On Wednesday morning session one patient came to me with chief complain of tooth pain in lower left back region of mouth while drinking cold water. Sometime while eating.
After through dental checkup- we diagnosed him with Reversible pulpitis in relation with 38. After explaining him whole procedure of the treatment, time & cost required. He asked us some queries which are now & from last few years are remained controversial.
After Diagnosing him with reversible pulpitis in relation with 38(tooth Number by zigmandi palmer system) due to caries on the occlusal surface of the same tooth. I explained him (this explanation is very important for patients consent) the procedure of cavity cutting & preparation. With that I mentioned him cavity feeling material.
I gave him few feeling material choices according to his need –
1) G.I. Cement (posterior tooth color restoration cement)
2) Composite filling (for posterior tooth colored restoration)
3) Silver amalgam filling.(Not a Tooth color material)
4) Metal Modified G.I. Cement (Non tooth colored)
5) Ketac Molar (G.I.Cement modified Excellent mechanical properties than G.I Cement, suitable for posterior teeth)
After all that explanation of treatment procedure, feeling material total cost & time required. He came up with few questions about my third option silver amalgam filling.
In general the questions were-
1) Is this Silver Amalgam Filling is safe?
2) Is this Mercury & silver are not considered poisonous?
3) Do I have to replace this Silver Amalgam filling?
4) What ill effect will one have on his body after using Silver Amalgam Filling for years? Why some people don’t prefer it? Some Environment Organization asking for ban on it?
It is not just this patient but there are thousands other too have the same questions.
So I explained my patient that Silver Amalgam filling is safe there is no any potential or any kind of hazardous effect on human body is recorded or demonstrated & according to ADA it is safe. So SAF is considered as a safe & it is in practice from last 2 centuries.
If you are considering mercury & silver separately then they are indeed harmful in some ways But Together after trituration (the proper mixing procedure) the Silver amalgam filling material is not considered as a harmful or poisonous. Till today There is No any recorded case, evidence or proof to shows that proportionate mixture of these two element is any way harmful.
Silver Amalgam feelings are only replaced in a case where -
· The restoration is worn out.
· Fractured tooth or restoration.
Many patients are having this Silver Amalgam fillings without any side effect of it. Few years back it was considered a one of the best cavity filling restorative material because of it’s strength, durability. Now a days there are some other good materials which are available like I mentioned you above G.I. Cement which is tooth colored (White), Composite restorative material Which is an excellent tooth colored material you can choose exact shade of patients tooth to fill the cavity. So it is hard to recognize after filling which part is restoration & which part is tooth exactly patients tooth color material. So when considering aesthetics we can not choose this Silver Amalgam Material for aesthetic purpose only.
Some people or environment organizations are against this material because- environmental damage of mercury, especially since its use by dentists goes largely unregulated in many places of the world, According to The WHO reports that mercury from amalgam and laboratory devices accounts for 53% of total mercury emissions, But we are using it in regulated manner & doing very safe practice. Disposing the mercury in a very safe & as per the pollution control rules under the regulation of Bio-medical & Bio-hazardous waste disposal treatment. So we are keeping environment clear, clean & free of mercury.
With all this explanation I told him this is his choice & if he is not considered about aesthetics then Silver Amalgam Filling material will be a choice for him.
All answers we gave him his each & every query is resolved. He gave us a written consent & told us what material he wants to use as a filling then without any delay we started our procedure & when it finished he was smiling & satisfied with results.
Silver Amalgam Filling & mercury content -What precautions dentist has to take while practicing
First introduced in France in the early 19th century developed in 1816. Louis Regnart added mercury to the metal mixture, lowering the temperature required significantly, and for this became known as the "Father of Amalgam"
Silver amalgam is a popular dental filling that has been widely used worldwide for over 200 years.
Mercury exposure in dental office can result from
· Incorrect storage of mercury or waste amalgam.
· Spillage of mercury or waste amalgam.
· Mixed but unhardened dental amalgam during trituration, insertion & intraoral setting.
· During finishing & polishing of amalgam.
· Removal of Amalgam.
Monitoring mercury levels
There are number of methods which can determine concentration of mercury in dental surgery atmosphere.
· Mercury vapour may be determined by using a mercury detection meter such as mercury sniffer.
· A badge system may be used in which mercury is adsorbed on gold foil.
· Paper discs impregnated with palladium chloride can be used. The major disadvantage is lack of reaction specificity for mercury.
· Mercury in vapour and dust form may be determined by passing the known volume of air through an absorbing system & then quantifying the absorbed mercury.
Hygiene Recommendations for using mercury in Dentistry
1. Mercury contaminating products must not be stored in open place, but always stored in closed air tight container & then always put them in closet or cabinet to minimize local concentration in rest of the dental office.
2. Local spill or spatters of triturated materials should not be collected with vacuum aspiration. Spilled mercury can be made harmless by dusting with sulphur powder or spraying with solution of sodium thiosulphate.
3. Mercury droplets are very difficult to remove from artificial floor coverings should either be avoided or intermittently replaced.
4. To control the vapours of mercury during placement and condensation procedures, rubber dam should be used to isolate the patient and high volume evacuation should be used to prevent intraoral vapour from diffusing.
5. Scrap dental amalgam from condensation procedures must be collected & stored under Water/glycerine/Spent X-ray fixer in tightly capped jar & these kind of jars are always stored in sealed bags.
6. Silver mercury has a very low melting and easily melt during finishing producing mercury rich liquid phase, So amalgam should be polished at slow speed using water spray.
7. Instruments used for inserting, finishing, polishing or removing dental amalgam may contain amalgam material on their surface. During instrument sterilization this material may be heated & release mercury vapour. So always clean those instruments & collect the scrap & stored it as indicated above. It is advisable to properly isolate or vent air from sterilization areas.
8. Provide proper ventilation in work place by having fresh air exchanger and proper replacement of filters, which may act as trap for mercury particles.
9. Mercury vapour level of dental office must be monitored periodically. Office personnel must be periodically monitored.
10. Precapsulated alloys should be used to eliminate the possibility of bulk mercury spill.
11. Amalgamators should be covered.
12. Skin contact with mercury or freshly prepared amalgam should be avoided.
13. Contact the Biomedical & dental waste product management teams for proper disposal. Health department or nature organization will help you to find such teams.
Keeping our environment clean & free of any bio-medical/dental waste product is our duty.
Source
· SAF – Mercury –toxic effects
· Mercury filling / dental fillings harmful effect
Disadvantages of Amalgam
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