US Dentists Still Place More Mercury Fillings Than You Might Think
Posted on Friday, June 24th, 2011
Then we run across headlines like this:
US Dentists’ Amalgam Use
The findings reported in this Medscape Medical News story surprised us, too. (Login required; bypass available via Bug Me Not)
According to a pair of studies recently published in JADA, “Despite improvements in resin-based composite technology, US dentists are placing more amalgam restorations than composites, and amalgam is still emphasized by US dental schools….” (“Composite” is the tooth-colored material used to make “white fillings.”)
For the first study, researchers analyzed reports from 182 American dentists on nearly 5600 fillings placed in molars (the back teeth). About 54% were amalgam, and just under 46% were composite. (The rest were made of other materials.) Lead author Sonia K. Makhija, DDS, MPH, says that while this sample isn’t strictly statistical, the results are in line with previous studies.
Interestingly, dental education doesn’t appear to be the main culprit here, judging by the other study, which looked at filling techniques taught at US dental schools. While both US and Canadian schools lag behind their British and Irish counterparts, about half the restorations placed are composite – 30% more than 5 years ago.
Instead, the bigger issue seems to be what happens after dental school. According to the first study, older dentists are more likely to place composite – this, despite having gone to dental school during a time when amalgams were emphasized. By contrast,
dentists who graduated in the past 5 years placed amalgam on 61% of the lesions they treated. One explanation may be that younger dentists are more likely to be in large group practices where they work on salary, rather than fee-for-service, said Dr. Makhija. The type of material might be dictated by managers of the group practice. In large group practices (4 dentists or more), 79% of the restorations were amalgam (P < .001). "It's quicker, it's easier and it's cheaper to use amalgam," Dr. Makhija said.
Indeed. Composite is much more technique sensitive and takes skill to place well, but the effect is a filling that is just as durable as amalgam but much safer and much more attractive. Placing it is also a less invasive procedure, allowing more of the natural tooth structure to be retained. As Dr. Makhija and her colleagues write, “These tooth-friendly features of resin-based composites make them preferable to amalgam, which has provided an invaluable service but which, we believe, now should be considered outdated for use in operative dentistry.”
To learn more about composites and other types of dental restorations, read Dr. Verigin’s article “All About Dental Restorations.”
Full text of Dr. Makhija’s study
Abstract of the dental school study