November 7th 2012
Hazmat At the Dentist?
Although Dentists have been using a composite material in dental fillings for quite some time now, newly conducted research has shown that some material that dentists use for filling cavities, may contain a harmful chemical that exhibits a potential to transpire detrimental effects within the human body. The composite material known as Amalgam is comprised of powdered alloy derived from silver, tin, copper, and the potentially deemed harmful substance of liquid mercury (Jensen 84). Within the past few decades, this argument has been a habitual debate with multiple viewpoints on whether or not the use of amalgam should be a continued procedure. Over the past 150 years, durability, low cost, ease of application, and bacteriostatic effects, have all made amalgam a popular material for fillings within dental community (Rathore et al. 81). Amalgam is composed of about 50% mercury by weight and has the potential to leech into various organs such as the kidneys, brain, liver, and pituitary glands (Richardson et al. 632).
Amalgam fillings have been a staple within the dental industry for quite some time and the prolonged familiarity may be the reasoning why federal safeguard public health associations such as the FDA (Food and Drug Administration) and ADA (American Dental Association) have deemed amalgam fillings as a safe procedure for the American public. Through my conductive research on the clinical use of amalgam fillings within the dental community, I will present an insight on the personal viewpoints of the FDA, the ADA, dentists, patients, and environmentalist that the use of amalgam may affect.
The ADA was founded in 1859 and is known as the pinnacle source for relevant information pertaining to dentists and their patients (About ADA). Coexisting with the ADA in enforcing a governing policy for the public’s health is the known as the FDA. The FDA holds a certain power over the medical procedures along with chemical compounds associated with dentistry. The ADA and FDA have displayed an interest with the use of amalgam within dental fillings. Although numerous studies showing that the mercury content within amalgam has a potentially poisonous harm that releases mercury vapor that accrues in the nervous system along with body tissue, the FDA and ADA perpetuate there stance that the micro-doses of vapor aren’t copious enough to pose a hazard to the patients health (Kleiner 26). With the FDA being the primary forefront of Americans safety from evaluation of food and drug, the ideology of whether or not the use of amalgam should continue is still up for debate while many question the motives of the ADA and FDA. The FDA has vocalized there stance on the subject by publicly displaying information found by De Rouen, et al. on the government regulated website saying, “Clinical studies have not established a causal link between dental amalgam and adverse health effects in adults and children age six and older. In addition, two clinical trials in children aged six and older did not find neurological or renal injury associated with amalgam use” (86). The FDA and ADA have deemed amalgam safe for the American public with the recommendation that patients consult with their dentists on a full range of alternatives.
Sharing a semi-acquiescent mindset with the ADA and FDA’s standpoint of the issue, about fifty percent of dentists are continuing the use of amalgam fillings as an option while the other fifty percent has ceased the placement of amalgam fillings altogether. In a survey conducted by The Wealthy Dentist, a program that continues dental education, showed collected data that indicated 52% of dentists have discontinued amalgam fillings while the 48% are continuing to place them. Although one out of two general dentists are not placing amalgam, four out of five specialty fields within dentistry such as endodontistry, periodonstistry, prostodontistry and cosmetic dentistry are all still placing amalgam. A Kentucky prosthodontist stated, "Dentists who advocate elimination of dental amalgam are building their practice at the expense of the rest of the profession. Dental amalgams are perfectly safe." Another Californian dentist stated, As long as ADA and FDA say it is safe, then that is good enough for me" (The Wealthy Dentist). In an article titled Are Fillings Hurting Your Teeth, Dr. Egbert along side with Dr. Sangiorgio, took a candid observation over the use of amalgam fillings and the believed myths surrounding amalgam. Within that article, Dr. Egbert and Dr. Sangiorgio laid out the statistical facts expressing that there has been no studies in humans saying that amalgam fillings have caused diseases. They also go on to say that the testimony of patients who claim they were cured overnight when their fillings were removed is the only supply of proof that can be offered. Dr. Egbert and Dr. Sangiorgio continue to back up the use of amalgam by expressing that from a scientific standpoint, mercury would take months to get out of your system and any symptoms that seemed to disappear overnight the day after having the fillings removed are highly unlikely symptoms deriving from mercury. Although about 52% of general dentists have abandoned the placement of amalgam fillings, 48% continue to use the material as a filling composite (104). Since the patients seems to be the main concern, only half of the general dentist population sees the use of amalgam filling as being a safe and cheap alternative to other composite materials. While half of the dental community along with the ADA and FDA are indicating amalgam to be completely safe, patients are showing more and more concern with the mercury-induced material.
