World Health Organization “Future Use of Materials For Dental Restorations” 2011 pdf
The World Health Organization Dental Amalgam Review
The World Health Organization recommends a global phase out of dental mercury. In the WHO’s newly released 2009 report on “Future Use of Materials For Dental Restorations”. This is a great article by Charlie Brown from Consumers for Dental Choice. You can find a full view of the WHO Dental Materials report here.
10/2011
In a clear sign that dentistry’s amalgam era is fading, the World Health Organization (“WHO”) just released its long-awaited report on dental amalgam. In Future Use of Materials for Dental Restoration, WHO urges “a switch in use of dental materials” away from amalgam.
“[F]or many reasons,” WHO explains, “restorative materials alternative to dental amalgam are desirable.” The report describes three of these reasons in detail:
- WHO determines that amalgam releases a “significant amount of mercury”: WHO concludes that amalgam poses a serious environmental health problem because amalgam releases a “significant amount of mercury” into the environment, including the atmosphere, surface water, groundwater, and soil. WHO says “When released from dental amalgam use into the environment through these pathways, mercury is transported globally and deposited. Mercury releases may then enter the human food chain especially via fish consumption.”
- WHO determines that amalgam raises “general health concerns”: While the report acknowledges that a few dental trade groups still believe amalgam is safe for all, the WHO report reaches a very different conclusion: “Amalgam has been associated with general health concerns.” The report observes, “According to the Norwegian Dental Biomaterials Adverse Reaction Unit, the majority of cases of side-effects of dental filling materials are linked with dental amalgam.”
- WHO determines that “materials alternative to dental amalgam are available”: WHO concludes that “Materials alternative to dental amalgam are available” – and cites many studies indicating that they are superior to amalgam. For example, WHO says “recent data suggest that RBCs [resin-based composites] perform equally well” as amalgam. And compomers have a higher survival rate, says WHO, citing a study finding that 95% of compomers and 92% of amalgams survive after 4 years. Perhaps more important than the survival of the filling, WHO asserts that “Adhesive resin materials allow for less tooth destruction and, as a result, a longer survival of the tooth itself.”
We have come a long way. Less than a year ago, dental trade groups were circulating an unedited and unreviewed draft of this report to government officials, implying that it was WHO’s final position. But the draft was riddled with factual errors and scientifically unsupported claims. Consumers for Dental Choice – working with non-governmental organizations, scientists, and environmentalists from around the globe – organized a letter-writing campaign to insist that the draft be immediately withdrawn, accurately rewritten, and properly reviewed.
And it worked! Now WHO has removed all claims of amalgam’s safety. Now WHO has committed itself to “work for reduction of mercury and the development of a healthy environment.” Now “WHO will facilitate the work for a switch in use of dental materials.”
Thank you to everybody who urged WHO to take this important step to protect future generations from dental mercury.
The Dangers of Removing Old Mercury “Silver” Fillings.
When old mercury “silver” fillings are removed/replaced the dental drill causes the filling to emit high levels of hazardous mercury vapor. Dr. Taylor has advanced training in “Safer Mercury Removal” and accreditation from the IAOMT (International Academy of Oral Medicine and Toxicology). When Dr. Taylor removes old amalgam (mercury) fillings he uses the most current practices available for “Safer Mercury Removal” to reduce the amount of toxic mercury vapors and particles that you and our staff are exposed to. Please watch this video from the IAOMT which demonstrates they need for protective barriers and what those protective barriers are.
Dr. Scott Taylor Addresses FDA Director Dr. Shuren
On September 22, 2011 Dr. Scott Taylor addressed the FDA Director over Mercury use in Dentistry at a San Francisco FDA town hall meeting. Dr. Taylor spoke directly on the need for FDA accountability to the established dangers associated with dental amalgam (mercury) fillings.
Here is a report issued from Charlie Brown of Consumers for Dental Choice covering the FDA town hall meeting.
FDA Director Shuren Confronted at Town Hall Meeting, Says Amalgam Announcement Coming Back
FDA agrees to amalgam announcement this year.
The U.S. Food and Drug Administration’s Director of the Center for Devices has agreed that FDA will issue an “announcement” on amalgam by the end of this year.
