Chapters
Is amalgam actually dangerous?
[00:00:04 – 00:08:11]
Silver amalgam has been used for around 150 years, and the word mercury is what frightens people. The material is roughly 50 per cent mercury before it is mixed, but once set it forms a stable alloy. The mercury is bound into that alloy and is not sitting loose in the filling.
A review of the evidence calculated that you would need 450 to 530 amalgam surfaces to reach the World Health Organization urinary mercury threshold. A large filling covers three or four surfaces, so that is around 100 very big fillings. A typical person with fillings absorbs roughly one to three micrograms a day, about twenty times below that threshold.
Cochrane reviews found no consistent or clinically important harm between amalgam and white composite for neurological, immune, or kidney outcomes, although the certainty of that evidence was rated very low. A separate 2021 review found no increased risk of systemic disease attributable to amalgam. Removing a stable filling out of fear does not improve health, and done badly it can make things worse.
Why two dentists give you opposite advice
[00:08:12 – 00:10:05]
The disagreement comes down to philosophy, training, and sometimes business model. One camp is precautionary and removes amalgam to eliminate any exposure at all. The other follows minimal intervention and leaves stable fillings alone.
Both positions can be defended in the right context. The problem starts when either one is sold as a universal truth for every patient. If you see two dentists in the same week and get opposite advice, it usually means your individual risk was never properly assessed.
One cost tends to get left out of that conversation. Every time a filling comes out, more natural tooth comes with it, and that compounds over a lifetime.
Safe removal and why suction matters
[00:10:05 – 00:16:11]
SMART stands for Safe Mercury Amalgam Removal Technique. A filling sitting quietly in your mouth is not the concern. Drilling it out generates vapour and particles, and that is the moment worth controlling.
The protocol uses isolation, heavy water spray, and high-volume suction. Suction is the part that matters most, and it needs to sit right next to the tooth. Research from 2023 found that with it running, mercury vapour stays well below the World Health Organization threshold, and without it levels run two to fifteen times higher.
For context, a plate of swordfish or tuna will expose you to more mercury than your fillings or the appointment to remove them. Mercury accumulates up the food chain into large fish. That is worth holding on to before panicking about a filling.
Cracks, expansion, and failing fillings
[00:16:11 – 00:19:47]
This is the real reason old amalgams come out, and it has nothing to do with mercury. Amalgam is wedged into the tooth mechanically and does not bond to it. Your tooth flexes when you bite and the filling does not flex with it.
Metal and tooth structure also respond to hot and cold at different rates. Thousands of hot drinks and cold drinks open tiny gaps, decay creeps in underneath, and the filling itself keeps expanding. Some shallow old fillings have pushed so hard on the enamel that the tooth looks like it has been hit with a hammer.
Cracked teeth often give no warning until a cusp breaks off. A tell-tale sign is sharp pain on releasing a bite instead of on biting down. Large old amalgams are worth monitoring for exactly this, because catching the crack early is far better than losing the cusp.
Does removal mean you need a crown?
[00:19:48 – 00:21:38]
No. The old default was to remove the amalgam, grind the whole tooth down, and fit a crown, which has cost patients a great deal of money over the years. It also starts a cycle, because dental crowns eventually leak too, and those cases often end in root canals.
A leaking amalgam can usually be replaced with bonded composite if it is small enough, or with an onlay that covers only what genuinely needs protecting. One patient was told elsewhere that she needed four crowns after amalgam removal. On assessment, two teeth needed an onlay and the others were fine with composite.
Before agreeing to any removal, ask what is going in and why that option was chosen over a filling, inlay, or onlay. If the answer is not a clear biological reason, get a second opinion.
Amalgam tattoos on the gum
[00:21:39 – 00:23:32]
An amalgam tattoo is a grey or blue mark in the gum, usually high up and towards the back where patients never see it. It happens when a fragment of amalgam is left behind, often after a baby tooth with a filling in it was extracted.
It is purely cosmetic. It does not spread, it does not cause disease, and because nothing is chewing on it, it releases nothing. On an x-ray it shows up as a few small white specks near the mark.
