Any dentists able to advise?

[intrepidgiraffe]

I'm 11 weeks pregnant and today the dentist has advised I need two fillings and an amalgam filling replaced.

During previous pregnancies I have been advised to minimise non urgent dental treatment during pregnancy and have therefore waited until after the birth.

I had a new dentist today. She seemed very blasé and said there is no reason to delay (she didn't say the treatment was urgent) and I should get this treatment now, she did add as an aside I could wait until the second trimester if I wanted.

This seems so different to what I've been advised before and a quick google suggests the department of health and oral health foundation both advise against replacing amalgam fillings whilst pregnant.

Getting new fillings seems less of a concern - I'd prefer a white filling for aesthetic reasons (again she was very dismissive of this) but also there seems some suggestion they might be safer in pregnancy? It would be good to know if there's any evidence for this as it's hard to justify the cost vs free treatment for amalgam.

I've booked in 3x amalgam fillings but I'm not really happy with proceeding, and if in fact she shouldn't advise replacing the amalgam filling, it's hard to trust the whole treatment plan.

Not a dentist but just anecdotal I was told by a dentist that they would not do amalgam fillings when pregnant and also when breastfeeding. Maybe search the NICE guidance on it too?

Thanks - I've heard that too although when I questioned my previous dentist when breastfeeding he was adamant that wasn't a thing - so I reluctantly did have an amalgam filling when breastfeeding (and regretted not paying for a white one).

If the dentist had talked me through pros and cons I probably wouldn't feel so nervous - but she reacted like being pregnant changed nothing which just doesn't mirror with what I've been told before.

The advice from NHS England is that amalgam should not be used in pregnant or breast feeding women unless there is a strong clinical need . The clinical need would normally be that they are large fillings that are difficult to keep dry etc.

There is no problem with getting dental treatment during pregnancy and indeed it is better to get it done to prevent stress from pain, infection etc.

I would query the fact that all three fillings are in amalgam . This is the guidance https://www.england.nhs.uk/south/wp-content/uploads/sites/6/2018/08/cdo-letter-amalgam-08228.pdf

As an aside I would look at your diet and what you eat and drink inbetween meals , as it seems you are needing a lot of fillings.

Thanks this is extremely helpful.

Can I call and request a call back from the dentist? Or should I email?

I don't want to wait until the appointment to query it if I can avoid it as I felt very rushed/ dismissed today and would prefer time to think things through.

I would email as it is extremely unlikely in a busy NHS practice that you will be able to get them on the phone, there just isn’t the time.

I would include the NHS England guidance and ask the justification for all three amalgams.

I would also ,though , look at what you are eating and drinking inbetween meals as every bite or sip of something sugary/starchy attacks your teeth for an hour afterwards. What you eat at meal times doesn’t matter , it’s what you graze/sip on . Not just sweets/biscuits/cake but yoghurt, fruit juice, granola bars, energy drinks, protein drinks, raisins , smoothies , flapjacks etc.

Ok thanks I will email.

And yes I will look at my diet - although I've been breastfeeding continuously since 2020 which I think also probably isn't ideal for my teeth.

Breast feeding makes no difference to your teeth. Calcium is not taken out of them , they are inert once they are formed . It will be your diet/grazing/snacking that’s the problem.

@Lollygaggle

Ok thanks.

If the dentist agrees not to do amalgam, do you know if they would cover white on the nhs? Or would it be pay for white or wait until I'm no longer pregnant?

Also are you aware of this from NHS website which says Department of Health recommends against amalgam removal during pregnancy? I presume even if they would replace with white this is because of risks of removing the current amalgam.

Is it more nuanced in practice? Ie are there risks to removing but also risks to leaving a filling which needs replacing in place?

https://www.nhs.uk/pregnancy/related-conditions/common-symptoms/bleeding-gums/

The only alternative to amalgam would be either to remove decay and put a temporary filling in or put a composite (white) filling in. NHS would include a composite filling.

The greatest exposure to mercury in amalgam is whilst filling is being removed, however if there is a lot of decay in the tooth , it is a large filling then leaving decay and the filling until baby is delivered has its risks of pain,infection , abcess so it is nuanced .

Whether the filling should be left until baby is delivered is a decision for the two of you, but if you are getting a lot of decay and quite quickly that may make leaving the filling unwise. That’s why amending your diet is so important now.

Ok thanks, appreciate the advice

It also has to be said with a high decay rate composite (white) fillings last a shorter time than amalgam .

Hi, I'm a dentist and the guidance is white composite fillings on pregnant women unless amalgam is clinically necessary. This isn't so much due to the harmful effects of amalgam but more due to reducing amalgam in environment. I however do not place amalgam fillings on pregnant ladies. You do get a miniscule amount of mercury vapour released on drilling and placing an amalgam filling. I need to stress though this is such a negligible amount and more harmful to the dentists who do it daily.
It's hard for me to comment on whether you're amalgam fillings are clinically necessary or urgent as I havent examined you but if you're not comfortable why not get a second opinion?

@Marmite1992 thanks so much for your reply. Can I ask your view on replacing an amalgam filling (even if with composite) during pregnancy?

Just an update in case anyone comes across this thread - I emailed with my concerns and the dentist has said she will do white composite fillings and leave the amalgam replacement until after the pregnancy unless it causes me any issues. Thanks for everyone's advice.

These days good quality white fillings are as long lasting as amalgum. On the continent they don’t even do amalgum any more.

Sorry but the research says otherwise in people with high decay rates and for large composites. https://www.researchgate.net/publication/257678476_A_Review_of_Amalgam_and_Composite_Longevity_of_Posterior_Restorations

The relevant passage is
On average, longevity of resin composite restorations in posterior teeth is two to three times lower than amalgam restorations. The resin composite is an appropriate material to restore small Class I and Class II lesions, with margins located in enamel, on patients with low caries risk and, when complete field isolation can be achieved. The use of amalgam is preferable to the use of composite in large and complex restorations, with margins located in dentine or cement, where isolation is deficient.

The reason in the EU that an amalgam ban is coming in is not because of problems with the material but because of environmental concerns with the manufacture of amalgam.