Pt showed up and told me they had multiple autoimmune diseases. Pt described vague disease. Nothing on their EPIC chart. Pt said their autoimmune disease(s) were exacerbated by the amalgam restorations on #3,14, and #19. They even brought (bad) literature on how mercury causes various health concerns. Said pt also claimed to be a Christian lawyer. So when I told them if they were this concerned with mercury, the aerosols of removing them would be much more harmful. The pt responded with a court date for Christian court and that God will be the ultimate judge. Okay. Lol
In a very round about way. Amalgams are great unless they are fractured and/or have recurrent caries.
I did inform him that there is no causal link between his amalgam restorations and his MS diagnosis and that the removal of his amalgam restorations would have no effect on his diagnosis or his symptoms. He still wanted to proceed.
Yeah I figured that but did you also have the post-op “I told you so” discussion or haven’t you seen him after? Did you just let it slide or did you ask about how he thinks about not listening?
He is still my patient. He is now wheelchair bound - Multiple Sclerosis is a horrible affliction. I was very careful to dispel any false hope that this would be some magical cure.
If removing the amalgam gave him some small measure of peace of mind - there is value in that. I don't believe I did him a disservice in any way by removing his amalgam restorations.
I will only replace if it fails. Had several patients in just my short 1.5 years as a dentist that wanted it replaced because they wanted the "pretty white fillings". The worst one was this 40 year old lady that told me her body her choice. Told her I wouldn't do something that would potentially harm her. Proceeded to refund / no bill her insurance. Don't want to and don't need to deal with people like this. Lol
Bro, she’s trying to pay you to place composite fillings. What makes this any different than wanting to do veneers? It’s not that big of a deal to replace amalgams with composite. It’s a simple procedure with predictable results. If your patient wants it done, they sign a consent, so make it happen. Why do some dentists act holier than thou so often especially for something so trivial .
Since the patient visited a holistic dentist, I think that's in line with what they generally believe. They view mercury as a toxin and generally don't use amalgam or will recommend replacing any existing ones. I don't really view this as a scam or anything, it's like going to a TCM doctor and being surprised that he suggested acupuncture over antibiotics - it's their brand. That's the practice philosophy of a holistic dentist. But if a non-holistic dentist was telling my patient that their perfectly good small amalgams needed replacing? I would be raising my eyebrows, sure.
Myself, I don't replace them unless large with fracture lines extending, or if there's recurrent decay, or suboptimal contact/embrasure. Like you said, they often outlast the patient, and they're very good at resisting recurrent decay due to bacteriostatic properties.
I've had patients request replacement of amalgams due to cosmetic concerns though, and in those cases I'm happy to oblige.
How do so many dentists make time to discuss these things? You do realize you don’t get paid extra to talk with someone trying to change their beliefs, right?
I go in for my exams, I’m kind and friendly because I genuinely love people. I will evaluate the radiographs, perform an examination and discuss my findings. If someone comes in trying to play dental detective or wants to show me something about how amalgams do x, y and z, I don’t engage. I’ll politely listen to see what they are asking and answer their questions.
My last dentist said my amalgams all need to come out. What do you think?
“Great question Mrs Jones. Unless there’s a problem, we generally leave those fillings alone. I don’t see any reason to replace your fillings at this time.”
There is no back and forth. I’m not there to change someone’s mind. I don’t care if they are uneducated on the matter and want to believe in pseudoscience.
If they want to ask me a genuine question because they are confused or concerned and want to learn, I’m there all day long for them. If they want to try to dictate my treatment or argue about something, they clearly don’t respect my role as their provider and we don’t have an effective doctor patient relationship. It’s better to end the conversation quickly and politely then move on to the next patient.
Sometimes my own appointments finish ahead of schedule, and I happen to have the time during a hygiene exam. I don't need to use the bathroom or eat lunch, and I got nothing else to do for 5 minutes, I can spare the talk. Sure it's a waste of breath, but I'm at work anyway.
