SPECIAL REPORT: Silver fillings and dental insurance

SALINAS, Calif. (KION) If you have ever had a cavity in your tooth, you probably went to your dentist to get it filled.

But for certain groups of people like children under six, getting the common, silver-colored amalgam could be riskier because of potential mercury exposure. While the FDA recommends these groups avoid silver fillings if possible, dentists say many insurances don’t cover the alternatives, forcing some to go with the silver anyways.

For George and Mimi Niesen, dental work has been a steady routine in their lives since the early years, especially for the Mrs.

“I was a very bad dog as a child and an adolescent. I ate all the wrong foods, and so I had lots of cavities and lots of silver fillings,” said Mimi Niesen, who is a Salinas resident.

Silver fillings were once a common sight in mouths. Now, only 50% of U.S. dentists still use the material to fill cavities in teeth. That drops to just 35 percent on the West Coast.

“It’s easy to put in. The material is cheap. It’s durable, it’s long-lasting. So it worked really, really good for pediatric patients, children, for places where it’s hard to put in a filling. The silver amalgam works pretty well,” said Dr. Eric Brown, the public relations director for the Monterey Bay Dental Society.

Silver fillings — formally known as dental amalgam — consist of a mixture of silver, copper, tin and zinc. There’s one more important addition that helps bind these metals together: mercury, which has been linked to things like mood disorders, sleep troubles, fatigue and tremors if there’s too much exposure in the body.

Dental amalgam is about 50% mercury by weight. Dentists, however, say once combined with other metals, it’ll form a safe, stable material.

Furthermore, multiple health agencies including the FDA, CDC and the World Health Organization also say based on years of studies and research, there hasn’t been a direct correlation between mercury from amalgam and possible harmful health effects so far.

While silver fillings are safe and effective for fixing cavities in the general population, they can release mercury vapor in small amounts.

The FDA warns inhaling those vapors can be harmful in certain patients who “may be more susceptible to the effects of exposure to mercury.” This includes pregnant women, nursing mothers, children especially younger than six and people with neurological impairments or kidney problems.

“The main reason for that is there haven’t been a lot of long-term studies that take those groups and research dental amalgam with them for those reasons because those are sensitive groups,” said Dr. Brown.

If you are one of these, the FDA recommends avoiding dental amalgam if “possible and appropriate” and go for alternatives like white composite resin or gold fillings.

But an issue many individuals and families in these groups face: many dental insurance companies don’t cover the alternatives for back molars because they’re more expensive and aren’t as durable as amalgam.

So sensitive patients end up having to pay out-of-pocket for them-- or end up choosing silver instead. It’s something the American and California Dental Associations have been trying to change for years, to no avail.  

A spokesperson for Delta Dental — the largest provider of dental coverage in the country — tells KION while they do cover composite fillings for back molars, it depends on the patient’s benefit plan.

“Insurance companies, especially dental insurance companies, for every dollar they don’t spend, it’s a dollar that they make," said Dr. Brown. "So they generally lag behind the standard of care. So most of them pay for the silver filling and then the patient has to pay the difference for the resin.”

Delta Dental defends their benefit plans, stating through email: “If an alternate procedure is used to calculate the benefit, the purpose of using a lower-cost alternate restorative procedure is to keep the cost of health care as low as possible."

For lower income families with children, out-of-pocket costs could add up.

The CDA emailed KION a statement saying: "With limitations posed by commercial benefit plans, patients may be influenced by cost as amalgam is generally less expensive than composite materials. While there are now many options for filling materials, amalgam’s long, safe history and comparatively lower cost continues to be a good option for many patients.”

“Well, the insurance coverage is not good. But I pay out-of-pocket because it’s a necessity,” said Niesen.

“Dental insurance companies should be paying for the composite resin because it is the most widely used material now,” said Dr. Brown.  

While things aren’t changing, for now, it’s best to talk to your dentist about your health history and see what the best options are for you.