By Karen Brandon
Chicago Tribune national
Published August 22, 2001
DIEGO -- Mercury, used to fill tooth cavities for 14
centuries, is at the center of a political and legal
debate over its use in modern dentistry.
An estimated 100 million U.S. residents have fillings
made of amalgam, a silver-colored alloy containing about
50 percent mercury. The American Dental Association says
amalgam is safe and is the least expensive, most durable
way to fill cavities. But opponents say dentists are
downplaying the potential risks of using mercury, a
highly toxic metal that can damage the brain and senses,
particularly in developing fetuses.
fillings slowly release tiny amounts of odorless,
colorless mercury vapor. Their effect on health has been
the subject of scores of conflicting studies, and no
federal agency has moved to prohibit the fillings.
"You can't say mercury fillings are bad for
you," said Dr. Myron Bromberg, a dentist in Reseda,
Calif., and spokesman for the Academy of General
Dentistry, an industry group. "You can't say it
because it's inaccurate. ... I have silver fillings in
my mouth. I have silver fillings in my kid's mouth. If
there were any problems with them, I wouldn't use
Yet in the past year, Maine and Arizona have passed
laws requiring dentists to give patients more
information about the potential risks of mercury,
mirroring a measure passed several years ago in
Colorado. Rhode Island this year began requiring
insurers to cover more expensive alternative fillings
that do not use mercury.
Several countries, including Germany, Sweden, Austria
and Canada, have found no widespread problems with
amalgam fillings but recommend they not be used in
treating pregnant women and young children.
The California State Assembly was so irritated by the
state dental board's nine-year failure to comply with a
law requiring it to prepare a fact sheet about potential
health risks from mercury that it voted in July to oust
The Democratic state senator who wrote the dental
fact sheet law, Diane Watson, is now in Congress, and
she plans to introduce national legislation to force
Medicaid to pay for more expensive alternative fillings,
a move driven mainly by her concern over the potential
health risks of mercury-based fillings.
Recently, an advocacy group opposed to amalgam
fillings has filed lawsuits in California and Maryland,
contending that the dental profession has deliberately
minimized the potential risk to patients and has in
effect gagged dentists who advocate mercury-free
fillings by revoking or threatening to revoke their
The Chinese first used mercury to fill decayed teeth
in the 7th Century. But its use in dentistry has been
controversial since the mid-1800s, when one dental
society's decision to require its members to pledge not
to use it led to the organization's demise and the rise
of the ADA.
The present debate comes as environmental
organizations are questioning the use of mercury where
alternatives exist, such as replacing mercury
thermometers with digital ones in hopes of keeping
mercury out of the environment.
At the same time, the popularity of amalgam fillings
is waning in favor of natural-appearing fillings made of
resins and glass. Dentists say that these composite
fillings are more popular for cosmetic reasons but that
they do not last as long, are more expensive and are
more difficult to put in teeth.
Though research into amalgam fillings is continuing,
it is difficult to measure its impact. Patients can be
exposed to mercury by a wide variety of sources, such as
contaminated fish and other seafood.
Mercury opponents point to studies linking the
metal's presence in fillings to an array of ailments,
such as increased resistance to antibiotics, impaired
kidney function, heart attacks, Alzheimer's disease and
But amalgam supporters question the procedures used
in many of those studies and point to other studies
rebutting their results. Defenders of amalgam say that
if there were any health problem from the fillings, they
would be obvious by now.
A national panel convened by the U.S. Public Health
Service to study amalgam fillings found no pattern of
problems, except for rare allergic reactions.
"For the last six years, the U.S. Public Health
Service has fixed its sights on the issue of potential
health risks from the use of dental amalgam," wrote
Elizabeth Jacobson, the panel's chairwoman, in its 1997
report. "One can and perhaps should ask the
legitimate question of why."
But a 1999 report by the Agency for Toxic Substances
and Disease Registry, an arm of the U.S. Department of
Health and Human Services, concluded that more research
is warranted, especially into how fillings might affect
pregnant women or young children.
Fillings called outdated
Charles Brown, the lawyer for Consumers for Dental
Choice, a coalition that filed the suits in California
and Maryland, contended that mercury fillings are
"What other aspect of the industry of medicine
is still using the same basic manufactured material that
they used 150 years ago?" he asked.
He charged that many patients are confused when
dentists refer to the fillings as silver and do not
mention mercury's presence.
The ADA insists there is no gag order prohibiting
dentists from explaining the benefits and risks of types
of fillings. But the group does prevent dentists from
suggesting that a patient remove their amalgam fillings
to cure health problems.
"There have been some notorious dentists who
made quite a bit of money by suggesting to patients
every ill they had was created by amalgam
fillings," said Peter Sfikas, the ADA's general
counsel, adding that many of them rightfully lost their
But Michael Ziff, a retired dentist in Orlando, said
he endured a nearly four-year legal battle in the
mid-1990s with the Florida dental board because two
other dentists complained he was misleading people about
"It is my belief that patients have to be told
that there's mercury in the fillings and the mercury
comes out," he said. "I was not claiming that
it would cause [multiple sclerosis] or that patients
should get all their [amalgam] fillings removed."
Copyright © 2001, Chicago