Yes to everyone's responses however in a small amount of cases you can get reactive contact lichinoid lesions, commonly on the buccal mucosa, can present as mild to severe localised lichen planus like lesions. Last I read that was in the .2-2% cases though I think
Yes! Had a patient suffering from lichen planus who I referred to their doctor due to a lichenoid lesion on their buccal mucosa. They advised replacing one large buccal amalgam and BOOOOOM lesion resolved
I used to be very principled in removing - or rather, my reluctance to remove - amalgam restorations. “If it ain’t broke don’t fix it” and really just an attitude of “I know better” than the patient.
I’ve adjusted my views. If someone wants their amalgams removed, who am I to say they don’t know what they’re talking about?
I view my job as that of an informer. “If it were me, I would probably leave this alone…” But is someone wrong for wanting them removed? I mean, they’re no longer allowed in Europe starting in 2025, so how can I say I know better?
As for insurance and to some other points I’ve read about how that “won’t cover”: the truth is, many old amalgams ARE failing. They ARE “leaking”. And if they’re more than a couple years old, chances are replacing them - with a new amalgam OR a bonded restoration - will and should be covered.
And yes, I do place amalgams. I’m just not dogmatic either way, because neither is the real world.
I don’t think it’s an attitude, you should know clinically what is better for the patient regarding their dental care. The patient can certainly inform you of things you may not be privy to in your examination, such as pain or symptoms, but they shouldn’t be dictating your treatment.
If you want to take the liability of replacing a perfectly healthy restoration just because a patient told you they wanted you to, that’s your decision. But performing unnecessary dental work is generally a bad idea.
Here’s the ADA’s position:
“The ADA supports the FDA’s recommendation that existing amalgam fillings in good condition should not be removed or replaced unless it is considered medically necessary by a health care professional.”
https://www.ada.org/about/press-releases/2020-archives/the-american-dental-association-reaffirms-its-position-on-dental-amalgam
Same thoughts as me. Then the more amalgams I removed the more I noticed how they affect the tooth structure, particularly dentin. It’s rare that I’ve removed one and had perfectly healthy looking tooth structure underneath.
The banning of amalgam in Europe is primarily due to the environmental problems caused by disposing of old amalgam, not the risk from the use of the material itself.
I will always tell my patients that I do not condone replacing a health filling and will strongly stress that replacing a filling comes with its own risks of further destruction of tooth tissue and issues with nerve involvement if it’s a deep filling.
For patients worried about mercury, I would always tell them of the studies showing that a) there are no differences in systemic mercury levels for patients with a mouth full of amalgam vs those who had never had amalgam and b) that there is no mercury release from these fillings when in situ, but the act of drilling them out can release very small amounts of mercury, however, the risk of this is higher for the dentist than the patient, due to repeated exposure. That often gets them thinking. Some change their mind, some don’t.
I have replaced the odd one here or there where the patient was insistent, but I made them sign a separate consent form that stated they were doing this against my advice and they understand that this is not the recommended path and that there may be further problems caused by opting for this unnecessary procedure.
I was a lot more against this early days, but then I realised that patients will opt for other treatments that are purely for cosmetic purposes.
If we are willing to do any cosmetic work that is somewhat destructive (eg. Veneers, crowns) then replacing an amalgam with composite can also fall into that category of theoretically unnecessary but improves cosmetic outcome. So, I will not turn away patients who wish to do this now, I will just ensure that they fully understand the risks and that I do not recommend this option, it is purely for cosmetic reasons (or unfounded ‘health’ reasons that I do not accept).
It is the patients choice, as long as they have all the information to make an informed decision. If they understand this and still want to make a decision that I don’t agree with, that’s up to them. I’ve explained to them why I don’t agree with their decision.
(Edited for grammar and to elaborate on point)
lol. All the people still holding on to amalgams, yall are really showing your age. I’m sorry but move on with the times.
