Do crowns replace fillings?

[Brent pigeon]

My dentist wants me to have a lot of crowns, I thought that they would replace the fillings but the last time I spoke to him he seemed to be telling me that I would still have the fillings. I want to get rid of the amalgam fillings, he thinks that they are not harmful but they are crumbling. I have known him a long time, he is OK. but I feel that I ought to be able to get the treatment that I want.

[MrXLA]

I'm unsure whether you have an NHS or private dentist but regardless, treatment would have to begin with what you 'need' not what you 'want'.
Amalgam is not harmful in itself however like every material (natural or otherwise) on the planet it does not last forever.
If you have heavily restored teeth with old restorations often cast restorations such as crowns or onlays/inlays are appropriate when said restorations need replacing (since usually more tooth is lost with each 'generation' of restoration).
So in answer it MAY be appropriate to replace some of your old 'filling's' with crowns however only another dentist would be able to comment (and no two will come up with exactly the same treatment plan).

[MrXLA]

I'm only guessing but I believe (after re-reading your question) that you dental situation is:
- Your dentist has noted that you have several heavily restored teeth (obviously molars or premolars)
- He believes (perhaps) that they are at risk of cusp fracture etc..
- the current restorations ('fillings') are perhaps old/worn
- he intends to crown a few of these teeth in order to 'protect' remaining tooth tissue
- ***He intends to leave the existing amalgam restorations as 'crown cores'

- Amalgam is a good core material and I'm guessing you would prefer him to remove these 'cores' prior to crowning these teeth
- I'll not bore you with information on biomechanics, dental materials science, moisture control, restoration longevity, occlusion etc...
- Suffice to see if you asked a joiner to put a window in but decided that you 'wanted' him to use a crepe paper window frame he might be unhappy to do so, then again...

[Brent pigeon]

I get the impression that the white fillings are OK, not the equivalent of crepe paper.. I do not know whether the amalgam fillings are bad for people but I am not happpy about having old crumbling bits of mercury compound in my mouth. I do not think that the risk has been thoroughly assessed yet and I would prefer to be on the safe side.
Thank you for taking the time ot reply in detail.

[MrXLA]

Well it depends if the restorations are deficient/failing if they are then they require replacing.
Amalgam has been used for over a century, and it is certainly true that anything containing mercury would never be licensed for use in medicine/dentistry should it be developed today.
However there has been a multitude of long term studies to show that amalgam is safe for use (dentists would refuse to work with it if it was dangerous as they would be most at risk).
'White fillings' namely composite resins are inferior to amalgam for posterior restorations in almost every way:
- lower tensile and compressive strength
- softer than amalgam
- greater pulpal irritant
- higher chance of leakage
- does not last as long
etc...

[Panic Button]

I have heavily filled molars.

Last year the whole corner of one broke off, and my dentist drilled out the amalgam and replaced it with white. He constructed the side to fill the missing area.

Now another has broken off, but the whole side this time.

He says there is not enough tooth left to do a filling, so he will have to do a crown.

On re-reading your question, this doesn't helpat all does it? However as it is typed I will hit this button here...

[Brent pigeon]

I think it helps a bit, this sounds like what i thought he was going to do, that is replace the lot but I evidently misunderstoof. I have the symptoms of mercury poisoning, my balance is very bad and my memory is failing badly

[sense4all]

In that case you might find this link interesting ( mercury seepage) my neighbour suffered from this!

http://www.life.ca/nl/53/mercury.html

http://www.whatreallyworks.co.uk/start/article s.asp?article_ID=178

[Panic Button]

I blame the booze and age.

[MrXLA]

You may have mercury poisoning although its very unlikely its from your amalgam restorations (they contain but are not entirely composed of mercury)
- mercury is a poison but its a dose related poison, too much of just about anything including water in one go will kill you
- its worth noting that despite there being no evidence that amalgam restorations are dangerous (there is plenty to show that MERCURY is, but AMALGAM and mercury are NOT the same thing) the greatest release (although not dangerous) of mercury from amalgam restorations occurs when they are removed
- so if indeed you have mercury poisoning and your assumption is correct removal of these restorations will in theory make you feel much worse in the short term

[MrXLA]

There are alot of people that make claims about amalgam and their general health (and I'm not saying you are one of them), here is food for thought (no pun intended)
- If there was any proof that the use of amalgam in dentistry was dangerous (without proper storage and precautions etc..) then there is one group of people that would refuse to use it and thats dentists (they would be at greatest risk)
- If you ask dentists which restorative material they would like used on themselves on molar teeth, most will say amalgam as opposed to composite
- the ones that say composite usually do so for its appearance but accept that it has more associated problems and needs to be replaced more frequently (and thats usually not a problem for dentists)
- If there was any evidence that amalgam restorations were dangerous, the GDC (an organisation all dentists have to pay a large fee to every year to practice dentistry) would prohibit its use
- they would do so because they are in place to ensure the protection of patients they do not represent dentists (dentists in effect pay their own prosecutors every year should they ever get hauled up!)
- The DOH would not condone its use

[MrXLA]

There are those individuals who believe there is a conspiracy to cover up the use of 'dangerous amalgam' in order to protect dental organistions from legal challenge.
This is an illogical view point for several common sense reasons including:
- as previously mentioned dentists would refuse to use it
- dentists (and dental organisations) would not be open to litigation since the use of amalgam was, is (and will probably continue to be for a long time) the most appropriate restorative material in many clinical cases
- Therefore it is considered 'best practice' for many restorative situations and their is a wealth of evidence to support it (it certainly would not be if it was thought to be hazardous to health!)
- there is no conclusive evidence that use or long term exposure (dentists have been tested) to amalgam leads to health problems
- true there are a small number of people allergic to amalgam however they can be sensitivity tested or empirically treated to establish this and any individual can be allergic to any compound or material e.g. latex
- mercury poisoning in any individual can usually be attributed to other sources of exposure, such as diet, industrial, accidental etc..

[MrXLA]

When materials, medicines, techniques etc.. are used in medicine/dentistry it is usually after years of randomised controlled clinical and non-clinical trials.
- Often people misunderstand, these 'tests' are not designed to 'prove' something works or is safe they are designed (as is all good science) to show that something does NOT work/is NOT safe/the theory IS incorrect etc...
- When these repeated tests fail time after time to DISPROVE a theory or hypothesis then the technique gets adopted and after its use is carefully monitored and followed up it becomes 'best practice'
- If at any point evidence emerges that there is a 'better way/method/material etc...' then the old technique is replaced with a new one and so on...

- Nobody has any conclusive evidence that the use of amalgam in dentistry is detrimental to health, if anyone ever does the its use will be discontinued...that simple

- Of course its far easier to listen to media nonsense or hacks (usually an opinion NOT fact) than it is to pick up a non-biased journal article or actually conduct research..