Dental amalgam controversy
[6] Consumer Reports has suggested that many who claim dental amalgam is not safe are "prospecting for disease" and using pseudoscience to scare patients into more lucrative treatment options.
[9] The WHO also points out that amalgam separators, installed in the waste water lines of many dental offices, dramatically decrease the release of mercury into the public sewer system.
This was further perfected in 1826, when Auguste Taveau of Paris used a silver paste made from mixing French silver-tin coins with mercury, which offered more plasticity and a quicker setting time.
The inevitable result of this affair was that silver amalgam was proven to be "an excellent filling material", and expanded dentistry's "ability to save teeth".
Another alleged case of "pytalism" causing headache, fever, rapid pulse, metallic taste, loss of appetite, and generalized malaise was reported in 1872 in a female patient following the insertion of eight amalgam fillings.
[45] The condition was originally proposed in 1878,[50] and became well known in Sweden during the 1970s and 80s, because of a campaign to educate about and replace oral amalgam fillings with mercury with other compounds such as ceramic or polymer restorations.
Germany, Austria, and Canada recommended against placing amalgam in certain individuals such as pregnant women, children, those with renal dysfunction, and those with an allergy to metals.
[51] Mutter in Germany, however, concludes, "removal of dental amalgam leads to permanent improvement of various chronic complaints in a relevant number of patients in various trials.
"[55] Huggins's license was subsequently revoked by the Colorado State Board of Dental Examiners for gross negligence and the use of unnecessary and unproven procedures.
Their research review found that most of the mercury vapor released from amalgam fillings is mixed with saliva and swallowed, some part is exhaled, and the remaining fraction is inhaled.
[14][68][69] A 2004 systematic review conducted by the Life Sciences Research Office, whose clients include the FDA and NIH, concluded, "the current data are insufficient to support an association between mercury release from dental amalgam and the various complaints that have been attributed to this restoration material.
"[51] A systematic review in 2009 demonstrated that mercury released from amalgam restorations does not give rise to toxic effects on the nervous system of children.
It is mentioned that evidence to date fails to account for all confounding variables (such as alcohol consumption) and recommends more comprehensive and rigorous studies to adequately assess the hazards faced by dental personnel.
[34] These societies also claim that removal of amalgam fillings, in addition to being unnecessary health care and likely to cause more mercury exposure than leaving them in place, is also expensive.
[34] Dentists who advocate removal of amalgam fillings often recommend wearing breathing apparatus, using high-volume aspiration, and performing the procedure as quickly as possible.
These alternative dental restorative materials are not free of potential health risks, such as allergenicity, inhalation of resin dust, cytotoxicity, and retinal damage from blue curing light.
[34] They also mention that the chelating drugs may have significant side effects, including dehydration, hypocalcemia, kidney injury, liver enzyme elevations, hypotension, allergic reactions, and mineral deficiencies.
[88] The broad lack of knowledge that existed among the public was also displayed when a December 1990 episode of the CBS news program 60 Minutes covered mercury in amalgam.
The following month Consumer Reports published an article criticizing the content of the broadcast, stating that it contained a great deal of false information and that the ADA spokesperson on the program was ill-prepared to defend the claims.
[7] For example, 60 Minutes reported that Germany was planning to pass legislation within the year to ban amalgam, but the institute of German Dentists said one month later that there was no such law pending.
On 18 February 2003, the New York Supreme Court dismissed the two amalgam-related lawsuits against organized dentistry, stating the plaintiffs had "failed to show a 'cognizable cause of action'".
Proposals to remedy the situation have ranged from removing amalgam-containing teeth prior to cremation to installing activated carbon adsorption or other post-combustion mercury capture technology in the flue gas stream.
[111] In 2009, the FDA issued a final rule which classified dental amalgam as a "Class II" (moderate risk) device, placing it in the same category as composite resins and gold fillings.
On 28 July 2009, the U.S. Food and Drug Administration (FDA) recategorized amalgam as a class II medical device, which critics claim indicates a change in their perception of safety.
This warning also applied to resin fillings for a time, since they contain bisphenol A (BPA) a chemical known to cause reproductive toxicity at high doses.
The CDA has established its position based on the current consensus of scientific and clinical experts and on recent extensive reviews of strong evidence by major North American and international organizations, which have satisfactorily countered any safety concerns.
[133] The Norwegian Dental Patients Association (Forbundet Tenner og Helse), made up of people who believe they suffered health effects from amalgam fillings, was a driving force in this debate.
[133] In 1991, organized through the ministry of the environment, Norway began phasing out the use of most mercury-containing products (not limited to amalgam fillings but also including mercury-based batteries, thermometers, sphygmomanometers, consumer electronics, vehicle components, etc.).
[134] The Norwegian officials stressed that this is not a decision based on using an unsafe health product, but rather that the "overall, long term goal is to eliminate the use and release of mercury to the environment".
[139] The British Dental Association has worked with the Council of European Dentists to prevent an immediate ban of amalgam until further research into practicalities has been undertaken,[140] which is currently ongoing.