Dr. Jeff Shuren, who signed the appalling 2009 amalgam rule, agreed to this timeline as he presided at an FDA town hall meeting in San Francisco on September 22. It was the third FDA town hall meeting this year – and for the third time, our movement showed up in force to confront Dr. Shuren about the dangers of mercury fillings. The first town hall meeting was in Texas, the second in Florida, and now the third in California – these states represent a quarter of the U.S. population!California grassroots director Anita Vazquez Tibau presented testimony on behalf of Consumers for Dental Choice. She highlighted amalgam’s devastating impact on the Latino community. “Many Spanish speakers told me that their dentists have never ever used the word ‘mercurio’ in a discussion,” Anita explained to Dr. Shuren. “Instead, it is deceptively called la amalgama plata – ‘silver fillings.’ I’d like to see you tell everyone that mercury is toxic, and please post it in Spanish as well.”
Then Anita reminded Dr. Shuren of his own famous boast: “We don’t use our people as guinea pigs in the U.S.” She held high a photograph of a Latino kindergartener whose mouth is filled – top and bottom – with mercury fillings. “FDA admits that amalgam can cause neurological harm in young children. Their developing neurological systems are ‘more sensitive to the neurotoxic effects of mercury vapor’ says FDA. And FDA admits there is no evidence that amalgam is safe in children under age six: ‘No clinical information is available’ says FDA.” So stop treating Latino children like guinea pigs, Anita concluded.
Dr. Shuren responded. “What I can tell you is we intend to come out with an announcement by the end of the year.”
The clock is running: FDA has 97 days left to act.
I congratulate all the Californian consumers and dentists who confronted Dr. Shuren at the San Francisco town hall meeting – and everyone who has spoken up for mercury-free dentistry in their community. It was the grassroots movement rising up all across America that put amalgam at the top of FDA’s “to do” list. Thank you.
So what will FDA do? Will FDA act as its own scientists recommended: (1) end amalgam use in children, pregnant women, and hypersensitive adults and (2) make sure that every parent knows amalgam is mercury, not silver? Or is FDA simply going to “announce” that it will do something at a later date?
As many of you have been doing since 2009, I urge that you write Director Shuren at jeff.shuren@fda.hhs.gov:
First, thank Dr. Shuren for agreeing to act on amalgam this year.
Second, ask Dr. Shuren to take real action this year – don’t just announce that FDA might act sometime in the future. As Anita explained, our children are being subjected to mercury fillings now – they cannot wait another year.
Third, tell Dr. Shuren to take the advice of the FDA scientists he convened in December 2010. Stop amalgam use in children, pregnant women, and hypersensitive adults immediately. And warn every consumer that amalgam is mercury – a neurotoxin.
Charlie
27 September 2011Charles G. Brown
National Counsel, Consumers for Dental Choice
President, World Alliance for Mercury-Free Dentistry
Mercury Fillings Are Alive and Strong Among Young Dentists
US Dentists’ Amalgam Use Surprises Researchers
June 17, 2011 — Despite improvements in resin-based composite technology, US dentists are placing more amalgam restorations than composites, and amalgam is still emphasized by US dental schools, according to the results of 2 studies published in the June issue of the Journal of the American Dental Association.
“I thought that most people were using composite,” researcher Sonia K. Makhija, DDS, MPH, an assistant professor of dentistry at the University of Alabama at Birmingham, told Medscape Medical News. “It was surprising that so many people are using amalgam.”
Dr. Makhija and colleagues in the Dental Practice-Based Research Network, a collaboration of practicing dentists who participate in research, analyzed reports from 182 US dentists on 5599 restorations of carious lesions in posterior teeth.
Overall, the dentists used amalgam for 3028 of these restorations, and composite in 2571 others. (The researchers collected no data on the 930 restorations these dentists made out of gold, glass ionomer, or anything else other than composite and amalgam.)
Although the dentists were not a statistical sample, previous studies have suggested that they are generally representative of what dentists are doing in the United States, Dr. Makhija said.
In the second study, researchers from universities in England, Wales, and Ireland and from the Georgia Health Sciences University in Augusta, surveyed 67 dental schools in the United States and Canada about how they teach students to restore posterior teeth.
At the 49 schools that responded, almost half the restorations placed in 2009 and 2010 were resin-based composites. Although this was a 30% increase from a similar survey done 5 years earlier, the study authors wrote that US and Canadian schools “lag” schools in Britain and Ireland, where composite gets more attention.
Not only is composite prettier, it is less invasive because it does not require as much cavity preparation, and in recent studies it has proved at least as durable, the authors write. “These tooth-friendly features of resin-based composites make them preferable to amalgam, which has provided an invaluable service but which, we believe, now should be considered outdated for use in operative dentistry.”
They called for new national guidelines that would emphasize the superiority of composite.
However, Dr. Makhija said such guidelines are premature. “I think we don’t have enough data yet,” she said. “You can find longevity studies on both that are good.” The Dental Practice-Based Network is following up on the 5599 restorations participants placed to see how they fare in coming years.