The trace amounts of mercury within amalgam does show a probable likelihood too leach into the blood stream but the link to if this is the root cause to the patient’s symptoms it still unknown (Jones el al. 145). The ingestion of liquid metallic mercury within amalgam does not appear to be toxic in itself; rather the health hazards from the liquid mercury are due to its impending probability to release mercury vapor within the filling (Davidson et al. 142). Some dentists have told patients that amalgam fillings are safe for adults but when it comes to children under the age of 6, there may be a possibility of hindering the development of the child’s brain. During a controlled study assessed by Dr. Al-Saleh and Dr. Iman, astonishing findings indicated that a over 74% of the children that had amalgam fillings have previously or still do show signs of inhibited brain development. The high mercury content has shown signs within children that force parents and some dentists to stray away from the clinical use of amalgam. Patients have obviously questioned the rational and reasoning behind why some dentists are continuing to place amalgam and seem to stay firm on there stance that they do not want a harmful mercury induced filling within theirs and their children’s mouths. While many topics regarding the use of amalgam is still up for debate, many environmentalists have their opinion on dental use for amalgam fillings.
Although the earth is made up a large quality of mercury, an encounter with the elemental compound in high doses can be very harmful. Because amalgam fillings have a 50% mercury ratio to the other metallic compounds, the environmental factor of disposal becomes a huge topic of debate when considering amalgam fillings. The mercury within amalgam has probable likelihood to discharge into the environment in numerous ways including water, air, and solid waste. The discharge into major water and airways don’t have the possibility to cause harm on its own. Rather, when the mercury within amalgam fillings came into contact with certain bacteria and species, the mercury content began to convert into a potent neurotoxin known as methyl mercury (Al-Khatib et al. 179). During this same study, Al-Khatib and his colleagues discovered that the American Dental Association has stated the average amount of amalgam fillings that one dentist removes per year is between 700 and 800. Though the number of the amalgam fillings that were improperly discarded is still unknown, Al-khatib and his colleagues found out through a questionnaire, one dentist produced an average of 22.55 g of mercury waste each week. With the average of 150,000 practicing dentists within the United States, the 22.55 g of amalgam waste accumulated weekly by one dentist adds up extremely quickly when considering the the grand scale of dentists contributing the mercury waste. Al-khatib expressed that this could have a dramatic affect on the environment along with the species that live in it (181-82). Environmentalists understand the prospective harm to the planet that is being presented within the amalgam controversy and have voiced their opinion that alternatives need be used.
Through my conductive research on the clinical use of amalgam fillings within the dental community, I found that the FDA, ADA has showed no signs of amalgam as being a harmful substance. About half of practicing dentists have ceased the option of amalgam altogether while the other half views it as a suitable option. Even so, patients seem to be questioning the rational behind the dentists that are still placing amalgam filling. It seems that the environmentalist show a vast amount of concern upon the use of amalgam expressing that the mercury has shown to create a potently harmful outcome for the environment. With a substantial quantity of contradicting information that seems to surround whether or not amalgam fillings should be a continuous procedure in a dental office, the foreseen debate seems as if it could continue on without flux.
In my opinion, I think it is important to take into consideration all aspects that pertain to amalgam fillings and consider the whether it is the right option for the patient. By being informed on what material the dentist is placing in the patient’s mouth, the patient has the right to make a proactive decision on substitutionary alternatives. I don’t think that the use of amalgams should be taken out of the dental community all together due to the fact that the ADA, the FDA, and half of the practicing dentists within the United States have deemed the procedure suitable. Rather, I think an enormous amount of effort should be placed on the shoulders of dentists to keep their patients informed on the material that is being used in their mouth.
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