The Use of umalgam in pediatric dentistry: review of the literature

Resident: Swan

Article Title: The Use of Dental Amalgam in Pediatric Dentistry: Review of the Literature

Author: Osborne, et al.

Journal: Pediatric Dentistry

Volume (Number): 24:5 2002

Major Topic: Amalgam use in Primary and Permanent teeth

Type of Article: Literature Review

Main Purpose: Confirm the use of amalgam as a safe, long-lasting, cost-efficient restorative material

Key Points/Summary: The authors presented a brief history of amalgam as a restorative material, detailing the advent of the current high-copper amalgams which exhibit much less corrosion and porosity than earlier amalgams.

Use of Amalgam in Primary Teeth: The authors conclude that while amalgams perform very well in primary teeth, recent material improvements in both resin based composites and RMGI cements have made them very attractive restorative options as well. It was interesting to me that in their lit review promoting the use of amalgam, one of the principal studies cited was a clinical trial that found a 9% failure rate of amalgam restorations, an 8% failure rate of GI restorations, and a 7% failure rate for RMGI restorations. Obviously, tooth colored restorations are achieving clinical success. The authors point out that amalgam is a good restorative option when isolation or patient cooperation is difficult.

Conservative Dentistry: In a 10 year study comparing traditional amalgam restorations through occlusal fissures to resin composite restorations, the two performed equally as well. However, when the traditional amalgam and resin composite restorations were compared with amalgam restorations placed only where carious dentin had been removed, then remaining fissures sealed, the latter restoration performed much better (2% failure rate over 10 years compared to 17% failure and 14% failure for traditional amalgam and composite, respectively.

Amalgam safety: The authors cited 24 studies that confirm amalgam’s safety. One study showed that for every 12 amalgam restorations in the mouth, the rate of release of mercury is 1.7 micrograms per day, or 10% of the daily intake of mercury from all sources (air, water, diet). This is less than .2% of the toxic level.

Assessment of Article: Thorough, well-researched lit review that concludes what we all know to be true: amalgam is a good thing.