Recent press coverage of legislation proposed to ban the use of dental amalgam raises several important issues that need to be fully explored before such a proposal should proceed.
I respect and share society's desire to reduce the amount of mercury in the environment. Vermont dentists have been in the forefront of eliminating mercury from the environment for many years. We follow "best management practices" to recycle any amalgam waste. Last year we supported legislation that required dental offices to install amalgam separators to catch tiny amounts of scrap amalgam from our water lines before the water returns to the municipal water system.
Dentists are the first ones to inform patients of the many different options available for treating tooth decay and other maladies when our efforts at preventive oral health measures are not successful.
But banning dental amalgam will hurt patients in Vermont by depriving them of an important health care option. I say this with no economic conflict of interest. Amalgam is less expensive for patients. Forcing me to use more expensive restoratives would only reduce financial options for my patients.
Dental amalgam is not mercury. It is a combination of materials that together form one of the toughest, longest lasting materials we have to restore teeth.
Amalgam contains mercury. But when combined with other metals it forms a stable alloy that has entirely different properties than mercury by itself. For some, it can be the best solution. For generations, dentists have used this option to treat dental decay in millions of Americans.
Why use amalgam?
For the young adult with major tooth decay below the gum tissue and bad oral hygiene. Constant bleeding makes the area difficult to keep dry. Using amalgam means the teeth are well sealed with a substance that will last a long time in a procedure than can be performed in one visit at a reasonable expense.
The patient with cerebral palsy who could not sit still in the dental chair. Composite materials would have required a long appointment and total isolation of the tooth from moisture. Short of a hospital setting, this patient would not have been able to have his treatment accomplished without dental amalgam.
To help patients keep their teeth for as long as possible when finances or health reasons do not allow for a more expensive and time-consuming option.
A ban on amalgam means these and other patients would not receive dental options they need and deserve.
The issue of dental amalgam and its use for the benefit of dental patients is complex. On the environmental side, we agree with supporters of the bill that mercury should be kept out of the environment. On the health side, however, we disagree and will continue to advocate for our patients' right to choose the best option.
It is strong and durable. Many dentists use the material on back molars where much of the chewing forces take place and where other materials can wear more quickly.
It is affordable. It allows me to provide patients in my practice with a range of options. And composite resins can cost up to 50 percent more than amalgam. Would we rather have people going without dental health care altogether under the guise of avoiding amalgam use? That is a disservice to thousands of Vermonters who struggle each day to make ends meet. Let's not burden them with higher costs.
It is safe. Respected health authorities from the World Health Organization to the National Institutes of Health and lately the Journal of the American Medical Association have all reached the same conclusion: There is little evidence to support a causal relationship between dental amalgam and human health problems.
In summary, dentists have an obligation to protect the environment while serving our patients. We will continue to do both. I urge the Legislature to reject an idea that would deprive dental patients from what is an important health care option.
Judy Fisch is president of the Vermont State Dental Society and a practicing general dentist in Rutland.
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