Written consent would be required for amalgam fillings in Vermont

By Nancy Remsen
Free Press Staff Writer

March 1, 2007
MONTPELIER -- Under a bill recommended Wednesday, dentists would face restrictions in their use of amalgam for fillings in teeth beginning in April 2008.

They could use the gray-colored material, which contains the toxic element mercury, only after providing patients with copies of a state brochure on alternatives and securing written consent.

The House Fish, Wildlife and Water Resources Committee had considered a partial ban on dental amalgam beginning in 2011, because of the possibility that the mercury in the filling material could escape into the environment. They settled for requiring informed consent.

"I think this is a good day for all Vermonters and all those who want to be informed before they get in the dentist chair," said Michael Bender, co-chairman of the Advisory Committee on Mercury Pollution. The advisory panel had recommended phasing out the use of amalgam.

The Vermont State Dental Society opposes the bill.

"We aren't advocating for increased use of dental amalgam," James Feehan, a lobbyist for the Dental Society, told lawmakers. "We are trying to maintain all options for our patients."

The Fish and Wildlife Committee approved a second mercury bill that would require thermostat manufacturers to set up a collection program in Vermont. The sale of mercury thermostats is banned here, but many old thermostats containing mercury remain in use. As these are replaced, lawmakers want to be sure they are disposed of properly.

This bill proposes that manufacturers provide homeowners and contractors with financial incentives -- with a minimum value of $5 -- to turn in the old thermostats.

The two mercury proposals had been combined in one bill, but the committee split off the thermostat provisions because those don't require review by any other House committees. The dental amalgam proposal is expected to move next to the House Human Services Committee.

The amalgam bill recognizes that Vermont dentists have installed equipment that captures amalgam particles before they go down the drain into wastewater.

Supporters of phasing out all use of amalgam argue that the mercury in amalgam also can be released when bodies are cremated and in human waste. Mercury is a toxin that can cause severe brain damage and birth defects.

Under the bill, the Department of Health would develop a brochure detailing the advantages and disadvantages of using mercury amalgam versus the alternatives available for dental procedures. The brochure would cover such factors as durability, cost and aesthetics.

Feehan said dentists would prefer to control the information they share with their patients, rather than hand out a one-size-fits-all, state-written brochure.

The bill also sets out the wording for the proposed consent agreement that patients would sign before receiving amalgam fillings. It would read, "Dental amalgam contains approximately 50 percent mercury, a highly toxic element with potential human risks. Such product should not be administered to a child six years of age or younger, pregnant women or lactating women."

Feehan argued the wording implied a ban -- at least for the groups cited.

In a telephone interview, Peter Taylor, executive director of the Dental Society, worried that requiring patients to sign forms might scare them away from using amalgam. "Our position is that it remains an effective and safe material to use."

Taylor said the proposed consent form might be a first across the country.

Susan Premo, a citizen advocate of banning amalgam, countered that consent forms are common in medical treatment. She noted that ban supporters compromised when they settled for signed consent by patients. "We want to make sure they got the information and made an informed decision."

All sides expect to debate the health risks before the House Human Services Committee.

Contact Nancy Remsen at nremsen@bfp.burlingtonfreepress.com

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