ traditional materials and practices. More contemporary applications in dentistry deviate from some of the traditional materials and standards. The dentists using new approaches tend to be much more accommodating with answering questions about process. Due to the improved technology of modern dentistry, the out of pocket expense tends to be much higher with advanced materials or approaches. That said, more insurance plans are increasing reimbursement for new procedure services.

I eventually found a dentist that provided the best protocol for what made sense to me through the aid of a web site that had listings of dentists who maintain a mercury free practice. The director of this clinic had written a book about biocompatible materials, alternative practices and diet, and he has been a pioneer in the field of using a variety of different lasers for preventative dental treatment (Dr. Richard Hansen). His clinic provides an intra oral exam with a microscopic camera that revealed to me, visually, several fissures in my teeth that were extending from or around my amalgam fillings. This was largely because no adhesive or bonding procedure is used when applying silver amalgam fillings. The metal mixture is poured directly into the tooth after it has been prepped. As it sets up in the tooth it can be easily be sculpted to fit the tooth’s outer contour (this is also true of the newer white composite fillings). This mixture of metals in the amalgam fillings will expand and contract slightly when heated or cooled though unlike the newer plastic material. Over time the stress of the metal movement can weaken a tooth because silver amalgam fillings are not bonded to the tooth; they merely conform to the inner shape of the hole they are filling (Pers. comm. with my dentist at Hansen’s clinic, August 8, 2005). The bigger the filling, the more it can damage the tooth over time.

CEREC technology now alleviates this issue. Once a traditional filling has been removed, the tooth is lightly sprayed with a photo sensitive powder and scanned with a camera that creates a three-dimensional computer image of the tooth and its recessed area. The tooth can be viewed from any angle by way of a CAD replication on a computer screen. The dentist uses a computer program to draw where the inlay will repair and sit inside the cavity of the tooth. This is done in a matter of minutes and is not unlike tools in Photoshop. A small piece of high-fire porcelain (the color of your tooth) is then placed in a milling machine and within minutes the machine uses two diamond bits to mill out an exact replica of an inlay that is the exact size of the cavity.

This piece fits right into the tooth and is fused to the tooth with a laser. The porcelain inlay is biocompatible, so no more shocks or sensitivity with forks, foil from wrappers, which is what I experienced with several of my large metal fillings. Since porcelain inlays are fused with the tooth, the inlay doesn’t work against the tooth when pressure is applied through chewing, so you have a solid tooth again without the danger of the tooth loosing structural integrity over time.

Reworking a Root Canal
I also had a traditional root canal redone in 2005. The dentist removed the old crown that was nickel with a thin layer of porcelain on top. He then removed the old filling material in the root of the tooth, called gutta percha, and replaced it with a material called Mineral Trioxide Aggregate. MTA is extremely alkaline and much more biocompatible than traditional gutta percha that is actually a latex mixed with several types of metal (including barium) so the dentist can see his handy work on an x-ray (Pers. comm. with my dentist at Hansen’s clinic, August 8, 2005). Removing the old root material took a few trips to the clinic due to the difficult nature of extracting the old material, which had hardened over years.

Ten years after having this awesome new porcelain crown work, I had to have that tooth redone, not because of the dentist work, but because I had neglected to wear a night guard because I clench my teeth at night, putting pressure on my molars. What had happened over the course of 2-3 years was I was clenching so hard that the root canal tooth – the last top molar on one side, was being pushed back and away from the neighboring molar which left a gap that food more easily got caught in. I thought I was cleaning that gap but an infection set in and the all porcelain crown had to be cut off to repair the infection further down. When the crown was removed, I could see the MTA filling on the inside from a decade ago – it was still clean and white. The new crown fits snuggly against my other teeth again, and I’m never sleeping without that night guard again!

References

Brown, E. and R. T. Hansen. The Key to Ultimate Health: Restore Your Health by Creating Balance in Your Diet. Vermont: Healing Arts Press. 2000. Print.

International Academy of Oral Medicine and Toxicology, The. Iaomt.org. n.d. Web. <https://iaomt.org/> Link last checked January 2016.

McGuire, Tom. Mercury Detoxification: the Natural Way to Remove Mercury from Your Body. Sebastopol, California: The Dental Wellness Institute. 2006. Print.

McGuire, Tom. Tooth Fitness: Your Guide to Healthy Teeth. Grass Valley, California: St. Michael’s Press. 1994. Print.

Sanoviv. Sanoviv Medical Institute. Sanoviv.com. 2014. Web. <http://www.sanoviv.com/> Link last accessed January 2016.

Wentz, M. A Mouth Full of Poison: The Truth About Mercury Amalgam Fillings. South Carolina: Medicis. 2004. Print.