Nov
In light of the 11/15/10 Journal of Alzheimer’s statement that dental mercury amalgam is linked to that disease and last week’s special FDA advisory committee meeting on dental amalgam risks, I feel incumbent to say a few words.
Mercury is a known neurotoxin. It is impossible to determine how much is “tolerated” by a single person. There are those who can function with high levels of mercury and are able to live to a happy, cognizant old age, just like there are those folks who can smoke multiple cigarette packs per day and not succumb to lung cancer or related illness. No one today, however would suggest that smoking is good for children, pregnant women, or immunologically compromised individuals. Yet smoking was claimed to be good for one’s health during a good part of the last century.
We may be at a similar ideological crossroads with public perception of dental amalgam. I think there are two main issues here: One – Is some entity, (government, dental schools, dental supply companies, dentists, to name some possibilities) responsible for keeping the full danger of dental amalgam from the public? Two – what to do with dental amalgam now?
The first issue I believe is so convoluted that we may never know the answer. Many well meaning practitioners placed and continue to place dental amalgam. They were trained by dental schools who felt it was acceptable to place it. The ADA, has always reported that it was safe but should be avoided in some instances. Dental supply companies in the 1980’s put fair warning of hazardous materials on their labels of dental amalgam. In a court case, a major manufacturer admitted that the Material Safety Data Sheet of dental amalgam and inorganic mercury was essentially the same. Governmental agencies have waffled over “just what is the safe level of mercury?” This latest Alzheimer’s report I see as another flow in the ebb and flow of the safe mercury level debate.
The second issue is much more interesting to me, because it is where I live professionally. We know that mercury is a neurotoxin, with a lethal dose of 100 (that is, the dose required to kill 100% of the tested population is one). One molecule Hg to one cell equals cell death. Exposure level to mercury is highest when it is placed and removed, and that mercury is released constantly from fillings in varying amounts during the course of eating, drinking, and functioning. We can not determine the vulnerability of some individuals, though we know it is definitely dangerous for children, and pregnant or nursing mothers. The question begs to be asked – why is it tolerable to expose bread providing parents, school age children, young adults, elderly, immunologically compromised, and middle agers. Just where do we draw the line?
My position is that we should try to get over the first issue, and concentrate on the second. The reason for this is that we already have the answer and it is so SIMPLE.
We have good, very good, and even excellent materials with which to replace dental amalgam.
These materials, gold, composite resin, glass ionomers are consistently well tolerated by the immune systems of the patients I see. I know this because of Biocompatibility testing which challenges the dental material against active antibodies of a patient’s blood serum. There is always some material that can be used that will minimally challenge the patient’s immune system. Are these the materials I want for my children, parents, siblings, and every one? The answer is YES, of course. Are there any other possible answers?
These materials have many advantages over mercury amalgam in addition to their biological tolerance such as bondability (thereby conserving tooth structure), temperature and electrical neutrality (except gold), and improved appearance. Improved esthetics is desirable, however if these materials came only in blue, they would still be the material of choice due to their benefits. When placed correctly, these materials rival and can exceed the longevity of amalgam due to their ability to require less tooth removal. Of course, practitioners must be trained in correct placement of these materials, understand their chemistry, and be willing to follow the proper protocol – but that is our job!
In addition to not placing dental amalgam, it needs to be removed safely from those who find it desirable to do so, whether that person feels it is aggravating their health, puts them at risk due to a family history of illness, for appearance, or when a dental amalgam area needs restoring. Finally, those of us who remove dental amalgam must dispose of the waste and waste water responsibly using amalgam separators so that high heavy metal sludge cannot contaminate or water, and ground water systems.
Whether or not one is in danger of Alzheimer’s or other disease, some will always need further proof in addition to what we already know. How to proceed with the amalgam issue? We have the answers. The question remains if we will put the old fight of who’s responsible behind us and step up to the new one of when will we demand and provide the best oral health care for all.
– Cynthia C Copeland, DDS, AIAOMT