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

Dentists Not Concerned About Chemicals Used in Dentistry

Dentists Not Concerned About Chemicals Used in Dentistry“Not particularly worried” is the most popular response for concerns about the chemicals in dentistry among dentists, according to a new The Wealthy Dentist survey, but the results are pretty evenly split.

The online survey asked dentists from the U.S. and Canada if they are concerned about the safety of dental composite and sealants.

54% were not worried, while 46% had concerns about safety.

Here’s how the dentists responded —

  • 21% – Definitely yes! I am very concerned about this issue.
  • 25% – Somewhat. I have some worries about safety.
  • 38% – Not really. I’m interested, but not particularly worried.
  • 16% – Definitely not! I’m not worried at all.

Chemicals Used in Dentistry Survey Results Graph

“It’s about the same argument as the amalgam and mercury issue. I don’t see that the literature to date points in any direction toward concern about BPA!” a Mississippi dentist said.

BPA in tooth fillings has been in the news recently due to a study linking the chemical to behavioral problems in children.

According to Dr. John Reitz of Reading Eagle Press, “When dental manufacturers became aware of the health risk of BPA they made a conscious effort at eliminating or at least limiting the amount in dental products. According to research by the American Dental Association, BPA is rarely used today as an ingredient in dental products.”

Most of the dentists who responded to this survey agree that there are minimal risks from dental chemicals.

Here’s what many dentists had to say on the subject —

“We need more long-term studies.” (New Jersey dentist)

“To temper this, we have to remember that ANYTHING in the body outside of what is indigenous is considered foreign and has potential to elicit yet another of those unexpected side effects, sort of like most of Congress’ laws. Since I stopped doing sealants years and years ago, I am less concerned about the effect on most adults.” (General dentist)

“Amalgam is on its way out. Let the chemist reformulate BPA-free dental products!” (Alabama dentist)

“I didn’t know that I need to be concerned…” (California dentist)

“No patients have shown any worry. I do feel extensive research should be conducted.” (Mississippi dentist)

“Yes – patients ask about it! But I understand there are different kinds…some more damaging than others.” (Michigan dentist)

“I’ve never had a patient even mention it, unlike the ‘wackos’ who won’t let fluoride touch their kids lips…” (General dentist)

“None of our patients have mentioned it, yet. But, I won’t be surprised if or when they do in the future. I’m personally concerned about BPA in composites. I certainly didn’t want it in the plastic baby bottles my child used, so why would I want it in composite resin dental restorations? Dentistry certainly needs to have BPA free restorative materials.” (Ohio dentist)

“Parents are now asking me about our materials and if they contain BPAs.” (Pediatric dentist)

The ADA Council on Scientific Affairs has not identified evidence to suggest that the use of resin-based dental sealants or composite resin restorative materials is linked to adverse health effects from BPA exposure. (Source: ADA)

Dentists, what are your thoughts on chemicals used in dentistry?

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