FDA Finally Takes a Stand on Mercury… Sort Of

Agency Promises to Make a Decision Next Year

The Food and Drug Administration (FDA) has long avoided taking a public stand on the safety or danger of mercury in silver dental fillings. However, with a recent settlement in a lawsuit brought by the organization Moms Against Mercury, the governmental health agency has finally agreed to take a stand on the issue. Eventually.

The agreement calls for the FDA to complete its reclassification of dental amalgam by July of 2009. (The agency began that process in 2002.)

Some news articles have heralded this as a major change in the FDA’s attitude toward amalgam, with headlines making grand proclamations about a new post-amalgam era.

Can you guess which of the following is not a genuine headline?

These are attention-grabbing headlines, to be sure! The problem is, they’re not necessarily true per se. (And okay, I made the last one up.)

In the ADA’s response to news of the decision, the dental organization disputes these suggestions. “As far as the ADA is aware, the FDA has in no way changed its approach to, or position on, dental amalgam,” reads the statement.

As part of the agreement, the FDA has updated the consumer information provided by its website on the subject of mercury and dental amalgam.

“Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses. When amalgam fillings are placed in teeth or removed from teeth, they release mercury vapor. Mercury vapor is also released during chewing. FDA’s rulemaking will examine evidence concerning whether release of mercury vapor can cause health problems, including neurological disorders, in children and fetuses.”
Questions and Answers on Dental Amalgam (FDA Consumer Information)

What do you think? Is this a new era, or just more of the same?

Dentists Passionately Love and Hate Dental Amalgam (Video)

Dentists have used dental amalgam to make metal fillings for a long time, but the material is more controversial now than ever before.

Some worry the silver/mercury alloy may cause health problems, while others think it’s still superior to tooth-colored composite fillings.

Read more: Silver Mercury Fillings Are Amazing… Or Else They’re Terrible

Dentists Split Over Amalgam Fillings (VIDEO)

Amalgam dental fillingsDentists are deeply divided over the issue of mercury in amalgam fillings. In this survey, 52% of dentists reported they are no longer using amalgam. The other 48% are still placing amalgam fillings.

Some dentists criticized amalgam for its possible toxicity and tendency to fracture teeth; other dentists defended amalgam’s long history and superiority to more modern composite fillings.

Read more: Dentists’ Thoughts on Amalgam Fillings

The Amalgam Controversy Is Alive and Thriving

Amalgam dental fillingsWe asked, “Does your dental practice place amalgam fillings?” Two years ago, 48% of dentists said they placed amalgams, and 52% did not. The numbers have changed very little since 2007. Today, 47% place amalgams and 53% do not. No survey topic we have ever run collects as many responses and passionate comments as the question of amalgam.

The Wealthy Dentist is a dental marketing information resource. We’re not scientists, and we don’t pretend to have answers for dentistry’s big scientific questions.

We don’t have a stance on amalgam. So far, the ADA and FDA say it’s safe, but no scientific study has conclusively demonstrated if amalgam is safe or not. It’s one of the most divisive issues in dentistry today, and we wanted to see what dentists think.

But we were accused of bias merely by asking the question. However, some accused us of being blatantly pro-amalgam, while others declared us obviously biased against amalgam. With an equal number of complaints on each side, hopefully that means we average out to neutrality.

We received well over 100 comments on this survey (you can read them all here), but some themes were common.

Top reasons dentists like amalgam:

  • Been around for over a century
  • Better than composite in some cases
  • Composite and resins may not be safe
  • Last longer and have less redecay
  • Affordable and paid for by insurance

Top reasons dentists avoid amalgam:

  • Mercury is bad for patients, dentists and the environment
  • An old dental technology
  • Today’s composites are superior
  • Silver fillings are ugly
  • Amalgam can crack teeth

Reviewing dentists’ comments on the subject, it’s clear that a doctor’s personal opinions about amalgam do not always line up with the policies of their dental practices. A number of dentists who don’t place amalgams think it’s a valid restorative material, and some dentists who do place silver fillings would prefer not to. Whether or not a dental practice offers amalgam fillings is often related to two things: (1) is the practice focused on cosmetic dentistry, and (2) does the practice serve lower-income patients.

