Amalgam Replacement Risks
Any dental procedure carries with it some risks and some benefits. Before replacing a filling it is important to be aware of the risks that you may encounter as part of your treatment.
It is known that mercury vapour concentrations are highest when amalgam fillings are placed or removed. At present the available scientific evidence does not suggest that this level represents a problem. However we do recognise that a number of patients have concerns about this. We believe that using our amalgam removal protocol reduces the likelihood that you will ingest ( swallow) amalgam particles or breathe in any mercury vapour that is released. Additionally common sense suggests that if you are replacing a large number of restorations ( fillings) that they should not all be carried out simultaneously.
Teeth with old fillings may be entirely pain free even if the old filling is leaking or has decay present under it. An x ray in advance of the filling can often provide a clue that the filling is deep or close to the nerve. Unfortunately, a definitive assessment can really only be made once the old filling is removed and the dentist can observe the resulting cavity visually.
If there is decay under an old filling the nerve inside the tooth may be mildly inflamed but pain free day to day giving the appearance or “feel” of a healthy tooth. One way to imagine this is that any “pressure” inside the tooth can “escape” through the leaking filling. Unfortunately, when a well fitting bonded restoration is placed and the inflamed nerve is “sealed” then pressure builds up within the tooth which leads to pain. Occasionally in these situations nerve death can eventually result within the tooth.
Thankfully this is reasonably rare, studies show that somewhere between 5 and 15 % of all teeth receiving crowns or very large fillings will ultimately follow this path. If this happens then a choice needs to be made between preserving the tooth with a root canal treatment or removing the tooth. In our experience when we use rubber dam during the removal of old fillings and their replacement the incidence of tooth death appears to be towards the lower end of the quoted range.