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How to Choose the Best Restorative Material for Your Patients

Dental amalgam has historically been the gold standard of restorative care. Recently, however, the use of composites as a restorative option has grown in popularity.

Long History of Amalgam

Dental amalgam has historically been the gold standard of restorative care. Recently, however, the use of composites as a restorative option has grown in popularity. In one survey 50% of dentist respondents reported a decrease in amalgam use over the previous 5 years. Composite may seem like the obvious replacement for dental amalgam, but some research shows that it is not as durable or long-lasting as amalgam. Amalgam has been used in dentistry for more than 165 years. Almost since its inception, the use of dental amalgam has been controversial. This is because it is composed of mercury, which has significant side effects with high levels of exposure.

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Dangers of Mercury

According to the United States Environmental Protection Agency (EPA), mercury can cause loss of peripheral vision; impaired speech, hearing, and gait; and muscle weakness. However, past studies have consistently proven that the levels of mercury in amalgam do not cause negative health effects and that it is a safe restorative material. Results of studies with large patient samples showed no correlation between a patient’s health risk and how many dental amalgam restorations were present.

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Effects on Oral Health Professionals

Recently, research has investigated whether the presence of mercury in amalgam has negative health consequences for oral health professionals. Dental professionals are repeatedly exposed to amalgam restorations during both placement and removal. One study surveyed dental assistants who had been practicing since 1970 and were exposed to amalgam restorations. The study reported that, in comparison to a control group, the dental assistants experienced a higher occurrence of neurological symptoms, including memory problems, difficulty concentrating, fatigue, and sleep disturbances. While the majority of the control group did not report these signs, high-quality research is still needed to demonstrate causality.

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Environmental Impact

In large quantities, mercury is harmful not only to humans, but also to the environment. The toxic environmental effects of dental amalgam, which contains mercury, must be considered. According to the EPA, dentists are releasing approximately 5.1 tons of mercury waste each year and serve as the main source of discharge into the environment through publicly owned treatment works, which are essentially government-owned sewage facilities.

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Alternative Options

Esthetically pleasing composites, resin ionomers, glass ionomers, ceramic inlays, onlays, and gold alloys serve as alternatives to dental amalgam. For the clinician, the decision is typically based on longevity, while a patient may prioritize cost-effectiveness. Studies have shown that gold restorations have excellent longevity—even more so than dental amalgams—but amalgams are still 3.8 times more cost-effective than a gold crown. Ceramic inlays have a 98% probability of survival over a 7-year period. Glass ionomer restorations also release fluoride, which may be beneficial to particular patient populations. However, the leading cause of glass ionomer restoration failure is secondary caries.

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Individualized Patient Care

Dental hygienists should understand the benefits of each type of restorative material so they can best advise their patients. Patients also need instruction on proper self-care in order to support longevity of their restoration. In 2005, more than half of the restorations placed in the US were replacements for failed restorations. Using proper in-office fluoride treatments, such as 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride, stannous fluoride, and others, can also help to prevent decay. Dental hygienists need to ensure their patients have all of the facts necessary to make informed decisions on their current and future dental needs.

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