The term "Biocompatible" or "Biological" Dentistry is being used for a whole new paradigm of dental care. Traditional dentistry has typically followed an outmode, problem-oriented model, focusing on individual problems with individual teeth. The whole body, and the whole person, has often been overlooked. Evidence is growing that traditional dentistry, however well intentioned, may have been contributing to generations of health problems. What has been overlooked is attention to concerns about how various dental materials and techniques may affect overall health. Biocompatible dentistry aims at optimal health for the whole individual. Materials and techniques are chosen that are compatible with health.
A great deal of concern has surfaced in the last two decades about materials used in dentistry that may actually be toxic to the body. Is there really cause for alarm? We believe there is, and that current scientific evidence supports this position. Chief among the offenders is the long-standard filling material, "silver" amalgam. When you look in your (or someone else's) mouth and see silver or dark gray fillings, these are amalgam fillings. Amalgam is a mixture of mercury, silver, copper, and tin. It is approximately 50% mercury. That is where the problem lies. Although there is clear and irrefutable evidence that some mercury does escape from this unstable compound, it is still widely used by the majority of American dentists.
It is well established, scientifically, that elemental mercury (mostly in the form of mercury vapor) is released in small amounts from amalgam fillings on an ongoing, daily basis. Chewing, or heat increases the vapor release some ten-fold, and it remains at that high level for an hour and a half or more. The exact amount of release is subject to some variation, but a panel of experts from the World Health Organization (WHO) has agreed that the single greatest source of exposure to mercury in humans is from amalgam fillings. It is greater than food (including fish), air, water and environmental sources combined. When we add to this the fact that mercury is an extremely toxic material, rated more toxic than the other heavy metals such as lead, cadmium and arsenic, then
Carefully done animal studies have shown irrefutably that mercury from amalgam fillings gets into the body. The uptake of this mercury into the body has been well established. Several studies have demonstrated that mercury does, in fact, accumulate in body tissues. This long-term, low-level exposure continues as long as the fillings are in the mouth. Mercury vapor may be inhaled, absorbing rapidly and almost completely into the bloodstream. Some may be incorporated into food while chewing and absorbed into the bloodstream through the digestive system. Local uptake through the thin and porous skin within the mouth also occurs. The fate of this absorbed mercury is variable, but there is a strong affinity for the brain, kidney and liver where prolonged accumulation will cause alteration in the function of these organs. One wonders why the organized profession of dentistry in the U.S. has not sought to restrict or limit its use. Rather, the American Dental Association (ADA), a professional trade organization representing the majority of American dentists, still maintains that mercury amalgam is a safe and appropriate filling material.
One can hold the opinion that amalgam is safe. But when opinion is at odds with fact, then opinion should be revised. The following are facts. That is, they are well established by scientific method (our thanks to Dr. Murray Vimy and his book, Your Toxic Teeth, for this list):
Mercury is an extremely dangerous poison. There is no safe level of mercury exposure for humans. Dental "silver" amalgam fillings contain 50% pure elemental mercury Mercury is released continuously from amalgam fillings, because these fillings are chemically unstable. In humans, mercury fillings produce a pharmacologically significant daily dose of poisonous mercury. Mercury fillings are the largest source of toxic mercury exposure in the general population. Toxic mercury released from mercury fillings collects in all adult human tissues, being highest in the kidney, liver, and then the brain. Dental mercury crosses the placenta and collects in the developing unborn baby and exposes the newborn via mother's milk. Mercury from dental fillings reduces kidney function. Mercury from dental fillings alters the normal bacterial populations in the intestinal tract, producing antibiotic resistance. Mercury from dental fillings has been implicated in nervous system disorders such as Alzheimer's Disease.
A list of some references is found at the end of this paper for any who want to see more details on mercury-amalgam research.
The above information is enough to cause those of us practicing "Biocompatible" dentistry to reject amalgam as a filling material. It isn't necessary to prove that mercury from amalgams will cause "XYZ" Disease. It isn't necessary (or appropriate), at this point in time, to claim that removing mercury fillings will bring about a specific positive health benefit. The above simple and irrefutable facts are enough to declare mercury amalgam to be an unsuitable material in people's mouths. Outside of the United States, many other countries are officially agreeing. Several countries have severe restrictions or outright bans on the use of amalgam fillings. It should also be noted that amalgam, when placed inside a tooth, greatly weakens the tooth and continues to expand and contract differently than natural tooth structure. This process over time leads often to fracture of the tooth and traumatic death of the nerve within the tooth thus necessitating root canal treatment. Further, amalgam leaks at various rates subjecting the deep and delicate core of the tooth to bacteria which irritate the nerve and can also cause the nerve to die. Bonded non-metal fillings do not have these detrimental side effects.
