I was reading a recently published report entitled “Economic Impact of Regulating the Use of Amalgam Restorations”. The study looked at the effects a ban on the use of dental amalgam (mercury/metal fillings) would have on our society.
Dental caries (decay) is still a widely prevalent oral disease in all ages of the population. Amalgam has been used for more than 150 years for filling back teeth and is composed of a mixture of silver, other metals, and mercury (50% by weight). As of now, the other options for filling teeth include composite resin, porcelain materials, and gold.
One of the concerns with the use of dental amalgam is that increased mercury levels for extended periods of time are associated with neurological, renal, and immunological impairments. It is known that amalgam restorations release mercury vapor during chewing, and that people with amalgam restorations have slightly elevated urine mercury levels. Another concern is the environmental impact that mercury has when it is disposed of from either excess filling material or removal of the material from teeth.
Although amalgam use is declining in the U.S., it is still widely used. Several countries, including Germany and Norway have limited the use of amalgam to adults and non-pregnant women. Denmark and Sweden have completely banned its use.
The debate in this study is the economic impact restricting the use of dental amalgam would have on our society. Materials other than amalgam are typically more expensive, and some of them do not have the same expected life-span of amalgam, which means they may need to be replaced more frequently.
Basically, the results of the study are as follows. Based on several studies, there is no evidence that the use of dental amalgam leads to any adverse neurological impairments. Likewise, according the report, the disposal of mercury from amalgam fillings is not a significant source of environmental mercury. Predictably, based on the increased costs associated with using other materials, lower-income segments of the population would be most affected by a limitation or ban on amalgam use. This in turn would lead to a higher prevalence of untreated dental disease.
If the studies show the stuff is reasonably safe and a ban would have a disastrous effect on a large segment of the population, it should not be banned. I don’t think the government has the right to limit one’s choice of what they fill their teeth with. Look at cigarettes for crying out loud. If the government wants to ban something ban those. We know those are unsafe. Actually, I do not think they should be banned, although I do agree with the limitation of use to decrease exposure to the rest of the population. If someone wants to smoke, knowing the risks, it should be their right.
Back to amalgam. I do not think there should be a ban on the use of amalgam, but I do think it is the right of the dentist to decide whether they offer it or not. It is also the right of the patient to decide who their dentist is and what is put in their mouth.
One more thing to think about….. if studies show that amalgam is perfectly 100% safe, why have the European countries I mentioned limited or banned its use?