Verhandelingen - Koninklijke Academie voor Geneeskunde van België vol:58 issue:5 pages:587-634
Dental amalgam is the most widely used filling material in dentistry. In our country there are an estimated 40 million amalgam fillings in place. The mercury present in these fillings has caused health concerns over the last 160 years that amalgam has been used in decayed teeth. The fears have always proven to be unjustified and no harmful effects have ever been demonstrated in dental patients. Mercury can be found in several forms. In dentistry, only the metallic form is used, while inorganic and organic compounds are also present in the environment. The metallic form is absorbed in the human body mostly through the lungs. Once mercury reaches toxic levels inside the body, it will interfere with cell metabolism. Most important among the target organs are the brain, the liver and the kidneys. Elimination occur through urine and feces. Mercury is universally found in blood and urine. The concentration depends on absorption by air, water, nutrition, medication (including dental fillings) and occupational hazards. There are four kinds of objectives to dental amalgam: oral galvanism, toxicity, allergenicity and ecological grievances. Disorders from oral galvanism are difficult and delicate to evaluate as the actual currents are very small. Furthermore, no significant difference can be found in current intensity between patients with and without complaints. Finally patients with complaints often present other oral disorders, the treatment of which most often eliminates all complaints that could be attributed to oral galvanism. Toxicity is dose dependent. Industrial safety rules indicate that the amount of mercury absorbed from dental amalgam fillings is far below the safety level. HgB and HgU levels in patients with amalgam fillings are situated well below the acceptable levels. Allergic disorders are observed in patients with amalgam fillings but far less than expected in view of the wide spread use of dental amalgam. The problem of mercury spilling from dental amalgam fillings into the environment will be resolved by strict legislation in the near future. In this context, it can be stated that the use of dental amalgam is safe and justified. Furthermore, it is also advisable as no other material can meet the actual dental needs as efficiently as can dental amalgam.