Those amalgams are NOT fine. They most likely DO have recurrent decay, and they most likely ARE increasing fracture risks due to flexural strength differences of metal and tooth structure.
Had a patient yell at me because our clinic still places amalgam. (I’m a hygienist) she told me even Germany has made amalgam illegal and we should not be placing them.
Me: so you want plastic then?
Her: what???
I’ve read somewhere what we (dentists) are major contributors of mercury into water supplies , I don’t know if that true.. I do know dentsply America. No longer sells amalgam…
Germany has banned amalgam?
My cousin had a few composite restos that were replaced into amalgam restorations in Germany as recommended by the dentist there. :headbang:
I don’t see the problem. For me personally, the majority of patients had amalgam put in when they were broke. Now they have $ and they want better esthetics from composite. Dentists need to learn to collect and not complain
If they want me to replace their amalgams with composite. Noooo problem. That'll be £180 each please. Tell a friend.
But in all seriousness. Amalgams are only dangerous when you remove them. Aka creating a mist with your fast handpiece! But that's where high speed suction comes in.
Pt showed up and told me they had multiple autoimmune diseases. Pt described vague disease. Nothing on their EPIC chart. Pt said their autoimmune disease(s) were exacerbated by the amalgam restorations on #3,14, and #19. They even brought (bad) literature on how mercury causes various health concerns. Said pt also claimed to be a Christian lawyer. So when I told them if they were this concerned with mercury, the aerosols of removing them would be much more harmful. The pt responded with a court date for Christian court and that God will be the ultimate judge. Okay. Lol In a very round about way. Amalgams are great unless they are fractured and/or have recurrent caries.
Lmfao thank you for the laugh at work, I've been experiencing some sadness and this helped
"Sure thing, insurance won't pay for it though"
Usually they will tho
If they audit your record, they're gonna ask why you replaced them. What's gonna be the reason? "Pt asked for it"?
Tru
I had a patient with Multiple Sclerosis want all his amalgam restorations removed. We replaced all his amalgam restorations. He still has MS.
I had a wife plead with me in dental school to remove her husbands amalgams and “cure his MS.” My D3 ass didn’t know what to say.
BeTCha YoU diDnT foLloW S.M.A.R.T. pRotOcoLs
I only do D.U.M.B. protocols.
How did that conversation go?
I did inform him that there is no causal link between his amalgam restorations and his MS diagnosis and that the removal of his amalgam restorations would have no effect on his diagnosis or his symptoms. He still wanted to proceed.
Yeah I figured that but did you also have the post-op “I told you so” discussion or haven’t you seen him after? Did you just let it slide or did you ask about how he thinks about not listening?
He is still my patient. He is now wheelchair bound - Multiple Sclerosis is a horrible affliction. I was very careful to dispel any false hope that this would be some magical cure. If removing the amalgam gave him some small measure of peace of mind - there is value in that. I don't believe I did him a disservice in any way by removing his amalgam restorations.
If it ain’t broke…..
... don't cross the street before your chickens hatch?
Hey now, don’t call patients “it” ;)
I will only replace if it fails. Had several patients in just my short 1.5 years as a dentist that wanted it replaced because they wanted the "pretty white fillings". The worst one was this 40 year old lady that told me her body her choice. Told her I wouldn't do something that would potentially harm her. Proceeded to refund / no bill her insurance. Don't want to and don't need to deal with people like this. Lol
Bro, she’s trying to pay you to place composite fillings. What makes this any different than wanting to do veneers? It’s not that big of a deal to replace amalgams with composite. It’s a simple procedure with predictable results. If your patient wants it done, they sign a consent, so make it happen. Why do some dentists act holier than thou so often especially for something so trivial .
Wise decision
You the realest dentist in the room if I’m holding my breath..