In the first half of the 1800s, dentistry consisted mainly of restoring teeth with gold for those who could afford it, and a lot of extractions for those who could not. In about 1860, two brothers came from Europe with a new material that's not much different from what is still used today as dental amalgam. It revolutionized dentistry, in that teeth could be filled with a material that was relatively inexpensive and easy to use. This meant that many more people could afford to have fillings done than ever before.
Many of the dentists at the time, however, were very concerned about this material, believing that it was not a good material (not healthy) and that it shouldn't be used. Proponents of this new material fought a heavy battle. The dentists who were against this material they believed to be inferior tried to get fellow dentists to sign an oath not to use it. In the end, economic pressures won out. A new society was formed of those dentists who decided to adopt mercury amalgam. This new society eventually became the American Dental Association.
In the 1920s, a German chemistry professor name Stock published research articles and scientific letters attacking the use of amalgam fillings on the basis of possible mercury toxic effects. Again, the dental profession's opinion prevailed and the controversy faded to the background until the late 1970s and early 1980s. A dentist and well-known nutritional advisor, Dr. Hal Huggins, began to champion the anti-amalgam position after learning about amalgam's mercury effects from Dr. Olympio Pinto of Brazil. Dr. Huggins was finding that his work with patients in balancing their body chemistry through nutrition was enhanced when he paid attention to their mercury load and removed their mercury fillings. His clinical success led him to conclude that the use of mercury amalgam fillings in dentistry has been causing health problems in many people.
Dr. Huggins' ideas were slow to take hold. However, new scientific research in the early '80s began to give credibility to the idea that amalgam use might be risky. Studies were done using careful and sophisticated measurements with a highly sensitive mercury vapor analyzer, and it was conclusively shown that mercury vapor does indeed come out of amalgam fillings in the mouth (a fact previously denied by the ADA). This led the way for further scientific investigation. In 1984, an organization was formed called the International Academy of Oral Medicine and Toxicology (IAOMT). This academy is dedicated to spreading information in the scientific community on the research being done regarding issues of mercury as well as other related topics in biocompatible dentistry. Some of the leading current research has come about from IAOMT members or as a result of IAOMT support.
Today, the IAOMT has chapters worldwide, and is the leading authoritative body in the field of mercury in dentistry (although the ADA would probably not agree with that statement.) The ADA, in spite of a huge accumulated body of valid, scientific, peer-reviewed research, still maintains their position that amalgam is a safe and appropriate material. We, in the growing ranks of biocompatible dentistry, regard it as an inferior, toxic, 19th century dental material that has no place whatsoever in 21st century dentistry.
Alternatives To Amalgam:
The question of what to use instead of amalgam fillings is a challenge for the biocompatible dentist. There are a variety of materials and techniques developed over the last several years that satisfy our requirements of providing long-lasting, comfortable, esthetic and non-toxic restorations of teeth. There is no "perfect" material. The best is still to have undamaged, natural tooth structure. So, prevention is still the first goal in dentistry. However, when damage does occur and needs repair, there are enough good materials available that make mercury amalgam obsolete. Dentists who were committed to mercury-free dentistry in the early '80s had to struggle with these materials in their emerging stages of development and refinement. Today, they continue to be improved as a revolution in non-metal dental materials has developed.
Most versatile of dental materials today are those in the category of ceramics. This includes "composite resin," porcelains, and hybrids between the two. They can be used anywhere that amalgam was used, with expectations of equivalent longevity and strength, or better. Their esthetic properties, when used properly, can nicely mimic the beauty of natural teeth and become virtually "invisible" in the mouth. Much study as been done on the biocompatibility of these materials, and they come out quite favorably. Gold is still preferred by some practitioners, and better gold alloys have been developed for improved biocompatibility. All of these materials do take more time and skill and advanced training to master. Unfortunately, many of these materials and techniques are still not being taught widely in dental schools. They are also more expensive to the patient than the old amalgam fillings. However, when patients are given the real truth about the toxic potential of amalgam, few choose to stick with this inferior material just to save some money.
