11 September 2019

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What do patients think about dentistry today?

Lorenzo Breschi

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Are amalgam fillings still the best materials for the reconstruction of our teeth? According to a survey conducted by the Italian Academy of Conservative and Restorative Dentistry (AIC) presented during the 21st National Congress held in May 2019 in Bologna, 35% of the Italians consider amalgam restorations the most reliable treatment for caries. On the other hand, only 26% of the interviewed seem to be aware of the fact that silver-colored fillings are no longer the material of choice. Indeed, theirs use, has been strongly limited by a European Union regulation that from 2018 prohibits its use in children and pregnant or nursing women. The reason for this regulation is the alleged toxicity due to the release of mercury, one of the main components of the alloy used for fillings.

Unfortunately, the knowledge that Italians have of dental treatment has remained at a standstill a few decades ago, when it was normal to use gold for prostheses and silver amalgam for fillings. However, despite the thought of the interviewed patients, dentists are well informed about the new European rules and have a good knowledge of the state-of-the-art materials for teeth reconstruction. As a matter of facts, only 4% of the fillings performed each year, for a total of about 1,000,000 interventions are made with amalgam, showing that the use of this material is now residual in the daily clinical practice, and is limited to specific cases and to particular welfare and social situations, where it cannot be replaced with the current materials on the market. The remaining 96% of the teeth that are treated each year are currently performed with resinous-based materials, which are adhesively bonded to the dental substrate and allow excellent aesthetic integration and a preservation of residual sound tissue. These materials, unlike amalgam, have a color that is similar to that of the natural teeth and, if placed following the appropriate protocols, guarantee a duration over time comparable to that of the well-established longevity of amalgam and gold. Moreover, the resin-based materials composed of organic resins, silicon crystals, quartz and other fillers, have the enormous advantage of being reparable over time, thus increasing their permanence in the mouth. 

Although amalgam has had, in the past, wide employment in the dental field, the scientific community is working to raise awareness among dentists, and especially patients, on the importance of preserving the residual sound dental tissue and therefore, of a more modern and conservative approach to the treatment of teeth that have undergone tissue loss due to pathological or traumatic causes.

The concept of minimally invasive dentistry does not mean that all amalgam fillings need an immediate replacement with an adhesive resin-based filling, but it lays the foundation for a more up to date dentistry, closer to the concept of respect and preservation of the natural tooth. Safeguarding teeth through less invasive procedures is of extreme importance, especially if it is considered that the data of the survey conducted by Datanalysis on 1000 adults representative of the Italian population confirms that the patients do care a lot about their smile and teeth.