(Notes to the Writer: (1) We start with dentist Simone (of Northbrook, Ill.) because he was interviewed by Dr Mercola and his interview is featured that day. But if the story comes before the interview, maybe you should transition it a different way. (2) This is footnoted, to shorten your research time; you are welcome to include the footnotes back into the text. ---Charlie Brown, telephone 202.544.6333)
Dr. Dave Simone works with Consumers for Dental Choice to fight amalgam because he knows this 50% mercury filling material is devastating to our health. Dental amalgam emits mercury vapor even after it is implanted in the body and this mercury is bioaccumulative. Dental mercury endangers our health in many ways:
Amalgam endangers our neurological health
The mercury in amalgam is a neurotoxin – and pro-mercury dentists are implanting it an inch from the brain!
Vulnerable populations – such as children, the fetuses of pregnant women, hypersensitive individuals, and people with kidney impairments – are known to be particularly susceptible to the neurotoxic effects of dental mercury.
That is why the U.S. Food and Drug Administration’s advisory panel on dental amalgam in December 2010 warned against the use of amalgam in vulnerable populations and insisted that FDA had a duty to disclose amalgam’s risks to parents and consumers. As panelist Dr. Suresh Kotagal – a pediatric neurologist at the Mayo Clinic – summed it up, there is “no place for mercury in children.”
The FDA panelists are not alone. Other countries are already working to protect vulnerable populations, especially children, from exposure to amalgam. For example:
- The forty-seven nations of the Council of Europe just passed a resolution calling on the nations to start “restricting or prohibiting the use of amalgams as dental fillings,” explaining that “amalgams are the prime source of exposure to mercury for developed countries, also affecting embryos, foetuses (through the placenta) and children (through breastfeeding). Exposure to mercury can seriously affect the health of patients and dental professionals, and early exposure to low doses of mercury (during pregnancy and through breastfeeding) increases the risk of a decrease in the intelligence quotient (IQ) among children.… According to the World Health Organization in 2005, certain studies show that mercury may have no threshold below which some adverse effects do not occur.”
- Australia’s National Health & Medical Research Council (NHMRC) says amalgam should be avoided in pregnant women, nursing mothers, children, and people with kidney disease. As the government of the state of Queensland explains, “Amalgam is now generally avoided for filling children’s teeth. Growing children tend to be more sensitive to the effects of exposure to any chemical substance in their environment…High level exposure to mercury (which is present in silver fillings) may affect the kidneys. Therefore, the NHMRC, suggest people with kidney disease may be more concerned than others to minimise exposure to mercury.”
- Health Canada directed its dentists to stop using amalgam in children, pregnant women, and people with impaired kidney function – way back in 1996.
Amalgam endangers our reproductive health
It is known that the mercury from amalgam causes reproductive harm – dental mercury even crosses the placenta and accumulates in unborn babies.
Due to mercury exposure from amalgam in the workplace, dental workers – including dentists, dental hygienists, and dental assistants – are at particular risk for suffering reproductive harm. Studies have shown that dental workers have elevated systemic mercury levels. Many of these dental workers are women of child-bearing age, which makes them particularly susceptible to the occupational hazards associated with handling mercury.
Few dental workers employed by pro-mercury dentists are given protective garb or air masks to minimize their exposure to mercury. After all, they would look like astronauts with all that protective gear and that would scare off the patients (who have every right to be scared of mercury). Many dental workers are not even aware of the risks of occupational mercury exposure. As a result, dental workers have reported serious health problems – especially reproductive failures and birth defects caused by amalgam in the workplace.
Interestingly, both the American Dental Association and the amalgam sellers have admitted that amalgam endangers dental workers – and attempted to profit off of it!
- In a brochure on occupational health in dental offices, the American Dental Association (ADA) explains that “Exposure to mercury is a potential hazard for anyone in the dental profession who handles mercury or mercury-containing compounds….Office spaces may be contaminated with mercury from leaky amalgam capsules and from the lingering effects of spillage. High speed handpieces and ultrasonic compactors that vaporize mercury can lead to unsuspected inhalation.” The brochure goes on to list the symptoms of dental mercury exposure, including “[g]rowing irritability, mood swings, and appetite loss…insomnia…tremors or numbness in the fingers…” But “[w]aiting for these symptoms to appear is far too late.” According to the ADA brochure, the solution is for dentists to buy an annual subscription to the ADA Mercury Testing Service for $75.00 per employee.