There is also the option today of doing individualized biocompatibility testing of dental materials. This may be particularly valuable for patients with multiple chemical, food, or environmental sensitivities. One of the most reliable is a test of blood serum (requiring a blood sample), checking the immune response to the ingredients of hundreds of dental materials and brands. This helps guide the dentist to select the most appropriate materials and brands for an individual patient. Other methods, such as "energetic" testing by means of "muscle testing" or acupuncture meridian testing have been found by some to be useful. We don't consider these tests to be foolproof, but often they may be helpful and appropriate. Based on the thousands of such tests done by Clifford Research (and others), a pattern emerges where some materials appear to be widely compatible. We try to use these "best" materials routinely, when individual testing is not done.
Should I replace my Amalgam fillings?
It is our recommendation that you never allow another amalgam filling to be placed in your mouth (of course, that would never happen in our office.) The decision to replace amalgam fillings that are already in the mouth needs to be considered more carefully. Many of our patients come to us because their physician feels that they may have some health problems where heavy metal (mercury) exposure or accumulation may be part of the problem. As an adjunct to their medical treatment, they recommend having their amalgam fillings carefully replaced (see below) with a more biocompatible material. Others came to us because they have read and learned enough about the mercury issues that they have decided they don't want this material in their mouths anymore and request that we replace it. In our opinion, either of these is a wise and valid reason for replacing the old mercury amalgam. We won't take the position that everyone in our office should replace all his or her previous amalgam fillings. We do, however, feel a responsibility to educate everyone on the mercury issues, and let them know that a mercury-free mouth is always available in our office, should you choose. It's always your choice. In our hearts, based on our knowledge and the combined experience of about thirty years of mercury-free dentistry amongst our doctors, we think it's a pretty good choice for most people. The doctors here agree they wouldn't want to allow this material to be in their mouths, or in the mouths of their families or staff. That is more or less the standard we like to hold for our patients in all that we do here.
You may notice we are not saying that if you replace your amalgam fillings you will have benefit XYZ in your life. We do see, over and over again (as do our colleagues worldwide), patients who have experienced significant, positive health changes when they have followed closely the amalgam replacement protocols described below. But that experience is by no means universal, and we want to be clear that we are making no specific health claims for replacing amalgam fillings. At the very least, you'll be reducing your exposure to, and body burden of, a known toxic material.
What's involved in Amalgam replacement?
The first step is the decision to do it. This decision should be carefully discussed with one of the doctors here. It may involve discussion with your physician, or one that we can recommend. It may involve some for of testing for body burden of mercury by your physician. It may just be a matter of learning and digesting the facts about mercury and amalgam. Once that decision is made, there are several factors that we feel are very important in proceeding with your decision. First, the treatment should be done by a dentist who is experienced with, and committed to, mercury-free dentistry because of the potential complexities involved. Deciding to replace your amalgams, and then deciding to run off to the nearest or cheapest dentist and talk them into doing it would not be wise.
The dental treatment needs to be done cautiously, in order to protect the patient from exposure to additional mercury during the course of the dental procedures. This is a very important point, and one that is likely to be overlooked by most dentists who are not committed to mercury-free dentistry. There are several steps we take to minimize, as much as possible, the chance of any additional mercury exposure to the patient (and to the doctor and staff as well.) As we learn more and better ways to accomplish this, we will continue to make those adaptations.
The choice of replacement materials also needs to be carefully considered. We want materials that are strong, long lasting, esthetically pleasing, and biocompatible. We believe all these factors can be achieved. As mentioned above, individualized biocompatibility testing may be advised for some patients at this point.
Lastly, it needs to be understood that removing amalgams from the mouth is only part of becoming mercury-free. As long as amalgam fillings have been in a person's mouth, that person has been continuously exposed to a low level of mercury coming out of the fillings, most of which has been accumulating in their body. It takes some help to get rid of this accumulated mercury. The body doesn't do it very effectively by itself. When appropriate, we will help steer you to medical practitioners who are experienced in dealing with heavy metal detoxification. This is a very important step in the effort to reduce or eliminate mercury in the system, and reduce its potential toxic damage.