Some patients are sent for unnecessary biopsies over these. Where the specks are visible on the x-ray, there is no need for a biopsy and no need to remove it.
Chewing, removal, and pregnancy
[00:23:33 – 00:27:51]
Chewing, clenching, grinding, and chewing gum all release very small amounts of vapour from an old filling, day after day, for years. A properly controlled removal is a single contained exposure. On that arithmetic, decades of a stable filling can add up to more than one removal appointment.
That is not an argument for taking out stable fillings for the sake of it. Most amalgams that genuinely need to come out are already large, leaking, or cracking the tooth. Where a small one sits beside a tooth already being treated and can come out without enlarging the hole, replacing it in the same visit makes sense.
During pregnancy, leave stable amalgams alone. Genuine clinical need such as active decay is treated with the right precautions, but elective work waits. Fear is not a clinical indication for treatment.
What global bans mean for South Africans
[00:27:51 – 00:29:57]
Several countries have restricted or phased out amalgam, and the driver is environmental policy. The Minamata Convention targets mercury across industry, including fluorescent lamps, and dental wastewater is part of that picture. A ban in Switzerland does not mean your fillings need replacing when you land back in Cape Town.
There is still a case for amalgam in rural settings, where it is quick, cheap, and saves a tooth that would otherwise be lost. Newer materials are closing that gap. Glass ionomers and resin-reinforced glass ionomers handle similarly and contain no mercury.
The takeaway
[00:29:57 – 00:31:27]
Stable amalgams are not a health emergency, and the evidence does not support removing them out of fear. Every removal costs you natural tooth, and that is a cost you cannot reverse.
Leaking, cracking, and failing fillings are a different matter, and those are worth acting on. Get your own mouth assessed before committing to any restorative dentistry.
Transcript
Eon Engelbrecht – E-Radio-SA (0:04 – 0:57)
Welcome back to Save Your Money, Save Your Teeth, the podcast that looks at what genuinely protects
your teeth and also your wallet. Now silver fillings, amalgam, depending on who you ask, it is either
perfectly safe or something you should have had ripped out yesterday. Both of these camps are quite loud
and neither camp is always right.
So today we are doing what we do best here, cutting through the noise, what the actual evidence says
about mercury exposure, why dentists disagree with each other in the same week about the same filling,
and also whether taking a metal filling out means you are automatically signing up for a crown. Joining me
as always from Sea Point in the beautiful Cape Town is Dr Clifford Yudelman from OptiSmile. Doctor,
welcome back.
Dr Clifford Yudelman – OptiSmile (0:57 – 1:22)
Thanks, Eon, great to be back. And yes, great subject. Today you would think that after so many podcasts
we would have already spoken about this.
But you know, every time I research some new podcasts to record, I find something that we have not
spoken about. So here goes. What is it today? Number 124?
Eon Engelbrecht – E-Radio-SA (1:23 – 1:24)
Yes, so much to cover.
Dr Clifford Yudelman – OptiSmile (1:25 – 1:26)
Yes.
Eon Engelbrecht – E-Radio-SA (1:27 – 1:45)
So I just said to you, I recently had one of these silver fillings removed. I do not know if it was a good thing
or what, because you hear all these scary things. So I think the first question, so we can settle it, is, doctor,
are these silver amalgam fillings actually dangerous or toxic?
Dr Clifford Yudelman – OptiSmile (1:46 – 8:11)
So I think the quick answer to that is, my wife still has two of them in her mouth. If I thought they were
going to kill her, and let us just take it that I love her, I would have replaced them a long time ago. I have
replaced a number of her silver fillings since I moved back to South Africa to be with her.
As you know, she is my high school sweetheart, and we got together after 37 years. She had quite a few
silver fillings, and we will get into some of the reasons why some of them got replaced and some did not.
But basically, amalgam has been around for 150 years.
I have mentioned before, my dad was a dentist for 57 years, and he would have used silver fillings. When I
was at university, we only put silver fillings in back teeth. We were doing white fillings in the front teeth.