- An advertisement from Henry Schein Inc., the leading amalgam seller, explains that amalgam’s “toxic vapor is quickly absorbed and accumulated within your body’s system, giving proven, long-term harmful side effects,” the flyer urges dentists to “protect yourself now from the harmful effects of mercury vapor” by purchasing new amalgam storage containers for $60.99 or $26.49.
Of course, the most effective – albeit perhaps less profitable – solution is to prevent dental workers from being exposed to this unnecessary source of mercury in the first place.
Amalgam endangers our environmental health
Even if you do not have amalgam in your mouth, your health is still at risk from amalgam.
Amalgam leaches into the environment via multiple pathways, polluting our water via dental clinic releases and human waste; our air via cremation, dental clinic emissions, sludge incineration, and respiration; and our land via landfills, burials, and fertilizer. Once in the environment, dental mercury converts to its even more toxic form, methylmercury, and becomes a major source of mercury in the fish people and other animals eat.
The environmental health effects of amalgam are well known, and have recently been reiterated by the United States Environmental Protection Agency: brain damage and neurological problems, especially for children and the unborn babies of pregnant women.
Amalgam endangers our oral health
On top of all the neurological, reproductive, and environmental harm caused by amalgam, it turns out that amalgam even endangers our oral health.
As a primitive filling material, amalgam can be detrimental to oral health. It is well known that placing amalgam requires the removal of a significant amount of healthy tooth matter. This removal, in turn, weakens overall tooth structure which increases the need for future dental work. On top of that, amalgam fillings, which expand and contract over time, crack teeth and create the need for still more dental work.
Superior modern alternatives preserve healthy tooth structure and actually strengthen teeth, leading to better oral health and less extensive dental work over the long-term. “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,” concluded a recent study of composite use.
The alternatives to amalgam
Far from being an essential mercury product with no viable alternatives, amalgam is interchangeable with numerous other filling materials – including resin composites and glass ionomers – that have rendered amalgam completely unnecessary for any clinical situation. In fact, the mercury-free alternatives are so advanced that entire nations, such as the Scandinavian countries, have stopped the use of amalgam. Already, about half of U.S. dentists are mercury-free and 77% of consumers who are told that amalgam contains mercury choose mercury-free alternatives.
One of the most popular alternatives to amalgam is resin composite. Resin composite is made of a type of plastic reinforced with powered glass. It is already common throughout the U.S. and the rest of the developed world, offering notable improvements over amalgam:
Composite is environmentally-safe: Composite, which contains no mercury, does not pollute the environment. This saves taxpayers from paying the costs of cleaning up dental mercury pollution in our water, air, and land – and the costs of health problems associated with mercury pollution.
Composite preserves healthy tooth structure: Composite preserves tooth structure because, unlike amalgam, it does not require the removal of significant amounts of healthy tooth matter. Over the long term, composite preserves healthy tooth structure and actually strengthens teeth, leading to better oral health and less extensive dental work over the long-term.
Composite is long-lasting: While some claim that amalgam fillings last longer than composite fillings, the science reveals this claim to be baseless. The latest studies show that composite not only lasts as long as amalgam, but actually has a higher overall survival rate.
A lesser known alternative is increasingly making mercury-free dentistry possible even in the rural areas of developing countries. Atraumatic restorative treatment (also called alternative restorative treatment or ART) is a mercury-free restorative technique that has ART has been demonstrated a success in a diverse array of countries around the world, including Tanzania, India, Brazil, Zimbabwe, Turkey, South Africa, Thailand, Canada. Panama, Ecuador, Syria, Hong Kong, Mexico, Sri Lanka, Chile, Nigeria, China, Uruguay, Peru, and the United States.
