Are fillings from amalgam
dangerous?
Charontakis Panos Surgeon Dentist
In
all the countries of our planet, for more than one century, the dental
amalgam maintains a basic central place in the clinical dental practice.
The reasons that
established amalgam more from each other dental material for a so much big
time interval, in the dentistry, are related with the nature of material
(attributes, functional), the form of damage that was intended it restores
(extensive caries alterations of back teeth) and the lack of other
material such possibilities.
It is make that the wide
use of amalgam contributed substantially in the long-lasting maintenance
of innumerable teeth in the dental barriers, changing the frame of dental
treatment and offering important social services.
Last 20 years the data
on the confrontation of caries damage have entered in other base and
dictate the intervention of dentist in level of pathology of illness and
her confrontation in initial stages. This make and in combination with the
growth and improvement the multilateral and ceramic materials, contributed
in the weakening of necessity of utilisation of amalgam.
At the same time from
the beginning of decade the ' 80 it began to be developed an intense
reflection relatively with the venturousness of amalgam and concretely the
content of mercury. This reflection was supported and was supplied in two
basic factors. First from them it was the heap of inquiring work that was
reported in the emission of steams of mercury and his detection in the
human organism and second in the pollution of environment from the waste
of dental amalgam.
The first factor was
helped substantially by the modern analytic technology that gives the
possibility of detection of metal elements of his order of part in the
billion (in this level of weight it means one gram in the thousand tons),
while second was strengthened by the growth of various ecological
movements internationally. This factors, as moreover they were expected
after they had they make with the public health, supplied the SME and the
pressures that were practised were not late they lead to the
decision-making of restriction or even prohibition of use of amalgam.
Up to today have not
been given persuasive answers in questions as: Justified the are noise and
the concern that has burst out the last years, with regard to the
repercussions of amalgam, so that are taken decisions of prohibition?
Supported this are decisions in inquiring data, that would prove the
damaged effect of reactions?
Does not exist doubt
that the mercury is a dangerous element for the health of persons and
animals when the report in this exceeds the allowed daily quantity that
has been determined in the 20-40 mg (micrograms).
The opinion that the
amalgam 24 hours afterwards his placement in the oral cavity etched and
remains there sure and innocent ceased it is in effect. Today believed
that no inactivation does befall. On the contrary, at all the duration of
his eve in the oral cavity and mainly in the periods where it suffers
processes of harassment (chewing, brushing of teeth, smoothing,), it
releases steams of mercury.
The precise detection of
mercury in the various liquids and bodies of human body, at least with the
current data, is exceptionally difficult. The occasionally proposed
standardisations of model capable it determines the daily reception of
mercury; it was proved complicated and arguable. A usual way that is used
is the cross-correlation of engaged mercury ma the concentration of this
in the urine and in the blood or even in the various webs. The daily
quantity of mercury that engages individuals which bring obstructions of
amalgam is calculated that it oscillates in 3-17,5mg with medium price the
8mg. In this case the stockings of mercury are: in the urine 2,3 m g/l,
in the blood 0,77mg/l, in brain 12mg/Kg and in kidneys 71mg/Kg.
As is marked that the
maximum permissible level of steams of mercury in the working place, as it
was determined in the conference of Health USA in 1973 is 50mg/kyv metre
of air.
Also, physiologic level
of mercury in the urine is considered 20mg/l with maximum permissible
limit 150mg/l.
All the researches agree
that exists cross-correlation of detected mercury in the urine, in the
blood, in the brain and in the kidneys with the number of obstructions and
surfaces of obstructions that brings the individual in his oral cavity.
Also it has been recorded that the steams of mercury in evaporated air of
individuals with obstructions of amalgam are found before the chewing in
2,24ng and afterwards the chewing in 18,97ng, while in individuals without
obstructions this prices are 1,13 ng and 1,0ñg respectively.
Patients that bring more
from 12 chewing surfaces of amalgam they engage 29mg of mercury the day
opposite 8mg that engages individuals that bring up to 4 chewing surfaces
of amalgam. Other researchers found these prices much smaller and without
fail they find to abstain considerably from the sum of engaged mercury
after 24wri report in the maximum permissible limit of concentration in
air.
A ceiling of safety of
obstructions of amalgam wants these do not exceed the 12 regular in size
re-establishments.
Certain researchers
support that the 50% of engaged mercury from the total of sources (foods.)
emanate from the obstructions of amalgam. At other this percentage does
not exceed 10%.
As is marked that the
more important source of engagement of mercury are considered the foods,
by which it is calculated that they are engaged on average the day roughly
10mg. The engaged mercury with evaporated air is calculated that
constitute the 1/10 of - 1/100 of the price.
Up to today any effort
of connection of low rates of mercury that is detected in the bodily
liquids and the webs with various degenerative situations, mainly the
central nervous system (illness Alzheimer, illness of Parkinson, and
hardening at plate) is ill founded and such something has not been proved.
