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Why Dental Amalgam Should Not be Phased Out in the Philippines

Why Dental Amalgam Should Not be Phased Out in the Philippines

Dental amalgam or silver fillings have been used by the
> dental profession for more than a century now. The question
> whether it is a health risk has been regularly researched on
> and scrutinized by experts and reputable organizations. Here
> is a listing of all these reputable organizations and their
> conclusions
> 1. Dept of Health and Human Services (USPHS) and FDA, 1993
> "…current scientific evidence does not show that exposure
> to mercury from amalgam restorations poses a serious health
> risk in humans, except for an exceedingly small number of
> allergic reactions. "
> 2. Dept of Health and Human Services (USPHS) and FDA, 1997
> "In 1997, with input from a broad cross-section of
> scientists and dental professionals within USPHS, the FDA
> completed a review of nearly 60 studies that were published
> in peer reviewed scientific literature and were cited by
> citizen groups that petitioned the agency for stringent
> regulatory actions against dental amalgam. The analysis of
> the cited studies indicated that the current body of data
> does not support claims that individuals with dental amalgam
> restorations will experience adverse effects, including
> neurologic, renal or developmental effects, except for rare
> allergic or hypersensitivity reactions."

> 3. Life Science Research Office (LSRO,) 2004. This NGO
> conducted a review of the literature published from 1996 to
> 2003. This was funded by the National Institutes of Dental
> and Craniofacial Research, NIH and the Center for Devices
> and Radiological Health, US FDA. They concluded that, “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….   Individuals with dental
> amalgam-attributed complaints had neither elevated urinary
> mercury nor increased prevalence of hypersensitivity to
> dental amalgam or mercury when compared with controls.” 

> 4. Agency for Toxic Substance and Disease Registry (ATSDR),
> 2005 
> "The practice of having all your dental amalgam fillings
> replaced with non-mercury filling materials just to remove
> the possibility of mercury exposure is not recommended by
> ATSDR. In fact, the removal of the mercury amalgam fillings
> would actually expose the patient to a greater amount of
> mercury for a while."

> 5. FDI (World Dental Federation) , October 2007 issued the
> following statements
>    a. dental amalgam releases very small
> amounts (nanograms) of mercury, some of which is absorbed by
> the body
>     b. the level of urinary mercury is positively
> correlated with the number of amalgam restorations, but can also be affected by sources other than amalgam.
>      c. there is no evidence to support an association between the presence of amalgam restorations and chronic degenerative diseases, kidney disease, autoimmune disease, cognitive function, adverse 
pregnancy outcomes or any non-specific symptoms
>      d. local hypersensitivity reactions
> can occur on the mucosa adjacent to amalgam
>      restorations, but are extremely
> rare and usually resolved on removal of the amalgam
>      e. further research into the
> possible adverse effects of dental amalgam is desirable
>      f. alternatives to amalgam may have adverse effects

> 6. WHO 2009 report on the ‘Future Use of Materials for
> Dental Restoration"
> "Existing alternative dental materials are not ideal due to
> limitation in durability, fracture resistance, and wear
> resistance... recognized the need for strengthening of
> research into the long-term performance, possible adverse
> effects, and viability of such materials". 

> 7. European Union Scientific Community on Emerging and Newly
> Identified Health Risks (SCENIHR), 2008. After looking at
> the researches done on the common filling materials,
> including dental amalgam, concluded that:
>    “All the materials are considered safe
> to use and they are all associated with very low rates of
> local adverse effects with no evidence of systemic
> disease.” The alternative materials such resin composites,
> glass ionomer cements, ceramics among others, are not
> without clinical limitations and toxicological hazards.”

> 8. National Center for Toxicological Research US Food and
> Drug Administration, July 2009
> "It is concluded that there is insufficient evidence to
> support an association between exposure to mercury from
> dental amalgams and adverse health effects in humans,
> including sensitive subpopulations" 

> 9. WHO Consensus on Dental Amalgam 2009
> Safety of Dental Amalgam
>     "While there has been a number of case
> studies and informal reports, no controlled studies have
> been published demonstrating systemic adverse effects from
> amalgam restorations. At present, there is NO scientific
> evidence showing that general symptoms are relieved by the
> removal of amalgam restorations"

> 10. American Dental Association,  Council on Scientific
> Affairs, July 2009
>    “The scientific evidence supports the
> position that amalgam is a valuable, viable and safe choice
> for dental patients.”

> 11. FDI (World Dental Federation), 2010
> "Amalgam is a safe and highly effective restorative
> material. To maintain and protect global public health, a
> phase down of amalgam will be only appropriate when an
> alternative and suitable restorative material is
> available."

> 12. United Nations Environment Programme (UNEP). Minamata
> Convention on Mercury, Geneva, 19 January 2013
> Delegates agreed to a phase-down of the use of dental
> fillings using mercury amalgam. 

> 13. International Association for Dental Research, 2013. As
> regards its participation in the UNEP Minamata Convention on
> Mercury, Geneva, 19 January 2013 "IADR participated and contributed to the negotiations,
> along with FDI World Dental Federation and the International
> Dental Manufacturers, and has advocated for a reduction in
> the use of dental amalgam (versus a ban) through increased
> attention to dental prevention and health promotion,
> increased research and development on alternatives, and best
> management techniques for amalgam waste."

> The University of the Philippines Manila, College of
> Dentistry is strongly opposed to the proposed ban on dental
> amalgam for the following reasons:

> a. All the reputable organizations listed above have
> concluded that there is no scientific evidence linking
> amalgam with any health condition 

> b. Banning dental amalgam in the Philippines will result in;

> ---an increase in the cost of dental treatment because the
> alternative, composite resin, is twice more expensive; 
> ---because of the high cost of the alternative, many people
> will instead have their teeth extracted. There will be more
> Filipinos that will become edentulous (toothless)

> c. There is no perfect filling material. All will have their
> indications, contraindications, advantages and
> disadvantages. Dental amalgam is economical, not
> technique-sensitive and is indicated for the restoration of
> moderate to large cavities which is commonly seen among
> majority of Filipinos. In contrast, posterior composites are
> two times more expensive, technique-sensitive and indicated
> for restoring small to medium- sized cavities in patients
> with good oral hygiene. We have to accept the sad reality
> that many of our kababayans have poor oral hygiene and do
> not even have a toothbrush. 
College of Dentistry
University of the Philippines Manila
Tel. No. 3033603