In fact, I was placing silver fillings all the way up until 2002 when I moved from California to Perth. Whereas
when I was in London from 86 to 89, some dentists were starting to put white plastic fillings in molars, and
it was a real disaster. It put me off putting white fillings in back teeth for a number of years until things
improved.
But the word mercury is what scares people. In fact, when you mix up a silver filling to put it in a patient’s
mouth, and I remember, I have not done it in 26 years, there are still dentists that do use silver amalgam
fillings. They do not call it silver and mercury amalgamated, but it is basically 50 per cent mercury before
you mix it up.
But then it becomes bound, and it is a stable alloy, and it is not like the mercury is sitting loose in the filling.
But just because it says contains mercury, it does not mean that it is toxic. Almost anything is harmful in the
wrong dose, including water.
And there are patients who have had stable amalgams for 30 years with no issues, and then they see a
Facebook or a TikTok post, and they get into a panic, and they want it all out immediately. Removing a
stable filling out of fear does not only fail to improve health, but if it is done badly, it can actually make
things worse for a number of reasons that we will get into now.
Basically, it is not that amalgam is evil. Amalgam is not perfect, and understanding the actual risk before
acting on fear is very important. I had the idea for this podcast a while back, and I always research these
podcasts ahead of time, and I went into something called Consensus. Instead of just going on ChatGPT or
some other AI, it looks at tens of thousands of papers, and one of the facts that I want people listening to
this to take away, in one of the reviews of all the articles, they said that they calculated you would need
450 to 530 amalgam surfaces in your mouth to reach the World Health Organization’s 30 micrograms per
gram of creatinine urinary threshold, which means to have mercury in your urine. That is the level at which
the World Health Organization says the more subtle preclinical effects start to appear. In other words, if
you had 450 surfaces of amalgam, and a big filling is like a three or a four surface, so take it down, you
would need 100 of these big, big fillings.
This suggests that a typical person with fillings absorbs something in the order of one to three micrograms
a day, and measures around one to two micrograms per gram of creatinine, which is roughly twenty times
below that threshold. We are going to jump around a bit with whether you should take them out and
whether you should not take them out.
There was another study that found that there was no correlation between amalgam surface count and
fatigue, because fatigue is often considered a mercury toxicity symptom. Then Cochrane, spelled C-O-C-HR-A-N-E, they are very famous for doing medical reviews. They identified no consistent or clinically
important harms between amalgam and composite, which is the white fillings, in people with neurological,
immune or even kidney outcomes.
The evidence certainty was rated as very low. That study was by Worthington from 2021. We will get
through all of this.
I just wanted this to be on file, as it is not my opinion. These are actual facts. I am not saying that mercury is
not harmful and that it should be in your body.
This is the actual research where the average mainstream dentist comes from, and we will get into people
removing them or replacing them. Then the last one, also very recent, they compared amalgam to resinbased or white fillings, and they found no increased risk of systemic disease, which means, let us say,
cardiovascular disease or any kind of cancer or anything like that, attributable to amalgam. This was a study
by Galussi in 2021.
Those are very recent. A systematic review means they take hundreds of articles, and then they go through
to see if they are good studies or bad studies. I did not actually look at how many articles, but sometimes it
is literally in the hundreds, and then they extract all the proper evidence from that, and they come to these
conclusions.
They are not actually running a study themselves. They are going back and reviewing it systematically. That
is a very long first answer for people that do not have time to listen to the rest of this.
Eon Engelbrecht – E-Radio-SA (8:12 – 8:20)
Okay. Then my next question to you is, why do some dentists say to remove them all while others say just
to leave them alone?
Dr Clifford Yudelman – OptiSmile (8:20 – 10:05)
Like a lot of things, it comes down to the dentist’s philosophy, which is a big word, their training.
Sometimes it is a business model, but neither side is necessarily lying to the patient. There are two main
camps.
One is precautionary, just remove them to eliminate any risk. These have got mercury in them. I am going
to take out all your silver fillings because no level of mercury is safe.
Then, and I will try not to digress and go off subject, versus minimal intervention, which is to leave stable
fillings alone. I have to stress stable fillings, so like the ones that I have left alone in Robyn my wife’s mouth.
