Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 296 - "FILLINGS: THE CHOICES YOU HAVE - MERCURY AMALGAM AND OTHER FILLING MATERIALS"

Current through 2024-29, July 17, 2024
DEPARTMENT OF HUMAN SERVICES
Angus S. King, Jr., Governor
Kevin W. Concannon, Commissioner
Printed under appropriation #: 014-10A-2565-022
In accordance with Federal laws, the Maine Department of Human
				Services does not discriminate on the basis of sex, age, color, national origin
				or disability in admission or access to or treatment or employment in its
				programs and activities. The Department's Affirmative Action Coordinator has
				been designated to coordinate our efforts to comply with and implement these
				Federal laws and can be con- tacted for further information at 221 State
				Street, Augusta, Maine 04333. (207) 287-3488, or 1-800-332-1003 (TDD).
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About this Brochure
In 2001, the Maine State Legislature passed a law telling the
				Maine Bureau of Health to make a brochure about the advantages and
				disadvantages to human health and the environment of using mercury amalgam
				fillings in dental work. The same kind of information is included for other
				filling materials, to help patients in choosing what will be best for
				them.
Mercury is a heavy metal. It is found in nature. Mercury is
				found in different forms. Too much mercury in your body can hurt you. Many
				years of burning coal along with using mercury in batteries, thermometers,
				fluorescent lights, electrical switches, and other products have caused too
				much mercury to get into the environment.
The State of Maine is concerned about the effects of mercury on
				human health and our environment. Maine's policy is to reduce how much mercury
				is released into the environment. Maine is a leader among states in removing
				mercury from products.
Because amalgam fillings mostly contain mercury, we are
				concerned about possible effects on human health and the environment.
This booklet will tell you more about:
Mercury in amalgam fillings
								 Health and environmental concerns with using amalgam
				  fillings
								 Cavities and dental decay and what you can do to avoid
				  fillings
								 Talking with your dentist about getting a tooth
				  filled
								 Choices you have for filling materials
Amalgam Fillings and Mercury
Amalgam fillings are also called
dental amalgams
or
mercury amalgams.
They are 40 to 50 percent
				mercury. These fillings give off mercury vapor. How much vapor is given off
				depends on how many fillings you have. It also depends on how much time you
				spend chewing, grinding your teeth, and drinking hot liquids. Mercury vapor can
				be inhaled and enter the bloodstream. It can then be carried throughout the
				body. For people with a number of fillings, this can be the major way mercury
				gets into their body. Any mercury from amalgam fillings we swallow is very
				poorly absorbed and mostly does not enter our bloodstream.
Health Concerns
There is a lot of debate about health effects from the mercury
				in amalgam fillings. Current studies cannot confirm if amalgam fillings cause
				health problems. Some people have allergic reactions to mercury. Too much
				mercury can damage the kidneys, nerves, and the brain. The brains of babies and
				infants that are starting to form and grow are most at risk.
To be careful, Canada and several countries in Europe recommend
				limits on the use of mercury amalgam. They advise that pregnant women should
				not have amalgam fillings placed in or removed from their teeth. Some of these
				countries issue the same warning for nursing women and people with kidney
				problems. Some countries advise limits on using amalgam fillings with young
				children and people with braces. The US Public Health Service thinks such
				advice is not needed. They say amalgam fillings are safe for most people. No
				country says people who do not have signs of mercury effects should have their
				fillings removed.
Environmental Concerns
Some countries limit the use of amalgam fillings to help reduce
				mercury pollution. Waste is made when new fillings are put in teeth or when
				fillings are removed. This waste contains mercury. It can pollute the
				environment. Your dentist can reduce this pollution by using traps and filters
				to collect the mercury for recycling. Amalgam fillings cause our body's waste
				(urine and feces) to have mercury. When these mercury-containing wastes enter
				sewers, they can add to the pollution of our waters.
Once mercury enters our waters, it can change to methylmercury.
				This builds up in fish. Many states, including Maine, have issued Safe Eating
				Guidelines on eating fish due to mercury pollution. Mercury used in dentistry
				is not the major cause of our mercury pollution and resulting fish warnings. It
				does add to the problem. Wildlife that eat fish, such as eagles, loons and
				otters, are also at risk of harm from mercury pollution.
What you can do...
The best thing you can do is avoid the need for
any
fillings by preventing tooth decay in the first place.
