A hot topic in dentistry over the past decade in the UK has been whether or not to eliminate the use of amalgam. 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. It has been shown to be safe, cost effective and durable in the mouth.
Why is there pressure for dentists to phase down the use of 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. This led to the signing of a treaty, the Minamata Convention on Mercury, which aims to regulate and reduce all man-made sources of mercury.
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.
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 amalgam a less attractive option for dentists practicing a minimally invasive approach.
Why is Dental Amalgam Still Used?
In some clinical cases 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.
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.
What kind of 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
