Money and ethics

Some dental insurance companies don't cover the more expensive alternatives to amalgam. And because science doesn't definitively link the silver fillings to health problems, the ADA considers it unethical for dentists to tell patients that removing amalgams can improve health. "Amalgam has the longest history, the most data and the largest number of studies supporting it. Yet time after time, we have to come back and address it," said Dr. Fred Eichmiller, director of the ADA Foundation's Paffenbarger Resource Center, where alternatives to amalgams have been invented.

Critics argue that the issue also is environmental. Mercury is emitted into the air when bodies with mercury fillings are cremated. It gets into the water when fillings are removed and leftover material is not disposed of properly. "Amalgams don't need to be used in the 21st Century," said Downers Grove dentist Janet Stopka, who uses composite, porcelain and gold. For consumers, the decision whether to replace amalgams can be a difficult one.

Urine, hair and feces can all be tested for mercury levels and chelating agents can pull mercury out of the organs. But the results don't necessarily tell whether there is enough mercury present to pose a health risk and an official diagnosis of "mercury poisoning" can be tentative. Swapping out old fillings can be expensive; each replacement can cost $75 to $200. And there are no guaranteed benefits. Nevertheless, Dawn Quast, a dental hygienist for Dr. John Rothchild in Hoffman Estates, decided to have four small fillings replaced after she witnessed both small and profound improvements in Rothchild's patients who had amalgams replaced.

"I had a migraine the night I had the last silver one removed and haven't had one since [in 12 years]," Quast said. Rothchild, a mercury-free dentist, said he doesn't push people into having silver fillings removed.

By Julie Deardorff