They are smaller.
They are stable. I have been monitoring them for 11 years. They are not changing.
The fillings themselves might be releasing a small amount of mercury, but I always go with what is
evidence-based. They are both defensible in the right context. The problem is whether it gets sold as a
universal truth for every patient.
In a real scenario, the patient sees two dentists in the same week and gets opposite advice. That usually
means that the patient’s individual risk was not properly assessed, not that anyone is lying. The one thing to
remember is that every time you remove a filling, you remove more of the actual tooth.
That is not free. That compounds over a lifetime. We will get into that more in some later questions.
You can fire away with the next one, unless there was anything that I did not make clear there.
Eon Engelbrecht – E-Radio-SA (10:05 – 10:19)
No, all clear, all clear. I want to ask you, doctor, what is the SMART protocol and why does isolation like the
rubber dam matter so much during removal?
Dr Clifford Yudelman – OptiSmile (10:20 – 16:11)
SMART is Safe Mercury Amalgam Removal Technique. That is basically common sense with an acronym.
The point is not that the filling is that dangerous sitting there quietly.
It is when you actually go to drill out the filling, it generates vapour and particles. The generally accepted
protocol is a rubber dam, which is necessary any time you do a root canal. Some dentists use rubber dam
for almost everything.
Some dentists, like myself, are old school. We still use something called the Optragate and cotton rolls and
gauze, and so on. I will give you some further facts about rubber dam in a second.
Then you use high-volume suction. That is very, very important. That means not the little suction that hangs
at the back of your mouth.
That is the big one that makes a huge noise. If you put a good, properly maintained and powerful highvolume suction in a full bucket of water, it can suck up that entire bucket in literally 10 or 20 seconds. We
are talking about it pulling a lot of air through your mouth.
It is venting it. It is taking it outside to where the suction motor is. That is the most important thing for me,
that your suction is working properly and it is right next to the tooth.
Then using a lot of water spray, that will basically reduce any vapour because the water spray is spraying on
the tooth. Then the suction is suctioning the amalgam particles and the vapour. That is very important.
The analogy is like if you are sanding. There is a big thing about lead paint. Sometimes children’s toys and
furniture were painted with this lead paint.
Lead and mercury are both heavy metals. They are both toxic in similar ways. Basically, you would contain
the area and contain the dust.
Then you may even do wet sanding. You do not just sand old lead paint furniture for repainting with the
windows shut. In fact, I would recommend just getting rid of the old lead paint furniture, not trying to sand
it and repaint it.
I do not think people do much of that. That is a USA thing, a hobby to restore old furniture. Anyway, one of
the side benefits, there are a lot of people that are adamant that you have to use a rubber dam.
Then I will get into that in a second. Then the main thing is patients should ask some of these questions if
they are going to get amalgams removed. There are some dentists, biological dentists we have spoken
about, and people that want to scare every patient they see into removing every single filling in their
mouth.
That is where we spoke about where it may be a business model. If I had to take out every silver filling on
every patient, whether they needed it for a dental reason or not, purely because I made them paranoid and
I said, I am going to put a rubber dam on and I am going to take out all your fillings. We are going to give
you vitamins and IV.
We have got our own IV bar. We are going to make sure that we remove all this mercury from your system.
You can really start freaking out.
It attracts a certain kind of person that is going to buy into all of that. I actually went again onto Consensus.
There are going to be an awful lot of those people who do have that as a business model.
Patients listening to this and other dentists can do their own research. Obviously, as we always say at the
end of every appointment, this is just my opinion. You should get your own independent advice.
Basically, the research showed that the mercury vapour is the primary exposure pathway during amalgam
removal. Its concentration in the operator’s breathing zone can reach levels of 0.1 milligrams per cubic
metre. It can go higher during, say, a 10-minute removal procedure.
Then it said that high-volume suction substantially mitigates this exposure. When used, mercury vapour
thresholds in the dentist’s ambient environment drop much lower. Whereas without it, the levels are 2 to
15 times greater than what the World Health Organization threshold limit value would be.