Glass Ionomer: Pros vs Cons
Offering another perspective, Douglas A. Young, DDS, EdD, MBA, associate professor of dental practice at the University of the Pacific, San Francisco, California, told Medscape Medical News that composite itself is becoming outmoded by glass ionomer. “The selection of the restorative material should be based on its ability to fight disease,” he said.
Glass ionomer binds better to teeth because of the ionic substitution that takes place between the fluoride in the glass ionomer and the calcium phosphate in the tooth, he said. In his experience, it is just as durable as composite resin, and the fluoride that it releases helps teeth remineralize, he said. “I like to use it on dentin and cementum, especially in sealants and small restorations.”
Dr. Young also argued in favor of using glass ionomer in combination with composite in the “open sandwich” technique, which he said helps lesions remineralize underneath restorations. The authors of the study on dental schools specifically rejected this approach, arguing that dentin regenerates better with phosphoric acid rinse.
So what are dental schools teaching? In the survey, 44 of the 49 schools said they taught the total etch technique for cavities in the outer third of the dentin, whereas the other 5 taught the glass ionomer cement approach only.
For cavities in the middle third of the dentin, 24 schools taught the total etch approach, and 24 the glass ionomer approach, whereas 1 taught calcium hydroxide and glass ionomer. For those restorations in the inner third of the dentin, 6 schools taught total etch and 30 glass ionomer, with 24 schools teaching calcium hydroxide and glass ionomer.
However, dental schools teachings are only one factor in what dentists practice, Dr. Makhija found. Surprisingly, older dentists were more likely to place composite restorations, even though they were more likely to have attended dental school when this approach was less emphasized (P = .02)
Dentists who graduated in the past 5 years placed amalgam on 61% of the lesions they treated. One explanation may be that younger dentists are more likely to be in large group practices where they work on salary, rather than fee-for-service, said Dr. Makhija. The type of material might be dictated by managers of the group practice. In large group practices (4 dentists or more), 79% of the restorations were amalgam (P < .001). “It’s quicker, it’s easier and it’s cheaper to use amalgam,” Dr. Makhija said.
Dr. Makhija, Dr. Young, and the authors of the dental school survey have disclosed no relevant financial relationships.
J Am Dent Assoc. 2011;142;612-620. Abstract
J Am Dent Assoc. 2011;142;622-632. Full text
Medscape Medical News © 2011 WebMD, LLC
The U.S. Calls for the Phase-Out of Amalgam Ultimately
The U.S. Calls for the Phase-Out of Amalgam Ultimately.
In an extraordinary developments that will change the global debate about amalgam, the United States government has announced that it supports a “phase down, with the goal for eventual phase out by all Parties, of mercury amalgam.” This statement- a radical reversal of its former position that “any change toward the use of dental amalga is likely to result in poitive public health outcomes” — is part of the U.S. government’s submission for the upcoming third round of negotiations for the world mercury treaty.*
While couched in diplomatic hedging — remember it is still early in the negotiations — this new U.S. position makes three significant breakthroughs for the mercury-free dentistry movement:
The U.S. calls for the phase-out of amalgam ultimately and recommends actions to “phase down” its use immediately. Incredibly, the government adopted three actions that the World Alliance for Mercury-Free Dentistry and Consumers for Dental Choice proposed at the negotiating session in Chiba, Japan. Our key ally, The Mercury Policy Project, laid the groundwork for this success at a World Health Organization meeting in 2009!
The U.S. speaks up for protecting children and fetuses from amalgam, recommending that the nations “educate patients and parents in order to protect children and fetuses.”
The U.S. stands up for the human fight of every patient and parent to make educated decisions about amalgam.
What does this mean? Our position — advocating the phase-out of amalgam — is now the mainstream because the U.S. government supports it. Who is the outlier now? It’s the pro-mercury faction, represented by the World Dental Federation and the American Dental Association. With the U.S. continuing its leadership role in this treaty, we will broadcast the U.S. position to other governments around the world, encouraging them to support amalgam “phase downs” leading to phase-outs not only globally, but within each of their countries.
We applaud the U.S. government. But tough work lies ahead. For example, we must demonstrate to the world that the available alternatives — such as composites and the adhesive materials used in atraumatic restorative treatment (“ART”) — can cost less than amalgam and will increase access to dental care particularly in developing countries.
For now though, let’s mark this watershed in the mercury-free dentistry movement: the debate has shifted from “whether to end amalgam” to “how to end amalgam.”
Charles G. Brown
National Counsel, Consumers for Dental Choice
President, World Alliance for Mercury-Free Dentistry