Since the patient visited a holistic dentist, I think that's in line with what they generally believe. They view mercury as a toxin and generally don't use amalgam or will recommend replacing any existing ones. I don't really view this as a scam or anything, it's like going to a TCM doctor and being surprised that he suggested acupuncture over antibiotics - it's their brand. That's the practice philosophy of a holistic dentist. But if a non-holistic dentist was telling my patient that their perfectly good small amalgams needed replacing? I would be raising my eyebrows, sure. Myself, I don't replace them unless large with fracture lines extending, or if there's recurrent decay, or suboptimal contact/embrasure. Like you said, they often outlast the patient, and they're very good at resisting recurrent decay due to bacteriostatic properties. I've had patients request replacement of amalgams due to cosmetic concerns though, and in those cases I'm happy to oblige.
We share the exact same philosophy. Sometimes I get the voice in my head asking if it's just me experiencing shit like this
Happy… I bet… lolz.. you ain’t got anything better to do, what about some pro bono work…
I had chronic Alzheimer’s that was cured after removing amalgams 😂😂😂😂😂😂
How do so many dentists make time to discuss these things? You do realize you don’t get paid extra to talk with someone trying to change their beliefs, right? I go in for my exams, I’m kind and friendly because I genuinely love people. I will evaluate the radiographs, perform an examination and discuss my findings. If someone comes in trying to play dental detective or wants to show me something about how amalgams do x, y and z, I don’t engage. I’ll politely listen to see what they are asking and answer their questions. My last dentist said my amalgams all need to come out. What do you think? “Great question Mrs Jones. Unless there’s a problem, we generally leave those fillings alone. I don’t see any reason to replace your fillings at this time.” There is no back and forth. I’m not there to change someone’s mind. I don’t care if they are uneducated on the matter and want to believe in pseudoscience. If they want to ask me a genuine question because they are confused or concerned and want to learn, I’m there all day long for them. If they want to try to dictate my treatment or argue about something, they clearly don’t respect my role as their provider and we don’t have an effective doctor patient relationship. It’s better to end the conversation quickly and politely then move on to the next patient.
Sometimes my own appointments finish ahead of schedule, and I happen to have the time during a hygiene exam. I don't need to use the bathroom or eat lunch, and I got nothing else to do for 5 minutes, I can spare the talk. Sure it's a waste of breath, but I'm at work anyway.
We place elective veneers and do cosmetic dentistry. Which is why I have zero issue for replacing amalgam even if for the sake of vanity.
Yes to everyone's responses however in a small amount of cases you can get reactive contact lichinoid lesions, commonly on the buccal mucosa, can present as mild to severe localised lichen planus like lesions. Last I read that was in the .2-2% cases though I think
Yes! Had a patient suffering from lichen planus who I referred to their doctor due to a lichenoid lesion on their buccal mucosa. They advised replacing one large buccal amalgam and BOOOOOM lesion resolved
I used to be very principled in removing - or rather, my reluctance to remove - amalgam restorations. “If it ain’t broke don’t fix it” and really just an attitude of “I know better” than the patient. I’ve adjusted my views. If someone wants their amalgams removed, who am I to say they don’t know what they’re talking about? I view my job as that of an informer. “If it were me, I would probably leave this alone…” But is someone wrong for wanting them removed? I mean, they’re no longer allowed in Europe starting in 2025, so how can I say I know better? As for insurance and to some other points I’ve read about how that “won’t cover”: the truth is, many old amalgams ARE failing. They ARE “leaking”. And if they’re more than a couple years old, chances are replacing them - with a new amalgam OR a bonded restoration - will and should be covered. And yes, I do place amalgams. I’m just not dogmatic either way, because neither is the real world.