That is a study in 2023. The study was by Dudega. Dudega, I think, is how you say it.
If you love sushi or fish, any kind of large fish, swordfish, salmon, any kind of fish, you actually get way more
exposure because the mercury goes in the wastewater. Then the small fish are eaten by the big fish. Then
you eat the sushi.
If you cook a large fish like a piece of swordfish and it has got mercury in it, you are going to get way more
mercury than you will from your amalgam fillings or removing the amalgam fillings. That is just my own
personal opinion.
Eon Engelbrecht – E-Radio-SA (16:11 – 16:17)
Is it true that amalgam fillings can eventually crack the tooth around them?
Dr Clifford Yudelman – OptiSmile (16:17 – 18:32)
Okay, now you are talking. I do remove a lot of amalgam fillings, but not because of the mercury. It is
because we will see an amalgam filling might be leaking, which means there is a gap between the filling and
the tooth.
When we take those out, we will almost always find decay underneath. Many of those old fillings expand
over the years and they cause cracks in the teeth. That is a completely different issue to the mercury
conversation.
We do not want people to get confused. Basically, silver amalgam is pushed into the tooth and it does not
bond. It is actually mechanically wedged in, and your tooth will flex when you bite over the years and the
filling does not flex with it.
This will cause cracks in addition to the filling. Some old silver fillings just keep expanding all the time. I have
seen people with very shallow silver fillings in the tops of their teeth and the entire tooth looks like it has
been shattered with a hammer because that filling has been expanding and pushing on the enamel.
What often happens with those, people do not have any symptoms, but they break a part of their tooth off.
It depends. The bigger fillings are more at risk.
We always monitor those large old amalgams, not so we can tell patients that they have to get a crown, or
what is called upsell. We do not like to actually do that, but there are dentists that rely on that. This is a
warning to both those dentists and those patients.
We will talk about that again. I think there is a question coming later, but basically, you want to catch the
crack before the cusp actually breaks off. We often get patients with a cracked tooth syndrome where, we
have spoken about this, you use a little stick that the patient bites on when they put pressure on that cusp.
It gives a lot of pain as they release, and that means that that cusp is cracked. That is often when there is a
silver filling. I know you have got through the questions.
That is going to cover some of this.
Eon Engelbrecht – E-Radio-SA (18:32 – 18:45)
Now, doctor, separately from cracking, do old silver fillings expand and contract with the temperature
differently to my natural tooth? Does it actually cause its own problems?
Dr Clifford Yudelman – OptiSmile (18:45 – 19:47)
Yes. The metal and the tooth structure respond to hot and cold at different rates. Every time you have a
coffee or a cold drink, they mismatch.
Thousands of sips over the years add up and then this is what causes the gaps. That is why people end up
getting cavities. It happens very slowly and quietly over years and that is why it is not usually an emergency.
You have been coming to me and I have been looking at your fillings for a number of years and we have
spoken about it. Then you move to, say, California and you see a new dentist and immediately they start
freaking out. Oh, you still have got silver fillings in your mouth.
We have got to get you in next week and we have got to do 10 crowns. This podcast is for those people, the
ones that we do not want to get freaked out, and to look into this and to take this podcast that I am doing
today as a start, as a kick-off to do your own research.
Eon Engelbrecht – E-Radio-SA (19:48 – 19:58)
Okay. Then let us say I remove my metal fillings. Do I automatically now need a crown or is there a more
conservative option?
Dr Clifford Yudelman – OptiSmile (19:58 – 21:38)
You definitely do not need a crown, and this has cost patients not only a lot of money historically, but it
continues to cost them more and more money. The old default was you remove the amalgam, you go
straight to a crown, you grind the whole tooth down and then you put a crown on it. In fact, what I always, I
should not say what I love to see, but in so many cases you take off an old crown and the dentist did not
even bother removing the silver filling.
There is a silver filling underneath the crown. Then those cases where the crown has started leaking and
then it gets to the silver filling and then that is leaking, those ones often end up with root canals. These
days, we can replace it with a bonded composite.