ART relies on adhesive materials for the filling (instead of amalgam) and uses only hand instruments to place the filling. ART is endorsed by the World Health Organization as “a perfect alternative treatment approach.” According to WHO, “The WHO Oral Health Programme (ORH) believes ART is one of the most suitable caries controlling approaches for use in primary oral health care programmes and therefore the continuation of the global promotion of ART is one of its major objectives.”
ART offers countless benefits to dental patients:
ART is environmentally-safe: Unlike amalgam, the glass ionomers used in ART do not contain mercury. Substituting ART restorations for amalgam protects the environment from this major source of mercury pollution.
ART is low-cost: While amalgam requires electricity and clinic equipment that makes the costs prohibitively expensive for many patients, ART uses only inexpensive materials and hand instruments that do not require electricity. As a result, ART restorations only cost half as much as amalgam restorations according to the Pan American Health Organization.
ART increases access to dental care: Amalgam is inaccessible to many disadvantaged people because it requires a dental clinic, a dentist, and a painful procedure. As a result, the World Health Organization has long recognized that “the majority of the world’s population still suffers from untreated dental decay. The main reason for this is the continued dependency on traditional approaches to oral health care,” such as the use of amalgam. ART increases access to dentistry by eliminating the barriers posed by amalgam:
- First, the hand instruments used to perform ART do not require electricity and they are portable. This easily allows ART to be performed in schools to treat schoolchildren, in patients’ homes to treat individuals with disabilities and senior citizens who might have difficulty obtaining transportation to a clinic, and in rural areas without electricity to treat children in developing countries.
- Second, the ART procedure is so simple to learn that ART can be performed by non-dentists as well as dentists, a valuable advantage in countries and regions that have a shortage of dentists.
- Third, ART is virtually painless and requires no anesthesia, which increases the likelihood that patients – especially children – will seek or cooperate with dental care in the first place.
ART is superior dental care: Not only does ART preserve the healthy tooth structure that must be drilled out and destroyed in order to place an amalgam restoration, but countless studies have shown that ART restorations have a longevity comparable – and even superior – to amalgam. For example, according to leading atraumatic restorative treatment researcher Dr. Prathip Phantumvanit of Thailand in an interview with Dental Tribune, “When we compared the results with amalgam, we found that ART restorations were more successful than amalgam up to eight years of follow-up…we believe that ART will be an alternative to amalgam restoration especially in the primary teeth, whose life span is less than ten years.”
Consumers for Dental Choice is fighting to protect our health
Consumers for Dental Choice is the leading U.S. consumer organization focused on protecting our health by eliminating dental mercury. Led by executive director Charlie Brown, Consumers for Dental Choice has tackled this health threat at every level:
- At the state and local level, Consumers for Dental Choice has made significant progress in getting out the word about amalgam’s health risks. Their efforts resulted in laws requiring dentists to distribute fact sheets warning patients that amalgam can cause neurological and reproductive harm in California, New Hampshire, Maine, and Philadelphia. Dental offices in California are required to post signs warning that “Dental Amalgam, used in many dental fillings, causes exposure to mercury, a chemical known to the state of California to cause birth defects or other reproductive harm.” Most recently, Consumers for Dental Choice won resolutions recognizing the health threat of dental mercury from the California cities of Costa Mesa and Santa Ana.
- At the national level, Consumers for Dental Choice has led the battle to convince the U.S. Food and Drug Administration to address the amalgam threat. First petitioning, then suing the Food and Drug Administration for failing to develop a rule to regulate amalgam, Consumers for Dental Choice’s lawsuit resulted in a federal judge ordering FDA to develop an amalgam rule and a federal magistrate overseeing a re-writing of FDA’s website. When FDA then refused to even order product labeling in its rule, Consumers for Dental Choice unleashed “unprecedented consumer-level pressure,” according to the trade press. “No final rule in FDA's modern history, or perhaps ever, has attracted this kind of organized opposition.” FDA is now reconsidering its amalgam rule and says it will address concerns about vulnerable populations – children, unborn babies of pregnant women, people with kidney impairments, and hypersensitive individuals.