				Because of efforts to prevent tooth decay, most amalgam fillings placed in
				teeth these days are to replace old ones. Knowing that you may have
				alternatives to amalgam fillings is another way to reduce the amount of amalgam
				that ends up in the environment. This brochure is to help you understand your
				choices for fillings. It is also to help you know what you can do to prevent
				tooth decay and avoid the need for any fillings.
About Cavities and Dental Decay
A cavity is a hole that forms in a tooth. It is the result of
				dental decay. Decay starts when there is a breakdown in tooth enamel. Unlike
				other kinds of injuries to your body, a cavity will not heal by itself. Not all
				dental decay results in cavities. Early decay can be stopped and even reversed
				with proper care.
Dental cavities need to be treated by a dentist. If you need a
				filling, there are different materials and treatment choices that you and your
				dentist can consider.
Because there are advantages and disadvantages to all filling
				materials, preventing dental decay from ever starting is
very
important.
Preventing Dental Decay
Over the past 30 years, successful preventive measures have
				helped reduce dental disease (tooth decay). Preventing decay is the best way to
				protect your oral health and your overall health. If you can keep decay from
				starting, you won't need fillings, and you'll be helping to protect the
				environment.
Follow these steps to help prevent dental disease:
Brush and floss your teeth every day.
								 Eat a balanced diet low in sweet sticky
				  foods.
								 Limit sugary sodas and fruit drinks.
								 Visit your dentist at least once a year for a regular
				  dental check-up.
								 Use fluoride to help strengthen tooth enamel.
								 Make sure children get dental sealants on their molar
				  teeth.
Talking with Your Dentist About Getting a Tooth
				Filled
When you visit your dentist and need to have a tooth filled,
				let your dentist know about any changes to your health since your last visit.
				For example:
Are you pregnant or nursing"
								 Do you have any allergies"
								 Do you soon plan to have braces"
								 Are you taking any medications" What for"
								 Do you have any kidney problems or a family history of
				  them"
								 Do you have
any
other health conditions
				  or specific health concerns"
Sharing these facts with your dentist may affect the choice you
				make for a filling material. If you have questions or concerns about these
				materials or the kinds of fillings you already have, you should read this
				brochure and talk with your dentist.
No matter what material is used, a filling is not like a
				natural tooth. Filling materials are man-made and as such they are foreign
				materials to your body. Whenever something foreign is put into your body, there
				is the chance of side effects. All dental materials may cause an allergic
				reaction in sensitive people. For every filling material, there are a few
				people who are allergic to it. This is why your dentist needs to know about
				your allergies.
If you need to have a tooth filled (restored), there are
				different kinds of materials that can be used. Your dentist will talk with you
				about the kind of filling material that is best for you and for the tooth that
				needs to be filled. Each kind of material has advantages and disadvantages. You
				should know what these factors are so that you can make an informed
				choice.
What you choose depends on your needs and the best way to
				repair the cavity in your tooth. There are other factors that may affect the
				choice of filling material. These include the location of the filling and
				biting forces in the area of the mouth where the filling is located.
For many years, the only choices for fillings were metals.
				These are a mixture or "amalgam" of mercury and silver alloys, or gold alloy.
				In the past 20 to 30 years, other materials have been developed for fillings.
				These are "tooth colored" rather than silver-colored and gold. They include
				composite resin, glass ionomer and porcelain.
The rest of this brochure will outline the alternatives that
				you have and help you make the right choice for you.
The final choice is yours.
Choices in Restorative Materials
				(fillings):
Advantages, Disadvantages and Concerns
				Amalgam
The word "amalgam" means a mix or blend. It can also be a
				mixture of mercury with another metal or mix of metals.
Dental amalgams include mercury, silver, copper and tin. About
				40% to 50% of the filling material is mercury. They have been called "silver
				fillings" because of their silver color when they are first placed. It is
				usually used on back teeth. It is one of the oldest filling materials and has
				been used for over 150 years.
Advantages:
Amalgam is very strong and lasts a long time.
								 Fillings are usually done in one visit.
								 This is the least expensive type of filling
				  material.
Disadvantages:
Amalgam fillings give off mercury vapor. The vapors can
				  then be inhaled and enter your body.
								 Current studies cannot confirm if this mercury causes
				  health problems.
								 Mercury used in these fillings can add to the mercury
				  pollution problem.
