Dentistry; dental treatment

As fas as I know, white fillings are available if they're on your front teeth or if you have a proven sensitivity to one of the metals used in silver amalgam. I imagine that's quite rare.

My dentist told me white fillings don't last long if you have to chew on them, so using them on a back tooth would result in more frequent replacement that damages the tooth a bit more every time. Different types of white filling might be available from private dentists—I don't know, I've never been able to afford it!

I can't think of any reason an amalgam filling would precipitate a relapse anyway. Dental treatment itself once made me relapse for a while, but it was the stress of being drilled for over an hour and the discomfort from a less-than-ideal anaesthetic (the more effective one makes me pass out). It was a wisdom tooth buried so deep they had to remove it at the hospital, no fillings were involved.
 
I do not know of any reason to think any sort of fillings would affect ME or Long Covid.
I agree that porcelain type white fillings are likely to be brittle at the back.

I don't think a GP would be in a position to recommend anything specific in the context of ME or Long Covid. It would probably be unfair to expect them to.
 
Thanks to everyone.

I have ME and considered removal of my mercury fillings but decided against due to risk of relapse. As a layperson I can't consider it in any way common sense to put Mercury deliberately into the mouth due to it being toxic.

A few countries have now banned mercury fillings, they must have a decent alternative? There must be some science there supporting this ban? I think neurological conditions are part of the high risk group for the UK to gain an exemption, so maybe Long Covid maybe included in that as a reason for refusing the Mercury?
 
Tara Green said:
As a layperson I can't consider it in any way common sense to put Mercury deliberately into the mouth due to it being toxic.
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Almost anything is toxic at a certain level. As far as I can see from the literature there is no evidence of a significant risk of reaching that level for mercury from fillings.

There do not appear to be perfect alternatives. The white fillings contain resin and fillers which I take to be porcelain or something similar. They are more fragile. The resin may be even more toxic than the mercury as far a I can see.

Where there is a ban it may simply be on the grounds of pollution affecting other people - I the past I think mostly from dentists waste pipes carrying away unused mercury. There is mercury around in fish so we all get some of it.

I have to say that if as a doctor I was asked to write an exemption I would be fairly irritated unless there was some better evidence.
 
Tara Green said:
If Mercury was safe, it could be used on pregnant women and children, surely?
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It's not about safety, as Jonathan says. It came in as the result of the EU regulation on the reduction of mercury use for environmental reasons. The British Dental Association says they don't know the reason for the restriction in children:

The issue of pregnant women (and by extension, breastfeeding women), is best explained by the general approach that all dental interventions regardless of materials used should be kept to a minimum during pregnancy; it is not a reflection on any specific safety concerns about amalgam.

The restriction on use in children under 15 is not based on any robust evidence. We can only assume that permanent teeth in young children might be deemed to have smaller cavities, which are best treated with alternative materials in accordance with a minimally invasive approach, but an explanation for this point has not been given.
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Even the MEA dentist makes it clear that his preference for other types of filling isn't based on evidence, or linked to ME. He uses them on almost everyone due to personal preference, and he doesn't give a reason for that.

I guess all I could advise as a very long-term ME patient is to focus on the things you know are risky for pwME and Long Covid, because they make life quite hard enough without adding things that are unlikely to be. If someone needed large fillings, it's even arguable that amalgam is less risky, because dental treatment itself is a big PEM trigger and amalgam is less likely to get abraded and need replacement.

Anyway, I hope your husband manages to get his teeth sorted, whatever he decides.
 
When I needed a molar filled, I was offered a (white) porcelain option. The porcelain option is the most durable, lasting 20 years or more, fine for molars, and said to be non-toxic. Amalgam fillings are estimated to last 10-15 years. The white composite resin fillings are said to last only 5 years, and aren't suitable for high impact fillings. I think they should really only be used for the side of teeth - non-impact surfaces.

We have to pay for all dental treatment here. Durability is important to consider when working out what option is best - having a filling break is a nuisance and expensive to fix, and each time you do that, you lose a bit more natural tooth. I know it might cost more upfront to get porcelain fillings and it takes a couple of visits to install them, but there are some good reasons to go for them in high impact positions, and they could be cheaper in the long run.

Perhaps there are some grants for people who are unable to work, or a scheme where you can pay the cost off slowly?

(I haven't read the MEA materials, so sorry if I've repeated things.)
 
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It says in this article that the WHO states there is no safe level of Mercury for the body. Wouldn't that be enough to cite to a GP when already ill especially? Also, I've seen a reference to a study, but can't find it that said there was 2-12 times the amount of Mercury in the skin of dead bodies who had mercury fillings than those without them. Isn't that significant?

Getting through the receptionist is proving irritating.

How mercury fillings wreck your health — Good Health Clinic
 
Tara Green said:
It says in this article that the WHO states there is no safe level of Mercury for the body. Wouldn't that be enough to cite to a GP when already ill especially? Also, I've seen a reference to a study, but can't find it that said there was 2-12 times the amount of Mercury in the skin of dead bodies who had mercury fillings than those without them. Isn't that significant?