- At the international level, Consumers for Dental Choice is ensuring that the world mercury treaty, which is currently being negotiated, addresses amalgam. Thanks to their efforts, the U.S. government now supports both the “eventual phase out” of amalgam and prompt “phase down” steps, including “educating patients and parents,” “protect[ing] children and fetuses,” and “training of dental professionals on the environmental impacts of mercury in dental amalgams.” With amalgam increasingly being dumped in developing countries, Consumers for Dental Choice continues to fight especially hard to protect these disadvantaged children from amalgam and to ensure their access to mercury-free alternatives like ART restorations.
Help Consumers for Dental Choice protect our health!
Consumers for Dental Choice is working to protect our health – and the health of our children – all around the world. Charged with this important mission at state and local, national, and international levels, Consumers for Dental Choice would appreciate your help!
Please consider a donation to Consumers for Dental Choice, a 501(c)(3) non-profit organization dedicated to advocating mercury-free dentistry.
Donations can be made online at http://www.toxicteeth.org/donate.cfm. Checks can be mailed to:
Consumers for Dental Choice
316 F St., N.E., Suite 210
Washington DC 20002
Thank you for supporting mercury-free dentistry!
- Parliamentary Assembly of the Council of Europe, Resolution 1816 (2011), available at http://assembly.coe.int/Mainf.asp?link=/Documents/AdoptedText/ta11/ERES1816.htm
- Social, Health and Family Affairs Committee of the Parliamentary Assembly of the Council of Europe, Report: Health Hazards of Heavy Metals and Other Metals (12 May 2011), available at http://assembly.coe.int/Main.asp?link=/Documents/WorkingDocs/Doc11/EDOC12613.htm
- National Health & Medical Research Council, Dental Amalgam – Filling You In (2002), http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/d18.pdf
- The State of Queensland (Australia), Consent Information – Patient Copy, Dental Fillings, http://www.health.qld.gov.au/consent/documents/dental_04.pdf
- Health Canada, The Safety of Dental Amalgam, http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/pubs/dent_amalgam-eng.php
- Marcelo Tomás de Oliveira et. al., Effects from Exposure to Dental Amalgam on Systemic Mercury Levels in Patients and Dental School Students, Photomedicine and Laser Surgery (October 2010, Vol. 28, No. S2: S-111-S-114), http://www.liebertonline.com/doi/abs/10.1089/pho.2009.2656
- See Mercury Policy Project, Neurotoxic Effects of Mercury in Dental Nurses (7 September 2006), http://mpp.cclearn.org/wp-content/uploads/2008/08/fdadentalmppnorwayfinal0907061.pdf
- Terry L. Meyers, When less is more -- Technology increases minimally invasive procedures, Dental Economics, http://www.dentaleconomics.com/index/display/article-display/6295266301/articles/dental-economics/volume-100/issue-5/columns/when-less_is_more.html (explaining that “with the resins and composites developed over the past 30 years, we don’t have to remove nearly as much tooth structure as we did when using amalgam. Before these new materials with their bonding capacity came along, in some cases dentists had to take out the whole back side of the tooth to get enough amalgam in there to work.”).
- Davis MW, Nesbitt WE. The wedge effect: structural design weakness of Class II amalgam. AACD J 1997;13(3):62-8, http://www.smilesofsantafe.com/pdfs/WedgeEffect.pdf.
- World Health Organization, ART-Atraumatic Restorative Treatment, http://toxicteeth.org/CAPP-ART.pdf.
- Christopher D. Lynch, Kevin B. Frazier, Robert J. McConnell, Igor R. Blum and Nairn H.F. Wilson, Minimally invasive management of dental caries: Contemporary teaching of posterior resin-based composite placement in U.S. and Canadian dental schools, J Am Denta Assoc 2011; 142; 612-620, http://jada.ada.org/content/142/6/612.abstract
- See Bio Intelligence Service/European Commission, Review of the Community Strategy Concerning Mercury (p.229), 4 October 2010, http://ec.europa.eu/environment/chemicals/mercury/pdf/review_mercury_strategy2010.pdf
- Zogby poll, http://www.toxicteeth.org/Zogby%20Poll--Results%202006.pdf .