Many dentists scoffed at the idea of there being a scientific controversy over the safety of amalgam. “There is no controversy — it is a safe material with the longest history of use, declared a Vermont dentist. On the other hand, a Virginia dentist stated, “There is no real controversy in the scientific arena. Mercury release from amalgam is the primary contributor of human body burden and causes pathophysiology. It should be banned.”

With so many comments, many doctors chose the same words to describe their feelings about the amalgam issue. Here’s how many times different dentists used the same phrases in their comments:

  • 6: “Overblown”
  • 5: “BS”
  • 5: “Much ado about nothing”
  • 4: “What controversy?”
  • 3: “Crap”

Interestingly, doctors on both sides of the issue dismissed the controversy as “crap” or “BS.”

In addition, each side accuses the other of being motivated by money. “The controversy is fueled by greed. Posterior amalgams are easier to place and last longer than composite,” said a general dentist. A dental machinist & engineer disagreed, saying, “It’s difficult to get a true picture; there’s a great deal of money on the pro-amalgam side that has a potential to bias the data.”

In a sea of loud, zealous voices, one dentist’s calm neutrality stood out.

“If you stop and listen to the people that are arguing about this point, you will get two skewed views. If you present the science in an unbiased way to your patients many will choose amalgam and many will choose composite. You need to be honest about all the treatments you present.”
– Colorado dentist)

Read more: Dentists Still Arguing about the Safety of Silver Fillings

Mercury Safety Is Different from Amalgam Safety

Mercury safety: Amalgam issues divide dentistsMercury safe dentistry seems like a good idea for everyone, so I wasn’t expecting so much controversy from Dr. Tom McGuire’s article on the topic (read the article). Though dentists have lots to say about the consumer safety of amalgam fillings, that’s not what we’re talking about here.

We’re just talking about protecting dentists, staff and patients from mercury exposure during amalgam removals. Doesn’t that seem like something everyone can agree is important, regardless of whether one is pro-or anti-amalgam?

I’d like to address some of the points readers raised about Dr. McGuire’s article.

Since when is anyone who wants to promote his moneymaking ‘seminar’ considered to be ‘a leading authority?’On what grounds?Is he an established professor at an accredited dental school? In which department? Sheesh, if I call myself an ‘expert toxicologist’ six times before lunch, does that make me one?”
– Bill C., DDS

I think it’s safe to call someone “a leading authority” when they’re authored multiple books on the subject and founded a professional association, like Tom McGuire, DDS, founder of the International Association of Mercury Free & Mercury Safe Dentists (IAMFD).

I understand you may disagree with some of Dr. McGuire’s opinions. But the fact of the matter is, he’s a heavy-hitter in amalgam debate.

As for his seminars…

“Since all of the uproar about Dr. McGuire’s article I decided to visit the seminar website. I didn’t see anything about arguing that amalgams are a health hazard. All I got was that dentistry is a high risk occupation because of mercury and that it would be prudent, for many reasons, to deal with the occupational exposure to it. I really don’t see this about being pro or anti-amalgam and I still think everyone is entitled to his/her opinion about that topic. What I read was that it is about being anti-mercury and finding out what you can do to protect yourself. After looking at the website I’m going to attend his seminar, and it is a 2 hour flight for me.”
– Bob B., DDS

Where Bill sees a chance to lose money, Bob sees a chance to gain important education. Either choice is fine. The Wealthy Dentist isn’t endorsing Dr. McGuire’s views, just giving him a chance to share his knowledge.

Odd how the studies seem to prove whatever it is you want them to show.
– Dr. Gary Hochstetler

An excellent point. When both sides of the consumer amalgam debate claim the science is clearly on their side, it’s hard to know who to believe.

That’s why we’re trying to move the debate away from if having amalgam fillings is safe and towards how much mercury exposure dental health professionals face.

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