19th March 2024
Amalgam is an alloy containing mercury and a mixture of metals that is routinely used as a filling material. Amalgam has been used for the past 150 years in dentistry as it’s cost effective and durable. However, mercury is a toxic substance, and there are concerns about mercury vapor release during the placement and removal of dental amalgam fillings, as well as its potential long-term adverse health effects on patients and dental professionals – all of which you should be aware of during your dentistry interview.

Why Is There Pressure For Dentists To Phase Down The Use Of Dental Amalgam?

Minamata Convention On Mercury:

Dental amalgam contributes to mercury environmental pollution. The most common way people are exposed to mercury is through eating fish that contain methylmercury. There are world-wide environmental concerns over the use of mercury that were highlighted at the United Nations Environmental Programme.

In response to these concerns, various organizations and regulatory bodies have taken steps to reduce the use of amalgam and promote alternative filling materials. The Minamata Convention on Mercury, a global treaty adopted in 2013, aims to phase down the use of dental amalgam and promote mercury-free alternatives.

In the UK, the National Health Service (NHS) has implemented guidelines to minimize the use of dental amalgam and encourage the use of alternative materials, particularly for children, pregnant women, individuals with specific health conditions or those likely to have an allergic reaction.

For them, any exposure to mercury from dental amalgam (even to a small amount of mercury) can result in an unnecessary health risk.

The NHS has also emphasized the importance of informed consent and providing patients with information about the benefits and risks of different dental filling materials.

Patient Preference:

Practicing dentists are finding that patients are preferring composite (white) fillings as opposed to amalgam fillings. This can because they are concerned about the mercury present in amalgam. However, many patients would like white fillings for aesthetic reasons.

There has also been an increased use of tooth-coloured composite resin fillings, which are aesthetically pleasing and do not contain mercury. These resin-based composites have improved over the years in terms of durability and longevity, making them a viable alternative to amalgam in many cases.

Minimally Invasive Dentistry:

Dentistry is moving towards a minimally invasive approach. This means preventing dental disease from occurring but also removing as little tooth structure as possible. Unlike composite (a white filling material), amalgam fillings requires more sound tooth structure to be removed.

This is because amalgam fillings rely on mechanical retention so predesigned cavities must be cut in the tooth for them to be successful. This makes dental amalgam a less attractive option for dentists practicing a minimally invasive approach.

Why is Dental Amalgam Still Used?

In order to succeed in your dentistry interview, you should know why dental amalgam is still used.

In some clinical cases dental amalgam is the most appropriate material to use. For example, in molar teeth that have high occlusal forces (during eating). Additionally, it is much faster to place than white fillings so it is beneficial for NHS dentists with short appointment times. Clinical research indicates that amalgam fillings are safe to use, however they are not recommended for women who are pregnant.

Here are the main reasons for the current use of dental amalgam:

  • Durability: Dental amalgam has a long track record of durability and longevity. It can withstand the forces of chewing and grinding, making it suitable for use in areas of the mouth that experience high levels of stress. Amalgam fillings can last for many years, reducing the need for frequent replacements.
  • Cost-effectiveness: Amalgam is a relatively inexpensive filling material compared to alternatives such as composite resin. This makes it a more affordable option for patients, particularly in cases where cost is a significant factor.
  • Ease of use: Amalgam is easy to handle and manipulate, making it a convenient choice for dentists. It has a relatively short setting time, allowing for efficient placement and shaping during dental procedures.
  • Versatility: Amalgam can be used in a variety of clinical situations, including large cavities, areas with high moisture, and areas that are difficult to keep dry during the filling process. Its versatility makes it a reliable option for many dental practices.
  • Long-standing evidence of safety: Despite concerns about the presence of mercury in amalgam, extensive research and studies have shown that dental amalgam is safe for most patients. The mercury in amalgam is bound within the alloy, minimizing the release of mercury vapor. The World Health Organization (WHO) and other reputable organizations have stated that the use of dental amalgam is safe for most individuals, with the exception of certain high-risk groups.
  • Accessibility: Dental amalgam is widely available and accessible in dental practices worldwide. Its long history of use means that dentists are familiar with its properties and techniques for placement and removal.

The Phase Down of Dental Amalgam

The European Commission in 2016 recommended that dentists should phase down the use of amalgam rather than imposing any direct bans. They recognised that amalgam can be an effective material to use to certain clinical circumstances.

The British Dental Association supported the phase down rather than banning of dental amalgam as it allows for dentists to adapt to the change and discover comparable alternative filling materials.

Which Questions Could I Be Asked About Dental Amalgam In An Interview?

  • Do you agree that dental amalgam should be phased down or should it be banned?
  • Is the use of dental amalgam safe for patients?
  • Should patients who want aesthetic white fillings pay to have these done privately?

How Should I Approach A Dental Amalgam Question?

  • Show that you have an understanding of dental amalgam and when it is currently used in NHS practice
  • Give a balanced answer, outline both the positive and negatives of using amalgam
  • Give the opinions of both the patient, dentist and those concerned about mercury in the environment
  • Consider what dental amalgam could be replaced with and how this may impact the NHS in terms of time and cost

Words: Joelle


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