- N.J.M. Opdam, E.M. Bronkhorst, B.A.C. Loomans, and M.-C.D.N.J.M. Huysmana, 12-Year Survival of Composite vs. Amalgam Restorations, Journal of Dental Research (October 2010), Vol. 89, 10: pp. 1063-1067.
- World Health Organization, ART-Atraumatic Restorative Treatment, http://toxicteeth.org/CAPP-ART.pdf.
- WHO, Atraumatic Restorative Treatment (ART) for Tooth Decay: A Global Initiative 1998-2000 (1998), http://whqlibdoc.who.int/hq/1998/WHO_NCD_ORH_ART_98.1.pdf.
- Pan American Health Organization, Oral Health of Low Income Children: Procedures for Atraumatic Restorative Treatment (PRAT) (2006), http://new.paho.org/hq/dmdocuments/2009/OH_top_PT_low06.pdf (“The costs of employing the PRAT [procedures for atraumatic restorative treatment] approach for dental caries treatment, including retreatment, are roughly half the cost of amalgam without retreatment.”).
- Pan American Health Organization, Oral Health of Low Income Children: Procedures for Atraumatic Restorative Treatment (PRAT) (2006), http://new.paho.org/hq/dmdocuments/2009/OH_top_PT_low06.pdf (The Pan American Health Organization concluded that its “study demonstrated a higher cost-effectiveness of auxiliary personnel in some countries than traditionally trained dentists.”)
- Olushola Ibiyemi, Olubunmi Olusola Bankole, and Gbemisola Aderemi Oke, Assessment of Atraumatic Restorative Treatment (ART) on the permanent dentition in a primary care setting in Nigeria, International Dental Journal (2011) (finding that 98% of patients “admitted that ART was not painful” and concluding that “One major deterrent to health seeking behavior especially for dental care is fear or perception of pain. This has been supported by the findings of this study in that the vast majority of the participants, even though they claimed they had never visited the dentist expressed immense fear and a wrong notion of what dental treatment experience should be. It is gratifying to note however that in spite of this initial bias, most of them admitted to having a pleasant experience [with ART] compared to this preconceived attitude. Furthermore, they would be willing to receive such treatment [ART] again and would encourage others to patronise the dentist for similar procedures. These observations were also reported in other previous studies conducted in environments with similar socio-demographic characteristics.”); Jo E. Frencken, Evolution of the ART approach: highlights and achievements, J Appl Oral Sci. 17 (sp issue): 78-83 (2009), http://www.globaloralhealth-nijmegen.nl/ProceedingsTandheelkundeBiWe.pdf (finding that“a high level of acceptance amongst those treated with ART and an unwillingness to be treated again amongst those in the traditional rotary hand piece group [using amalgam].”)
- van Amerongen WE, Rahimtoola S., Is ART really atraumatic?, Community Dent Oral Epidemiol. 1999 Dec; 27(6):431-5, http://www.ncbi.nlm.nih.gov/pubmed/10600077 (concluding that “preparations with hand instruments were smaller than those produced with rotary instruments.”)
- E.g., Frencken JE, Taifour D and van’t Hof MA. Survival of ART and amalgam restorations in permanent teeth after 6.3 years. J Dent Res, 85:622-626 (2006), http://jdr.sagepub.com/content/85/7/622.full.pdf+html (concluding “that the restorations produced with the ART approach, with high-viscosity glass ionomer, survived longer than those produced with the traditional approach, with amalgam, in the permanent teeth of young children”); Steffen Mickenautsch, Veerasamy Yengopal and Avijit Banerjee, Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review, Clinical Oral Investigations, Volume 14, Number 3, 233-240 (2009), http://www.springerlink.com/content/ng3g624824682h53/ (“In the permanent dentition, the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years…”).
- Daniel Zimmerman, Interview, Dental Tribune, http://www.dental-tribune.com/articles/content/id/3978/scope/news/region/asia_pacific
- Proposition 65 warning, http://www.toxicteeth.org/CAPatientNotice2.doc