I welcome the latest UN Treaty which seeks to reduce mercury pollution. It is called the Minamata Convention and will be adopted later this year in Japan. It is named in memory of the victims of mercury poisoning from industrial pollution that occurred when residents of the Minamata Bay ingested contaminated fish and shellfish in the 1950s. The treaty will require nations to phase down the use of mercury containing dental amalgam fillingsover an appropriate time period relevant to each country’s national requirements.
As dentists we are involved with the use of mercury in dental amalgam fillings but mercury has wide uses in other spheres of life for example thermometers, energy-saving light bulbs and uses in the mining, cement and coal-fired power sectors. We work with mercury in a highly controlled and structured manner within rigorous safety guidelines. There was a widespread worry amongst the dental profession that the treaty would call for the total withdrawal of dental amalgam fillings over a short timeframe. In the end lobbying from various organisations including the British Dental Association proved to be persuasive against this approach. It was argued that more time was needed for oral health prevention programmes to be implemented and produce effects, and also time was needed for suitable alternative dental filling materials to be developed.
We as a profession must look harder at reducing the use of mercury in dentistry and we must always seek alternative cost effective materials that can be used. In terms of the future of dental amalgam some of the highlights include:
National governments to set the pace of the phase down according to local domestic requirements.
There should be a focus on public health programmes designed to reduce the incidence of dental disease.
Using non mercury based filling materials should be encouraged and research into such materials should be encouraged.
Best practice measures should be used to minimise the load from waste dental amalgam.
It looks as though the lead on dental amalgam mercury reduction is going to be taken forward at a European level by the council of European dentists – the CED. Within our current National Health Service structure dental amalgam is and continues to be the most cost effective material to use for our patients. This applies to many other countries in the world where the cost of alternative filling materials that are not mercury based is prohibitively expensive and cannot be justified. Pulling the plug on dental amalgam in an abrupt and dogmatic way would be very destabilising for patient care and I am glad that the UN Treaty does not seek to do this. They have taken a very pragmatic and sensible view. A steady move away from dental amalgam fillings is dependent on good, cost effective, evidence based materials being brought forward.
As dentists we always seek to put the health, safety and well-being of patients above all else. We use dental amalgam under strict conditions of safety and support the progressive phase down over an agreed time frame. Dental amalgam is a cost effective and proven material and until viable cost effective alternatives are developed it will remain the material of choice within our health care systems.