If it is small enough, or an onlay that only covers what actually needs protecting. Early on, we did a nice
podcast called crown versus onlay. An example is a patient that gets told elsewhere she needs four crowns
after amalgam removal, and then we go and we check and we see that only two teeth genuinely need
maybe an onlay or something small and the others can actually be replaced with bonded composite.
And before agreeing to any kind of removal, ask the dentist what is replacing it and why that has been
chosen, and why do they recommend a crown over an inlay or onlay or a filling. And if they cannot give you
a clear biological reason, then that could be a good time to get a second opinion.
Eon Engelbrecht – E-Radio-SA (21:39 – 21:48)
And then I believe there is something called an amalgam tattoo on the gum. Can you just explain that to us?
And also, if you have it, should you be worried?
Dr Clifford Yudelman – OptiSmile (21:49 – 23:32)
A lot of the time, it might be somewhere that the patient can barely see it on the upper gum, quite close to
the back. And then we see it for the first time, we take photos and scans and I say to the patient, oh, I like
your tattoo. And they look at you all funny and it is like, but I have never had a tattoo.
And then you show it to them. And sometimes, like just now before recording this podcast, I had a patient
where I saw on an x-ray that there was a tiny bit of amalgam between the gum and the bone, because
when they were young, they would have had maybe a baby tooth removed and the baby tooth had a silver
filling in it. And a little bit of the amalgam went into the hole where the tooth came out.
It can actually look like a grey or a blue mark in the gum. And it is purely cosmetic. It does not spread.
It does not cause disease. And obviously, this is much more stable because you are not chewing on it and it
is not releasing vapour. And it is a tiny little piece of amalgam.
You can see it on the x-ray often. And it is usually in a place where there was a baby tooth that would have
been extracted. And the patient sometimes even remembers getting that tooth extracted.
If a tooth falls out naturally, it is not going to cause an amalgam tattoo. But sometimes people sadly get
unnecessary biopsies, because that is just what some dentists do. But if it can be seen on an x-ray, they
usually show up, I call it shrapnel, like a few little white specks on the x-ray near the area where the blue
mark is.
There is no need to get it removed or to get a biopsy.
Eon Engelbrecht – E-Radio-SA (23:33 – 23:46)
And I hope this is not too difficult a question, doctor, but do you get more mercury exposure over the years
from chewing on an old filling than you would from having it removed properly?
Dr Clifford Yudelman – OptiSmile (23:46 – 26:46)
So, yes, I mean, obviously, all of these things have to be taken on a case-by-case basis. When you chew and
you grind and you clench, especially people who grind a lot, and then in doing my research for this,
especially chewing gum, which I do a lot of after meals and snacks and sometimes in between every few
patients just to keep my mouth nice and moist, and we have spoken about that in a number of podcasts
about saliva, but that does release very small amounts of vapour from an old filling or old fillings
continuously day after day, year after year.
When you remove old fillings under SMART, what we mentioned, especially with high-volume suction and
lots of spray, that is a one-time controlled exposure, not an ongoing one. So a stable filling left in place for
decades can possibly lead to more mercury exposure than just a one-time removal appointment. But it
does not mean that one should remove stable fillings just for the sake of it, but also, leaving it in forever
might not be the answer.
And basically, it is very rare, like most of my patients, except possibly in the case of my wife and a handful,
most of the silver fillings are very big and they need to be removed for reasons other than mercury-based if
you go purely on Cochrane and other advice. So if you are trying to do the most evidence-based dentistry,
and without contradicting myself, I will also say if I am doing a large amalgam removal on an upper first
molar and we are going to be putting in an onlay or inlay and the patient is numb and we have everything
isolated and the patient is already getting treatment in that area, and there is a small silver filling in that
area that we can remove without making the hole bigger and it is simply a case of putting in a small white
filling, I will sometimes even do that for the patient at no charge because it does not take long.
And that is just the way I do it. It is not because I think that they are going to get a lot of mercury from that
tooth in the future. It is to help prevent it from, as we said, expanding and causing a crack, and they do not
look great.
