Dentists have been thrust into the role of having to defend amalgam when their silence on the issue could have had them replacing billions—yes, billions—of amalgam restorations with the more expensive resin-based composites.
Amalgam, dentistry’s mainstay restorative material, is under fire—again, for the umpteenth time. Controversies fueled by those who question the safety and efficacy of amalgam date to amalgam’s introduction in 1833 as the Royal Mineral Succedaneum.
You remember that story. A silver/mercury paste was promoted cleverly by two French dentists who more often than not placed the filling material over carious areas without removing the decay. It didn’t take long for patients to develop painful conditions. In light of these unacceptable outcomes, many dentists sought to ban amalgam outright.
The furor between amalgam supporters and detractors, known as the "Amalgam Wars," threatened the existence of the entire profession. Fortunately, for those hundreds of millions worldwide who have enjoyed the benefits of this superb restorative material, "silver" amalgam still remains the dominant restorative material in dentistry.
It’s the mercury in amalgam that has its detractors dancing around like the Mad Hatter from "Alice in Wonderland." Attributing almost every conceivable health woe to a person’s dental fillings, amalgam opponents state that these restorations release sufficient mercury to cause multiple sclerosis, or MS; Parkinson’s disease; Alzheimer’s disease; and a host of other conditions.
Regardless of repeated scientific evidence of amalgam’s safety—plus the endorsement of all the major national and international public health organizations—amalgam’s critics remain vocal and active, often using misinterpretation of facts to promote their cause.
The insidiousness of the antiamalgamist approach was evident in what I call the "throw-away-the-crutches" speech delivered in a 1990 "60 Minutes" broadcast on CBS-TV. The presentation featured a woman with MS who declared that she was able to go dancing immediately after her amalgam restorations were removed, giving new, false hope to many MS sufferers.
No TV host tried to explain why her relief was so instantaneous, especially considering that the vapors from amalgam are at their highest during removal. No one described MS as a disease that often is characterized by spontaneous remission. Nor, a few months later, did "60 Minutes" air the fact that the woman in the earlier broadcast was back to using crutches.
How many others suffered a similar fate of false hope, brought by those who choose to ignore the absence of any science linking MS and mercury in dental fillings?
Instances such as this led the ADA to include in its "Principles of Ethics and Code of Professional Conduct" the statement: "... removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation of the dentist, is improper and unethical."1
Apparently failing to develop sufficient "science" of their own to refute safety claims by the U.S. Public Health Service and the ADA, the antiamalgamists are turning to the legal community to assist them in their quest.
A suit filed in May by five dentists and seven patients in a Maryland federal court alleges that dental regulators use "control of dental licenses to punish or threaten punishment of dentists who criticize ‘mercury’ amalgam."2 The desire of the antiamalgam activists apparently is to demonstrate First Amendment interference with the ability of dentists to share with their patients the "hazards" of dental amalgam.
A related legal initiative was filed recently against the ADA and the California Dental Association, claiming that the organizations weren’t telling all about what’s in amalgam. Adding to the turmoil is a ruckus between California state officials and the California Dental Board over a fact sheet the board is supposed to produce regarding various restorative materials, including the mercury in amalgam.
With all of this brouhaha, one would think that dentists are reaping huge financial rewards from amalgam use. In actuality, the opposite is true. Dentists have been thrust into the role of having to defend amalgam when their silence on the issue could have had them replacing billions—yes, billions—of amalgam restorations with the more expensive resin-based composites.
It’s the fluoride story all over again. Dentists continually have been called on to defend the science behind one of public health’s most crowning achievements. Had dentistry simply acquiesced to the antifluoridationists’ claims, the result would have been a drill-and-fill bonanza of immeasurable proportions.
There still is no sound scientific evidence supporting links between amalgam fillings and systemic diseases or chronic illness.
But the profession has stood fast in both situations, believing that the science behind the restorative material and the preventive value of fluoride support their continued use. The winner, so far, has been the American public, which—as pointed out in the U.S. surgeon general’s report on oral health earlier this year—enjoys unprecedented oral health. The report also indicated the importance of oral health to general health, emphasizing that there still was room for improvement in the health needs of certain pockets of Americans who have difficulty gaining access to dental care.
Removing amalgam as a restorative material will make that goal far more difficult to achieve. Considering that many public dental programs suffer from underfunding, using a more costly dental restorative material to replace the durable and low-cost amalgam could result in less care for fewer people.
For example, substituting composite resins for amalgam at 1999 fee index levels would increase the cost of a two-surface restoration by 35 percent. With the present difficulty in boosting present funding levels of public programs to even approximate private-practice levels, imagine the impact of a 35 percent increase just to supply the same amount of service.
Worldwide, removing amalgam as a restorative material would be devastating. Many fledgling dental public health programs presently offering amalgam restorations as an alternative to extraction would collapse under the burden of higher material costs and lack of clinical expertise in placing resin-based composites.
Antiamalgamists, take note. Regardless of what you may think, there still is no sound scientific evidence supporting links between amalgam fillings and systemic diseases or chronic illness. However, if ongoing scientific inquiry ever were to indicate that amalgam is detrimental to the health and welfare of the public, I can assure you that dentistry would need no outside organization, group or individual to remind it of its obligation to do no harm.
