Counting On

Hi friends! I haven’t written in a couple months. The truth is, school has been monotonous since I’m repeating courses from last year and I didn’t want to give you the same dry run through D2 year. I’m now in Occlusion, General Pathology, Operative II and Professionalism with only some minor changes in each course.

I can’t express how good it felt to nail Operative I this past Spring, and while I’m still not the strongest in my class, I’

m doing significantly better in Operative II than in the previous summer. I have a far deeper understanding of dental anatomy and I’ve (finally) figured out how to get the perfect convergent wall. Better late than never, right? In the meantime, I’ve collected heaps of inspirational quotes to keep me sane.

Our focus for the first half of Operative II has been Amalgam—a topic that brings a lot of controversy, so I thought I’d bring it up in Dental School Diaries. Amalgam is a dental alloy made of silver, copper, tin and… mercury. That last one sometimes raises alarm bells for patients, in part because the media has mentioned consequences linked to excess mercury exposure. In fact, there has been a back-and-forth war on amalgam fillings dating back to at least the 1800s1. So why do dentists still use it?

The Deal with Mercury in Your Mouth

  • Well, it’s first important to point out there are many forms of mercury.
  •  Very volatile, reactive and neurotoxic dimethylmercury
  •  Methylmercury, consumed when we eat fish and shellfish
  •  Elemental mercury, like that found in dental amalgam fillings
  •  Ethylmercury, a preservative

The minor amount of elemental mercury we mix into an amalgam restoration essentially becomes chemically inert as it compounds with tin and silver, so it doesn’t go on to react negatively with your body, unless you have an allergy. There is a great deal of peer-reviewed literature on the topic and we have no sound evidence to suggest adverse health effects with the use of amalgam fillings in patients. Investigations of released vapors, and even noted mercury bioaccumulation from fillings, suggest it would take nearly 400 fillings in a single mouth to reach the toxic threshold in a person2,3—and I’m going to say it’s pretty unlikely you’ll ever need that many fillings.

The American Dental Association routinely investigates material safety and backs the use of amalgam in dental practice, but some dentists choose not to use amalgam for other reasons3,4. Here are a couple reasons River Oak Dental opts out of placing amalgam restorations:
1. Amalgam preparations tend to be less conservative. They require “retention form”, which often reduces more tooth structure than we would with a composite (tooth-colored) filling. This leaves the tooth vulnerable to fracture in some cases, depending on how large the restoration must be.
2. We must be careful when disposing of amalgam. When any metals are leached into the environment, it runs a risk for building up or being converted into other, dangerous, chemical forms so some countries discontinued the use of amalgam for this reason. Fortunately, this concern is much less of a problem in recent years. Our office had a Syclone Amalgam Separator installed into our drainage line to make sure we aren’t dumping any amalgam out into the environment when we take amalgams out. Let’s face it, the Indian River Lagoon has been polluted enough, so we want to prevent increasing environmental wastes.
3. We know a healthy, sparkling smile can bring confidence. A lot of patients request a bright, white smile from our team and prefer a more esthetic material. In these cases, amalgam is not the material of choice.

 

No matter what material we use as dentists, it’s important to first and foremost evaluate ourpatients with individualized attention and determine what best suits the immediate needs of his or her case. As a student at UFCD and a member of River Oak Dental, I’m passionate about only using evidence-based techniques and materials to give patients the absolute best of everything we have available to us. The desire to feel informed, safe and comfortable is perfectly reasonable. If you ever have a question about why we use something in our office, we love discussing the science behind our standards of care!

UPDATE: National Dental Board Examination (NDBE)

I mentioned taking the Board Exam early with Class of 2021, but upon further research and discussion with our Office of Education, I’ve decided to wait and complete the exam with Class of 2022. The test-makers recently re-calibrated the exam to be more challenging and cover topics such as pharmacology and endodontics, which are courses I haven’t yet taken. Once we get closer to that time frame, I’ll fill you in on all the study materials I use. Nevertheless, my dear friends from Class of 2021 passed their NDBE with flying colors and are on their way to seeing patients in clinic!

References
1 Amalgam: Its history and perils. J. M. Hyson, Jr. J Calif Dent Assoc. 2006 Mar; 34(3): 215–229.
2 Mackert, J.R. and Berglund, A.: Mercury exposure from dental amalgam fillings: Absorbed dose and potential for adverse health effects. Crit Rev OraI Biol Med 1997; 8:410.
3 Delgado, Alex J. Dental Amalgam and Mercury Academic Presentations. University of Florida College of Dentistry. Retrieved 2019-06-18.
4 “Current Policies: Dental Amalgam”. <https://www.ada.org/en/advocacy/current-policies/dental-amalgam>. Retrieved 2019-06-21.

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