We call them silver fillings, but face it, they are black, and the black on the white tooth really does not look
great either, which is also why some dentists will push people towards getting silver fillings out, scaring
them about the mercury, about the cracks and how it looks, when in fact that is the patient’s choice.
Eon Engelbrecht – E-Radio-SA (26:46 – 26:52)
Exactly. And doctor, what about pregnant women? Should they have their amalgam fillings removed?
Dr Clifford Yudelman – OptiSmile (26:53 – 27:51)
So generally, no. I mean, one would leave all stable amalgams alone during pregnancy. If someone cracked
a tooth or a filling, you do minimal treatment, but generally, we try to avoid any elective or non-urgent
dental work during pregnancy.
If there is a genuine clinical need like active decay, or it is sensitive, it is going into the nerve, then you
would treat it with the right precautions. But fear is not a clinical indication for treatment. And yes,
pregnancy, there is a lot of research and so on.
And even if it is just for psychological reasons, the less you do during pregnancy the better. It is safe to take
x-rays, although we generally do not. And we have discussed that in a previous podcast. I know we are at
question number 10 now and I do not want to make this too long.
So next question, yes.
Eon Engelbrecht – E-Radio-SA (27:51 – 28:02)
Doctor, just finally, some countries have restricted or phased out amalgam altogether. Should we as South
Africans be worried about the fillings that we already have?
Dr Clifford Yudelman – OptiSmile (28:03 – 29:57)
Yes, so that comes a lot from patients that are just back from overseas trips. Personally, I do not think there
is a good reason to place amalgam fillings anymore, but they are very quick and easy to place. They are very
cheap.
In a rural area, where a dentist does not have the proper equipment or training, it means that you are going
to save someone’s tooth. Otherwise, the cavity is going to get bigger and they are going to lose their tooth.
I am not sure that we should phase it out in Africa, as long as proper precautions are used with making sure
that the excess amalgam and mercury does not go into the wastewater.
There are now regulations coming in and in force to protect the environment. And the whole world is on
the same wave. I think it is called the Minamata Convention.
Mercury is found in fluorescent lamps and in many different places in industry. So it is mainly being driven
by environmental policy. Actually, even then, when I said a few seconds ago that perhaps silver fillings
should still be used in those lower socioeconomic areas and so on, there are newer materials in the last few
years.
There is something called ART. There are materials that do not have silver or mercury that can be placed
quite easily. They are called glass ionomers or resin-reinforced glass ionomers.
They handle very similarly to amalgam and they can possibly be an amalgam replacement. Just because
they have banned amalgam in Switzerland, for instance, does not mean to say you have to come back to
South Africa and get your fillings all replaced quickly.
Eon Engelbrecht – E-Radio-SA (29:57 – 30:18)
So I think context is very important. And after today, the message is do not panic and stop worrying about
it. There is a lot of fear-mongering going on about mercury and amalgam.
So thank you, Dr Yudelman. That was very insightful once again today and we appreciate your time.
Dr Clifford Yudelman – OptiSmile (30:19 – 30:23)
Thank you very much and looking forward to speaking to you next week.
Announcer (30:43 – 31:27)
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Disclaimer: The content provided in this podcast, “Save Your Money Save Your Teeth” on Medical Mondays, is for informational and educational purposes only. It is not intended to serve as dental or medical advice. The insights and opinions expressed by Dr. Clifford Yudelman and any guests are designed to foster a better understanding of dental health, preventive measures, and general well-being, but should not be interpreted as professional dental or medical recommendations.Dr. Clifford Yudelman does not diagnose, treat, or offer prevention strategies for any health conditions directly through this podcast. This platform is not a substitute for the personalized care and advice provided by a licensed dental or healthcare professional. We strongly encourage our listeners to consult with their own dental care providers to address individual dental health needs and concerns.The information shared here aims to empower listeners with knowledge about dental health but must not be used as a basis for making health-related decisions without professional guidance. Your dental care provider is the best source of advice about your dental and overall health. Please always seek the advice of your dentist or other qualified health professionals regarding any questions or concerns about your dental health.