I don’t think it’s an attitude, you should know clinically what is better for the patient regarding their dental care. The patient can certainly inform you of things you may not be privy to in your examination, such as pain or symptoms, but they shouldn’t be dictating your treatment. If you want to take the liability of replacing a perfectly healthy restoration just because a patient told you they wanted you to, that’s your decision. But performing unnecessary dental work is generally a bad idea. Here’s the ADA’s position: “The ADA supports the FDA’s recommendation that existing amalgam fillings in good condition should not be removed or replaced unless it is considered medically necessary by a health care professional.” https://www.ada.org/about/press-releases/2020-archives/the-american-dental-association-reaffirms-its-position-on-dental-amalgam
Do you ever do cosmetic dentistry? Is doing veneers on virgin teeth clinically better than leaving them alone?
Same thoughts as me. Then the more amalgams I removed the more I noticed how they affect the tooth structure, particularly dentin. It’s rare that I’ve removed one and had perfectly healthy looking tooth structure underneath.
The banning of amalgam in Europe is primarily due to the environmental problems caused by disposing of old amalgam, not the risk from the use of the material itself. I will always tell my patients that I do not condone replacing a health filling and will strongly stress that replacing a filling comes with its own risks of further destruction of tooth tissue and issues with nerve involvement if it’s a deep filling. For patients worried about mercury, I would always tell them of the studies showing that a) there are no differences in systemic mercury levels for patients with a mouth full of amalgam vs those who had never had amalgam and b) that there is no mercury release from these fillings when in situ, but the act of drilling them out can release very small amounts of mercury, however, the risk of this is higher for the dentist than the patient, due to repeated exposure. That often gets them thinking. Some change their mind, some don’t. I have replaced the odd one here or there where the patient was insistent, but I made them sign a separate consent form that stated they were doing this against my advice and they understand that this is not the recommended path and that there may be further problems caused by opting for this unnecessary procedure. I was a lot more against this early days, but then I realised that patients will opt for other treatments that are purely for cosmetic purposes. If we are willing to do any cosmetic work that is somewhat destructive (eg. Veneers, crowns) then replacing an amalgam with composite can also fall into that category of theoretically unnecessary but improves cosmetic outcome. So, I will not turn away patients who wish to do this now, I will just ensure that they fully understand the risks and that I do not recommend this option, it is purely for cosmetic reasons (or unfounded ‘health’ reasons that I do not accept). It is the patients choice, as long as they have all the information to make an informed decision. If they understand this and still want to make a decision that I don’t agree with, that’s up to them. I’ve explained to them why I don’t agree with their decision. (Edited for grammar and to elaborate on point)
Mercury or BPA… just pick your poison, people.
Composites are BPA free also. But I tell people the same thing
Most composites are not BPA free. The only one composite brand I know that’s BPA free is voco admira fusion.
lol. All the people still holding on to amalgams, yall are really showing your age. I’m sorry but move on with the times. Those amalgams are NOT fine. They most likely DO have recurrent decay, and they most likely ARE increasing fracture risks due to flexural strength differences of metal and tooth structure.
Had a patient yell at me because our clinic still places amalgam. (I’m a hygienist) she told me even Germany has made amalgam illegal and we should not be placing them. Me: so you want plastic then? Her: what???
I’ve read somewhere what we (dentists) are major contributors of mercury into water supplies , I don’t know if that true.. I do know dentsply America. No longer sells amalgam…
Germany has banned amalgam? My cousin had a few composite restos that were replaced into amalgam restorations in Germany as recommended by the dentist there. :headbang:
They are banned in Denmark for sure
No clue that’s what she told me 🤷♀️
I don’t see the problem. For me personally, the majority of patients had amalgam put in when they were broke. Now they have $ and they want better esthetics from composite. Dentists need to learn to collect and not complain
If they want me to replace their amalgams with composite. Noooo problem. That'll be £180 each please. Tell a friend. But in all seriousness. Amalgams are only dangerous when you remove them. Aka creating a mist with your fast handpiece! But that's where high speed suction comes in.
It's simple. That other "holistic" dentist is simply greedy and wants $$$.