The use of amalgam in pediatric dentistry

Resident: Cho

Author(s): Fuks, Anna.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2002. 24. 448-455.

Major topic: Amalgam

Type of Article: Position Paper

Main Purpose: This report summarizes the several factors regarding amalgam restorations, including the material itself, the operator, and the patient.

Key points/Summary:

Factors related to the material:

- Toxicity of amalgam:

All estimates of daily total amalgam-associated mercury intakes are well below threshold for hazard to health. One human study demonstrated that the correlation between mercury levels in the mother and the newborn child was more closely related to the amount of fish consumed than to the number of amalgam fillings in the mother. True allergies to amalgam are rare, though there have been reports of an associated oral lichenoid lesion adjacent to amalgam restorations on rare occasion.

- Marginal integrity:

Amalgam is the only restoration nowadays in which the marginal seal improves with time. This is due to the acid environment and the low oxygen concentration in the space between the tooth and the restoration, leading to corrosion.

Factors related to the patient:

A disadvantage of amalgam is that it is unsuitable for minimal carious lesions. Studies have reported that the lifespan of SSC’s were twice that of amalgam for children age 4 years of age and younger. If the carious lesion is extensive and/or in more than 2 surfaces, a SSC would be indicated even for children older than 4 years of age.

Factors related to the operator:

Amalgam tends to be much less technique sensitive and more operator friendly compared to other restorative materials.

Recommendations for amalgam:

1. Class I restorations in primary and permanent teeth

2. Two surface Class II restorations where prep does not extend beyond proximal line angles

3. Class II restorations in permanent molars and premolars

4. Class V restorations in primary and permanent posterior teeth

Assessment of Article: Good summary of why amalgam is a great restoration!