It is easy to support the environmental rationale of the Minamata Convention and to understand why so many countries have signed up to it. We accept the well-established environmental and health risks from widespread, large-scale, and long-term mercury pollution such as occurred at Minamata through the industrial discharge of waste. However, the risk from existing or new amalgam restorations is minimal and practice processes and clinical techniques already minimise the exposure of patients to mercury.
Although in transition to Brexit (post vote of 23/06/16), the UK remains a full member and the obligations of membership remain during the BREXIT negotiations. The UK therefore had to continue to negotiate, implement and apply EU legislation, and risked significant fines for non-compliance.
We were already moving towards most of the incoming restrictions relating to amalgam anyway because preventive interventions are reducing decay levels, and alternative filling materials can be used in cases of early decay. We would expect that the use of dental amalgam will continue to decline as oral health further improves.
There is however no universal restorative material for all clinical scenarios, especially for more extensive restorations. Material technologies are improving but alternative resin-based materials are better for smaller cavities or where there isn’t as much occlusal loading, and they can have their limitations (not as durable, technique sensitivity, biocompatibility, polymerisation shrinkage, effect of moisture during placement etc.)
Amalgam remains a useful restorative material for some clinical scenarios because it is durable, strong, can be used in wet conditions, expands to seal cavities, is easily manipulated and placed, and is cost effective.
There is no real evidence of risk from dental amalgam, either to patients or to dental professionals who would be at greater risk of exposure.
There are different oral health needs and restorative needs across the EU, and indeed within the UK regions. Whilst dental health is improving across the UK regions there is still a need to use amalgam in more extensive restorations in younger people, and to repair and replace existing amalgam restorations in older people.
The UK has already been avoiding the use of amalgam for pregnant women for 20 years. This was introduced solely on the precautionary principle that it was generally accepted to avoid unnecessary medical interventions during pregnancy so as to minimise any potential risks to fetal health; and that exposure to mercury vapour from amalgam is greatest during the placement or removal of restorations and that mercury was known to cross the placenta.
What is an amalgam filling?
Sometimes known as a metal or silver filling it has been used for more than 150 years to fill teeth. It is a mixture of mercury and other metals such as silver and copper that sets to make strong, long-lasting fillings.
What are the alternatives?
Fluoride varnish and sealants can be used to prevent or stop decay in the early stages. Alternative materials are suitable for use in other types of filling, particularly smaller cavities or where the cavity doesn’t extend over several surfaces. Pre-formed metal crowns can sometimes be used on deciduous (baby) teeth. Dentists will often use different techniques and materials but in some circumstances dental amalgam is still the best filling material to use. Your dentist will discuss the treatment options with you.
What should I do if pregnant or breastfeeding?
Unnecessary medical or dental treatment is best avoided when pregnant but if it is urgent, for example due to pain, alternative materials can be used until after the pregnancy or breastfeeding stops when the full range of treatments will be available again.
Will this be affected by Brexit?
Despite the ongoing BREXIT negotiations, the UK remains a full Member State and must comply with this EU Regulation.
Do I need to having my fillings (or my children’s) replaced?
There is no evidence that amalgam fillings cause any harm to the health of dental patients, including children, pregnant and breastfeeding women, and their babies. There is no need to replace any existing amalgam fillings unless urgent treatment is necessary or your dentist advises to do so.
What is the best way to prevent the need for fillings?
Three top tooth tips to avoid tooth decay and the need for fillings:
- Reduce sugar-containing food and drinks, particularly at bedtime
- Brush your teeth with a fluoride toothpaste at least last thing at night, and another time during the day. Your dental team can advise on toothpaste strength and quantity
- Visit your dentist regularly, taking your children from a very early age