Practice Management

The Controversy That Is Amalgam

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Dr Johanna Rosette Po

There have been a lot of questions surrounding the use of amalgam in restorative dentistry. But with a long line of history on its usage this dental material has been tried and tested and is still proven as one of the most durable restorative materials available in the dental market. However, despite its durability, many still question the usefulness of amalgam as a filling material, especially after biohealth activists raised concerns about its mercury content.

History of Amalgam

The first recording of amalgam use is dated back in 659 A.D. by a Chinese fellow named Su Kung. (J Conserv Dent. 2010 Oct-Dec; 13(4): 204–208.) From then on, Amalgam has been spread throughout Europe and eventually into the Americas. Over the years, the components of this material has evolved along with its proportions, but the use of mercury remains constant through evolution.

Amalgam controversy

The use of amalgam in the dentistry has been widely advocated because of its strength and not to mention its price. Then in 1980’s, questions regarding its mercury content started to arise. Reports regarding amalgam and its possible effects on the nervous system, the kidneys as well as reports of amalgam being a possible carcinogen started to spread. However, if one is to look at the many reports that have been written regarding the ill effects of mercury, it can be very well said that none of them are conclusive. Moreover, there were many recommendations presented with regards to further studies.

Multiple sclerosis, for example, has been greatly linked to the use of dental amalgam and mercury. Although if we look at the causes of the disease, one would see that multiple sclerosis is an AUTO IMMUNE disease which may even be genetic in nature. Environmental factors an even viruses have been implicated in multiple sclerosis but none have been clearly identified. (

Autism is another condition resulting due to genetic disorders. It is a disease that runs in families due to an unknown cause. Studies have been made and yet have been found to be inconclusive — just as vaccines have been found to be safe for children — with regards to amalgam use and autism.

As for cancer, there still has to be much research done with regards to its development. One has to consider genetic predisposition as well as other environmental factors with regards to cancer formation. Although there are indeed carcinogens that contribute to cancer formation, one also has to consider dosage when it comes to cancer formation. In today’s world, people encounter different forms of carcinogens everyday. To solely implicate mercury or amalgam in cancer development would be quite rash. The ratio of patients who have developed oral cancers after having used amalgam fillings, for example, have yet to be determined. Clear-cut evidence has yet to be presented. In fact, if one were to consider the amount of carcinogens in dental materials, the use of composites should also be studied as COMPOSITE IS BASICALLY MADE OF RESINS WHICH ARE ALSO CARCINOGENS.(ToxInt.19:3,225234,2012)(

Inconclusive studies

Although there are many theories regarding the dangers of amalgam use, solid evidence has yet to be produced. In fact, in recent years, there have been less and less proof on the dangers of mercury in amalgam. According to the ADA website, many government agencies and organizations have already taken a stand and have spoken on the safety of amalgam use.

It would be good to do continuous research on the safety of mercury in amalgam as this definitely concerns the health of many patients and individuals worldwide. But unless proper research and results are shown, it would be disadvantageous to many to draw such dire conclusions.

Amalgam is still one of the best and durable dental filling materials in the dental market. Inspite of the surge of newer dental restorations such as composites and glass ionomer cements, Amalgam still remains to be one of the staples in dentistry. To add, Amalgam has been used for more than a century and is still being used by many dental professionals who require strength and formidability in their restorations. Most importantly, Amalgam is an affordable choice of dental restorative material that may is utilized in other developing countries. To deprive patients of this option because of fear and anxiety that has no scientific basis would be depriving them access to good oral health care.

About the Author: Dr Johanna Rosette Po is a graduate of the University of the East College of Dentistry. In 2004, she received her doctorate degree in molecular biology from Hokkaido University, specializing in cancer research. She continues to hold practice in Manila and teaches part-time at the Cranio-Facial Foundation of the Philippines and the University of the East.

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  1. Dr. Angelito Mananquil July 9, 2015 at 6:47 pm - 

    It requires a relatively high level of substantiation on claims related to patient’s health or safety that, “in recent years, there have been less and less proof on the dangers of mercury in amalgam. (Just a humble opinion)

  2. Medardo Chua July 10, 2015 at 12:12 am - 

    That’s a good point Dr Mananquil. Though in other countries, especially in Europe they do not use amalgam for preventive reasons. What are your thoughts on this?

  3. Dr. Angelito Mananquil July 15, 2015 at 10:06 am - 

    Yes, in some countries in Europe, they do not use amalgam to reduce environmental pollution. The World Health Organization advocates the phase -down of amalgam use over an appropriate time period. This is to allow a sufficient time for the development of effective and safe alternative dental restorative materials and I like that. I humbly believe that the Government and the Dental community should focus on designing programs to ensure the reduction of incidence of dental caries.

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