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Banning of dental amalgams: A topic we should bite into

There is overwhelming evidence of the harmful effects of mercury on human health and the environment. In fact, for the World Health Organization, mercury is one of the ten products o chemical group products which have a special negative consequence on public health.

This was agreed at the fifth session of the Intergovernmental Negotiating Committee on Mercury in Geneva of 2013. In 1956, two sisters, aged two and five, were diagnosed in Minamata Bay, Japan, with the crippling, untreatable, and stigmatizing effects of mercury poisoning.

The introduction of the convention reads: In the decades that followed, their story would be retold many times, becoming synonymous with the tens of thousands of adults, children and unborn infants to suffer from what is now known as Minamata disease”.

This convention came into effect in August of 2017, being the first global agreement on health and environment concerted in almost a decade. The agreement looks to control the anthropic emissions of mercury during its life cycle.

The major highlights of the Minamata Convention on Mercury include a ban on new mercury mines, the phase-out of existing ones, control measures on air emissions, and the international regulation of the informal sector for artisanal and small-scale gold mining.”

The Colombian Congress approved the Minamata Convention in Law of 2018, looking to solve the mercury issue in Colombia, banning imports as of July of 2023.

The discussion emerges when the government says it will comply with the convention, without conferring with the academia in reference to added mercury. An annex of the law also establishes that: “The measures taken to reduce the use of dental amalgam will take into account the national circumstances and the pertinent international orientations […].”

Fractured oral health

The preceding provides a discretionary nature to the government regarding the elimination of dental amalgam.

It is important to remember that the last Colombian Survey on Dental Health showed that dental cavities continue to be a high-prevalent disease in the Colombian population. It showed that 66.9% of children between 1 and 5, 60.5% between 5 and 12 and 98.6% of the people with permanent teeth have cavities with diverse degrees of severity, with a greater incidence of rural populations.

In Colombia, although healthcare coverage levels are close to 100%, it has not solved the serious issue of access barriers to healthcare and eliminating the use of a material which has the best clinical evidence of performance, will not only increase these barriers but on the short and long-term could impact the oral health indicators in the country.

The policy of the government should go through the path of increasing healthcare in order to diminish the rates of dental cavities, provide early diagnosis allowing a non-restorative management or use conservative restoration techniques.

In this manner, they would discourage the use of dental amalgams in face of alternative materials, which in small restorations have similar clinical levels of performance. On the other hand, implementing control protocols for disposal and management, which already exist, could help to diminish the impact of dental amalgams on the environment.

In another sense, the Minamata convention provides nine measures to implement the agreement; the third measure says: “Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration.” There are no dental materials currently in the market with the same levels of performance on the long-term as dental amalgam.

In this respect, Dr. Falk Schwendicke, an expert in dental prevention and restoration of the Charité – Universtätsmedizin Berlin published a cost-effectiveness analysis of some alternatives to dental amalgam. Although they conclude that all these alternatives are inferior to amalgam. The American Dental Association issued a Statement on Dental Amalgam stating: Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper, and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.”

It also reads: The ADA Council on Scientific Affairs supports ongoing research on the safety of existing dental materials and in the development of new materials, and continues to believe that amalgam is a valuable, viable and safe choice for dental patients.”

Pending discussion

Colombian dentist professionals provide an alert on the imminent disappearance of dental amalgam in a country with high levels of cavities and which does not have the substitute materials offering better or at least equal levels of clinical performance on the mid and long-term.

In face of the avalanche of aesthetical demands, they have forgotten of the clinical decision over the restoration material to choose also obeys to other factors such as material performance forecasting, in regards to the risk of patient cavities, the extension of the cavities and the location of the teeth in the mouth, among others.

The Dental Faculties and professionals need to provide a deep and academic discussion over this aspect, which impacts almost 100% of Colombians.

The country needs to face a decision which in the current situation will negatively impact the oral health of the Colombian population on the mid and long-term.

The academia needs to support the government to consider all the aspects related to the disappearance of dental amalgam as a restoring material.

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