This opinion confirms with her statement the American union of individuals
suffering from hardening at plate, reporting that do not exist elements
for the incrimination of amalgam. The cases of individuals with
neurological symptoms that are eased or even are cured afterwards the
abstraction of obstructions of amalgam, should be considered coincidences
or reactions placebo. (Reaction placebo or virtual reaction is said the
phenomenon of "treatment" suffering with the reception of colourful water
or pills without medicine, that however believes that is drastic)
The problem however
appears to be focused more in the effect of mercury of amalgam in the
environment. The bibliography has also recorded in this sector, from the
decade ' the 60 tragic ' experience of city Minamata of Japan, after
consumption polluted from industrial waste of fishes, as well as the
pollution of atmospheric air at the incineration of dead.
The increased rates of
mercury in atmospheric air are recycled in the trophic chain via the
plants and the vegetables, where the mercury afterwards his transformation
in mecyl-mercury is accumulated in the fatty web.
The dental mercury, via
the sewage system, certainly and participates in the tax of environment.
It is calculated that the complete wastewater already polluted from
mercury of a sewage system network, even if from today stops the use of
amalgam, would require 30-35 years. Even in this case the millions
obstructions of amalgam that exist in the dental barriers, would continue
constituting source of tax of environment, after at intervals somebodies
of them would need repair or replacement. The right and absolute
entrapment of remains of amalgam constitutes the alone solution for the
protection of environment, even at the duration of period of this removal
of material from the dentistry.
The discussions and the
noise that continuously expands in countries with increased ecological
sensitivity, possibly show that we cover a transient period, in the end of
which will stop the use of amalgam.
This will happen no
because the amalgam is not one from the better materials of
re-establishment of rear teeth, but will be result of environmental
concerns, change of form of caries alterations (all show that the next
generation dental ill will present extensive caries alterations) and
development of new materials.
In this transient
period, the dentist cannot and she should not be neither lover, but also
not adversary of dental amalgam. Moreover it knows very well that the
continuously increasing tendency for replacement of amalgam, not only does
not begin from the him, but becomes and despite intense tries projection
from the side of him virtues of this material. Obviously the speculated
dangers from the content mercury, the protection of environment (in the
developed countries it is elected in fundamental subject), but also the
aesthetic requirements of our season, constitute powerful reasons in order
to they refute any opposite opinions.
Finally, even if the
spirit of season to us strengthens the disturbance of opinions, it should
also it is pointed out that in the threshold 2000 the fable of almighty
dental amalgam it does not exist anymore. Functional, cheap, sure and
durable in the oral conditions dental amalgam, that nourished generations
and generations of dentists and contributed in the maintenance of
innumerable teeth for a lot of years, has been affected by the elements
that elected the environmental problems in our planet.
Fortunately that this
happens in a season where at the same time are modified the form of caries
alterations and the technological development in the sector of dental
materials it is in place it covers the void of likely removal of amalgam
from the clinical dental action.
It
could
be use amalgam at the duration of pregnancy?
It is known
that the mercury can cross the placenta from mother in the foetus and can
also be detected in the maternal milk but do not exist elements of any
connection between the use of amalgams and the imperfections or still the
abnormalities in the birth. Generally, it is reason are minimised the
interventions of health at the duration of pregnancy. The report 1998 from
the European Committee with regard to the toxicity reports that does not
exist no reason for be considered that the placement or the abstraction of
obstructions from amalgam at the duration of pregnancy was harmful. The
Committee of toxicity agreed with the team of experts of European
Committee, nevertheless, that she will be supposed it is avoided, where
possible, the placement or the abstraction of obstructions from amalgam at
the duration of pregnancy.
This does not
constitute prohibition in the use of dental amalgam at the duration of
pregnancy. Will exist cases when decide the patients, with regard to the
advices from a dentist, that the profit the amalgam (from the opinion of
permanence, for example) exceeds up to now theoretical danger of
systematic toxicity at the expense. The dentists should always have the
consent of one ill before they undertake any treatment.
Should be
used amalgam for the children?
The children
that have need of dental treatment this can become successfully using the
resins and the glass ionomer obstructions that are dangerless. But hardly
the later cavity approaches the one third of chewing' width the glass
ionomer obstructions is not recommended and the amalgam is a acceptable
material of reconstitution
.
Exist any does team of patients for
which the amalgam shouldn't be used?
The patients
with the evidenced sensitivity and allergy in amalgam in somebody of his
components, it is the alone team for which the placement of new
obstructions from amalgam is not allowed.
Deductively:
· With the current scientific data
the dental amalgam can be considered dangerous for the health of
individuals.
· The attendance of mercury of
amalgam in the pollution of environment is uncontradictable.
· the restriction of use of amalgam
or even his likely removal from the clinical action, is dictated and
strengthened by factors as the aesthetics, the environmental problems, the
change of form of caries alterations, the reflections with regard to the
reduction of minerals and the growth of new materials.
· Today the dentist can use amalgam
for re-establishments, at least in the following cases: in the early
teeth, in bicuspidate (apart from extensive cavities 3 or 4 surfaces) and
in the relatively small cavities. In this cases it can use as filled
material the complex resins.
· In all the other cases the
amalgam should offer still his services. His replacement in these cases
should become with ceramic materials.
