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There's a lot of talk on the internet that mercury amalgam fillings are toxic and should not be done. In the 20 years since my first cavity I've only received metals-free composite fillings. My current dentist informs me that composite fillings are qualitatively better, while disregarding the health concerns with amalgams. This has made me wonder, what percentage of fillings performed today are done with mercury amalgam? In other words, I have a suspicion that it is an increasingly irrelevant problem.


I've tried the basic Google searching for an answer, but results on the topic are obfuscated by reports concerning the percentage of mercury in fillings, rather than percentage amalgam fillings administered.

I did find:

According to the American Dental Association (ADA), more than 100 million silver-amalgam fillings are placed in American mouths each year.

...

As a sign of the times, in 1999, around 86 million composite restorations were placed in the United States, as against 71 million amalgam restorations.

I'd like something more current though. Plus, I don't know if the sum of those figures represents the total.

Data about the United states is preferred, but any data is accepted as useful.

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Some recent estimated numbers recently were:

45% of all dental restorations world wide (Heintze 2012),
50% of all American fillings

But

Many developed nations have virtually eliminated dental amalgam. Dental amalgam use is banned in Sweden and Norway; only used in 3% of all dental restorations in Japan and Finland; 5% in Denmark; 10% in the Netherlands, Switzerland, and Germany; and 20% in Singapore.

Quoted from Chicago Declaration to End Dental Industry Mercury Use (PDF)


On amalgam use:

WHO Policy Paper (PDF)

SD Heintze & V Rousson: "Clinical effectiveness of direct Class II restorations—a meta-analysis" J Adhes Dent. 2012; 14(5):407-431.

SK Makhija et al.: "Practitioner, patient and carious lesion characteristics associated with type of restorative material: findings from The Dental Practice-Based Research Network", J Am Dent Assoc. 2011; 142: 622-632.

Simececk et al.: "An evaluation of replacement rates for posterior resin-based composite and amalgam restorations in U.S. Navy and Marine recruits", J Am Dent Assoc. 2009; 140 (2): 207. PMID: 19188417

United States Food and Drug Administration: "About dental fillings: potential risks. Last updated 2 February 2017. FDA Web site

World Health Organization: "Future Use of Materials for Dental Restoration" (2011), PDF , p.21

Bio Intelligence Service/European Commission: "Review of the Community Strategy Concerning Mercury" (p.213-14), 4 October 2010, (PDF)

BIO Intelligence Service (2012): "Study on the potential for reducing mercury pollution from dental amalgam and batteries, Final report prepared for the European Commission-DG ENV", PDF, p.190–191.

World Health Organization: "Future Use of Materials for Dental Restoration" (2011), (PDF, p.21.

Letter, Federal Office for the Environment to Francesca Romana Orlando (8 August 2011), (PDF).


Commentary:

Dental mercury amalgam is also an environmental and social justice problem: Dentistry Today 2018: Berlin Declaration Shows Amalgam Has Entered Its Twilight Era

  • So if the usa tends towards the way Sweden, Japan, and others have moved, my suspicion that it's an increasingly irrelevant problem is correct. I guess I need to see if there's a downward trend in amalgam use. My 1999 data point from a comment above may indicate it's been a steady half-and-half for 20 years. – fredsbend Mar 23 at 17:51
  • @fredsbend If amalgam is a problem (FDA says no, I say yes), then you also have to look at a lot of older teeth, or remnants of those. You might say it is decreasing as a problem, but quoting Angus Young in reverse, "it's a long way from the top, if you wanna irrelevancy" (have to improve the metrics for these lyrics, though) – LangLangC Mar 23 at 17:55
  • Well, replacement is different than installing, and comes with unique risks. Without widespread replacement, decreases in installs will result in decreases in prevalence, albeit slowly. Health concerns aside, filling longevity seems the biggest argument among dentists now, with many suggesting that composites and resins simply don't last as long. Personally, I don't mind having to replace a few fillings every 10 years, instead of every 30. – fredsbend Mar 23 at 18:05
  • @fredsbend "Longer lasting" is against resin-based, and pales a bit against gold or ceramics. The kickers are cost and tradition, ease-of-use. And I haven't seen a global (re-)view on resin vs amalgam that takes tooth survival longer term into account (amalgam needs more removal of healthy enamel). What I have seen is the hazmat gear dentists wear when removing amalgam in a living patient… – LangLangC Mar 23 at 18:10
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    Removal often requires vaporizing the amalgam. I'd wear a hazmat too. That's the main reason I'd think twice before removing my own (I fortunately have none anyway). – fredsbend Mar 23 at 18:15

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