Getting through the receptionist is proving irritating.

How mercury fillings wreck your health — Good Health Clinic
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No not significant. The WHO's 'no safe level' isn't a practical guide it's a 'worst case' statement where there's no possible way to estimate a minimum. Amalgam of course isn't pure mercury, but a very stable mixture of materials, so the two are not equivalent. UK dentists will follow the BDA guidance: https://bda.org/about-the-bda/campaigns/amalgam/Pages/minamata-convention.aspx

NHS dentistry is underfunded and dentist providing NHS contracted care will be cutting costs to the minimum - it's why most UK dentists only provide private treatment because they can't run a busines on NHS fees. If you have an NHS dentist then you are mostly going to have to accept what it is they are offering. Some dentists working under the NHS contract will mix and match private with NHS - so if amalgam fillings are genuinely a problem the dentist may agree to use resin if the patient pays for it, some may charge simply for the cost of the filling material, others may only do the work if the whole session is done privately, you have to ask.

As a matter of personal experience I have had problems with amalgam sensitivity - that is that the metal itself seemed to cause ongoing sensitivity of the tooth. The usual explaination of this is that the base of the cavity wasn't properly sealed before the amalgam was put in, I'm not sure this is absolutely the case, and in the past I've paid to have resin fillings on top of the NHS fees, uexcept where dentist has been certain that only amalgam will work where the cavity is large.

Resin fillings aren't problem free, I've found that they produce their own brand of discomfort - always feeling very tight in the tooth for many months after treatment. And they do have their own leaching problems.

This seems to be the research you refer to: Dental Amalgam and Mercury Levels in Autopsy Tissues full paper free on SciHub: https://sci-hub.se/10.1097/01.paf.0000201177.62921.c8
The authors are very cautious in their conclusions - their figures point to the fact that those who have more amalgam fillings have more mercury detectable in tissue after death than people who have fewer amalgam fillings, a not very surprising conclusion, they say nothing about toxity or what mercury in human tissue might actually mean beyond gross chronic exposure in mercury miners. The study is of only 18 cadavers and there's no exploration of confounding data where ill health was correlated - for example someone who has had 12 amalgam fillings is likely to be either much older, in poorer health, and/or has been much poorer than someone who has only 3 amalgam fillings.

My advice is that if you've got an NHS dentist and you can't afford private care - hang on to them, accept their advice and if you need something beyond the NHS offer see if you can negotiate to pay the extra if you can afford that. The availablity of NHS dentistry isn't going to improve any time soon and if you have access to a competent dentist offering NHS care that's a definite plus.
 
I thank you all for your considered replies. Always a lot to think about and all angles being discussed here.

I think the ME Association Dentist advisor should be pushing for ME patients to be made exempt from amalgam fillings so they have access to them via an NHS dentist. I am appalled by the thought of being forced to house mercury in the mouth when chronically ill due to lack of financial options. I won't even risk removing mine so it's a constant unwelcome burglar. I don't know if I would be one of those folk who would improve in health if I had my Mercury filling removed. My dental work and mercury filling coincided with my ME and virus.

I also found this https://pubmed.ncbi.nlm.nih.gov/25617876/ I would like more of these to cite.

I am checking with the dentist to see if I was quoted correct prices. £200 and £130 for the fillings. Under the NHS all the work is around £70.
 
Tara Green said:
I think the ME Association Dentist advisor should be pushing for ME patients to be made exempt from amalgam fillings
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I would be very against that.
The more that organisations like MEA put out unsubstantiated advice of that sort the more PWME will be branded as having false beliefs about themselves and their illness. The more the psychologists will have a field day convincing GPs PWME are all nuts. We are trying hard to minimise that.
 
Don't put Mercury in your mouth, Johnathon. For ME patients to be exempted from amalgam fillings, we need some back up from the charities that are supposed to represent our health and well being.

Would rather have the choice of white fillings than to be offered CBT.
 
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Tara Green said:
Right, I didn't know one of the authors is an anti-vax quack. What is wrong with the study exactly?
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I'm not inclined to put much effort in to reading stuff from authors I know to produce junk - I have though had a look. Firstly with one exception (Bjørklund - who is a journalist) all the authors have a close relationship with the Geiers (father and son) so there is no independent scientific authority involved. Secondly it's not a scientific paper as such it's a claim of evidence without any of the evidence being tested against a falsifiable hypothesis. It's the same trick the Geiers pull with thimersol and autism - throw out a lot of loose associations and claim there's a causal link without any actual evidence such a link exists, while ignoring the rest of the world shouting "Correlation does not imply causation" .

There vast amounts of this sort junk published every year, it's best to develop an allergy to it otherwise it ends up completely drowning out the good stuff. Once an author has embraced quackery it's very, very rare they ever turn back - and those few that do usually loudly repudiate their earlier errors.

There's lots of things to worry about but mercury in fillings is way down the list of things that might at some distant point and under very unusual circumstance impact an individual human's health.
 
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