								 Amalgam has a silver color that can get darker over
				  time.
								 In rare cases there are allergic reactions to
				  amalgam.
Composite (resin)
Composite is a mixture of plastic resin. These fillings are
				also called plastic or "white fillings." This type of material may be either
				self-hardening or may be hardened by exposure to blue light. Composite is used
				for fillings, inlays and veneers. Sometimes it is used for replacing parts of
				broken teeth.
Advantages:
These fillings are the color of natural
				  teeth.
								 Composite may be used on either front or back
				  teeth.
								 Fillings are usually done in one visit.
								 Composite is a relatively strong material.
Disadvantages:
This type of filling can break and wear out more easily
				  than metal fillings, especially in areas of heavy biting forces. As a result,
				  composite fillings may need to be replaced more often than metal
				  fillings.
								 Compared to other fillings, composite fillings are
				  sometimes difficult and time-consuming to place. They cannot be used in all
				  situations.
								 Composite has a moderate cost. It costs more than
				  amalgam.
								 A chemical called Bisphenol A can be released from
				  composite fillings. This chemical has hormone-like activity. Current studies
				  cannot tell if this is a health problem. No government has recommended limits
				  on its use.
								 Allergic reactions are rare.
Glass Ionomer
Glass ionomer is a glass product. It is used for small or
				temporary fillings. It is also used as a cement for dental crowns. It is
				usually not used on the chewing surfaces of back teeth.
Advantages:
These fillings are the color of natural
				  teeth.
								 Glass ionomer contains fluoride. This helps prevent
				  further decay.
								 Fillings are usually done in one visit.
Disadvantages:
These fillings will not last as long as other
				  materials.
								 Glass ionomer is not recommended for use on the chewing
				  surfaces of back teeth.
								 This material has a moderate cost, like a
				  composite.
								 Allergic reactions are very rare.
Gold or Gold Alloy
Gold or gold alloy fillings are a mix of gold and other metals
				such as silver and copper. This material is used for crowns, bridges, inlays
				and onlays. Fillings made of gold alloy are made in a dental lab and sent back
				to the dentist to cement into place.
Advantages:
Gold is extremely strong. Fillings made of gold alloy
				  will last a long time.
								 Gold alloy may have porcelain fused to the outside
				  surface to make it tooth colored.
								 No toxic or environmental effects have been identified
				  to date.
Disadvantages:
Gold has a high cost, more than all other
				  materials.
								 More that one dental appointment is needed to complete
				  these fillings.
								 Fillings are gold colored if not covered with
				  porcelain.
								Allergic reactions are rare.
Porcelain
Porcelain is a mix of glass-like materials. Sometimes it is
				called ceramic. It is used for tooth colored crowns, bridges, inlays and
				onlays. Fillings made of porcelain are made in a dental lab and sent back to
				the dentist to cement into place.
Advantages:
These fillings are tooth-colored.
								 They may be used alone or fused to gold alloy to make
				  them tooth colored.
								 Porcelain usually lasts a long time.
								 No toxic or environmental effects have been identified
				  to date.
Disadvantages:
Porcelain is somewhat brittle and may
				  fracture.
								 More than one dental appointment is needed to complete
				  the filling.
								 Porcelain has a high cost, similar to gold.
The Maine Legislature has required that as of July 1, 2002 all
				Maine dentists who use dental amalgam, which contains mercury, must provide
				this brochure to their patients to help explain the advantages or disadvantages
				of the use of mercury, mercury amalgams or other filling materials used in
				dental procedures. This brochure explains the possible effects that the use of
				such fillings may have to your dental health, general health or the
				environment. This brochure is intended to assist you in making choices
				regarding your dental and total health needs that are right for you.
For more information on:
U.S.
Public Health Service Statement on
				Amalgam Fillings:
www.fda.gov/cdrh/consumer/amalgams.html
ATSDR Toxicological Profile for Mercury:
http://www.atsdr.cdc.gov/toxprofiles/tp46.html
Health Canada Statement on Amalgam
				Fillings:
www.hc-sc.gc.ca/hpb-dgps/therapeut/zfiles/english/publicat/dental_position.html
Bureau of Health Safe Eating Guidelines for
				Fish:
www.state.me.us/dhs/etp/fca.htm
Mercury in Maine's Environment: Department of
				Environmental Protection Web site
www.state.me.us/dep/mercury
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