Amalgam — Resurrection and Redemption Part 1:
The Clinical and Legal Mythology of Anti-Amalgam
Michael J. Wahl, D.D.S.
© 2001 Quintessence Publishing Co.
Dental amalgam has come under attack for its alleged effects on systemic health, its allegedly poor physical properties and clinical performance, and for its unacceptable cosmetic appearance. The editor of a prestigous peer-reviewed dental journal stated in 1995 that amalgam should no longer be used as a first-time restorative material and should never at all be used in children . One dentist called amalgam “an inferior restoration that I would not place in the mouths of my family or friends, much less into patients’ mouths.”  Lutz et al have stated, “The amalgam age is fadingand the profession is on the threshold of the postamalgam age.” 
Some go even further in their criticism of amalgam. Dickerson called amalgam “a disgusting restoration”  and stated that it is a “crime” that after 100 years, amalgam is still the most common restoration in dentistry . After calling any dentist still using amalgam “a fool,” one newsletter editor summed up his opinion (and probably the opinion of most anti-amalgamists) succinctly with just two words: “Amalgam sucks.” 
These authors and other anti-amalgamists assert that nonamalgam materials, especially resin composites (the most commonly used amalgam alternative), equal or surpass amalgam in virtually every way. Although it is obvious that resin composite restorations are more esthetic than amalgam restorations, anti-amalgamists assert that resin composites are also more biocompatible and have superior physical properties and clinical performance. After acknowledging that amalgam still has certain indications, Urban called composite the material for the new millennium . One group of researchers stated, “It would seem that now is the time for dentistry to use composite (polymeric and ceramic) alternatives and discard the metal alchemy bestowed on its profession from a less enlightened era.” 
The reasons many dentists use amalgam, the anti-amalgamists say, include a “stubbornness to change [and] lack of material education.”  However, a close look at the literature available on dental amalgam, resin composites, and other restorative materials shows that most of the anti-amalgamists’ assertions are based not on scientific facts, but rather on a collection of myths and half-truths, creating a virtual folklore of anti-amalgam that has rarely been challenged. The clinical and legal mythology of anti-amalgam is discussed below. In a separate article, we will discuss the medical mythology of anti-amalgam. The time has come for the resurrection and redemption of dental amalgam.
Clinical and Legal Myths
- Myth #1: Amalgams commonly cause fractured cusps.
- Myth #2: The majority of clinically sound amalgam restorations have recurrent caries; the majority of resin composite restorations do not.
- Myth #3: Resin composite restorations last as long as amalgam restorations.
- Myth #4: Amalgams cannot be bonded to teeth.
- Myth #5: Because of recent advances in materials and techniques, most studies of composites are outdated; most studies of amalgams are not.
- Myth #6: Resin composites are superior to amalgam because composites can be repaired.
- Myth #7: Amalgam is 100 years old; composite is much newer and therefore better.
- Myth #8: The ADA refuses to admit that mercury-containing amalgam is unsafe for fear of lawsuits.
- Myth #9: The American Dental Association holds the patent on amalgam and receives a royalty on each amalgam placed.
- Myth #10: Amalgam has been banned in Germany and Sweden and therefore should be banned in the United States.
- Simonsen RJ. Move over amalgam at last. Quintessence Int 1995;26:157.
- Harper W. Amalgam is inferior. [Letter.] Dent Econ 1999;89(8):18.
- Lutz FU, Krejci I, Oddera M. Advanced adhesive restorations: the post-amalgam age. Pract Periodont Aesthet Dent 1996;8:385-94.
- Dickerson WG. Integrating cosmetic dentistry into a busy practice. Dent Econ 1997;87(1):30-6.
- Dickerson WG. Why is esthetic dentistry grouped with the outlaws? Dent Econ 1998;88(12):42-46,105.
- Maroon M. The fab five. The Dental Leader, March, 1998:2-3.
- Urban DW. Amalgam, amalgam, and amalgam. [Letter.] Gen Dent 2000;48(1):15.
- Lorscheider FL, Vimy MJ, Summers AO. Mercury exposure from “silver” tooth fillings: emerging evidence questions a traditional dental paradigm. FASEB J 1998;9:504-8.
- Vocaturo AJ. One-sided vote. [Letter.] Dent Econ 1999;89(7):17.
Dr. Wahl practices dentistry in Wilmington, Delaware. This article was originally published in Quintessence International 32:525-535, 2001 and is reproduced here with the kind permission of Quintessence Publishing Co. The author also thanks Drs. J. Rodway Mackert, Ivar A. Mjör, and Fred Eichmiller for reading the manuscript and offering several helpful suggestions.
This page was posted on November 1, 2002.