FDI policy statement on dental amalgam and the Minamata Convention on Mercury

SCOPE

The present FDI Policy Statement covers dental amalgam for tooth restoration in the light of the special provisions for a phase down in its use, contained in the 2013 Minamata Convention on Mercury.¹

INTRODUCTION

Dental caries remains one of the most common diseases worldwide, even though substantial progress has been made in its prevention. Dental amalgam (a mercury-added product containing approximately 50% mercury, which forms an intermetallic alloy with silver, copper and tin) is widely used to repair teeth damaged by caries because of its ease of use, appropriate mechanical and bacteriostatic properties and cost-effectiveness. Amalgam has been available for over 150 years and has one of the longest life expectancies of direct restorative materials used for the repair of carious teeth. Although much research effort has been expended in developing amalgam alternatives, no universal substitute is currently available. Therefore, dentists must have dental amalgam available as a treatment option.

The Minamata Convention on Mercury is a global treaty (governing the mining use and trade in mercury) to protect human health and the environment from the adverse effects of mercury and governs the mining, use and trade in mercury. The major highlights include a ban on new mercury mines, the phase out of existing mercury mines, control measures on air emissions and the international regulation of the informal sector for artisanal and small-scale gold mining.¹ The Convention also calls for a phase-down approach to dental amalgam (Annex A, Part II) through greater emphasis notably on prevention, research into new dental materials and best management practice. FDI is on record as supporting the provisions of the Minamata Convention on Mercury.²

STATEMENT

• 1Safety of dental amalgam

  FDI reiterates the main conclusion of the World Health Organization (WHO) Consensus Statement on Dental Amalgam, adopted by the FDI General Assembly in 1997: ‘The current weight of evidence is that contemporary dental-restorative materials, including dental amalgam, are considered to be safe and effective.’³

  The official position is contained in the FDI Policy Statement, Safety of Dental Amalgam, adopted by the FDI General Assembly in 2007.

• 2Adverse effects of dental amalgam

  Possible adverse effects of dental amalgam are detailed in the FDI Policy Statement, Possible Local Adverse Effects of Amalgam Restorations, adopted by the FDI General Assembly in 2007.

• 3Phase down of dental amalgam
  The Minamata Convention calls for a phase down of dental amalgam, with provisions for monitoring progress. The phase down will necessitate a reduction in the use of dental amalgam, coupled with measures to:

  • •
    Improve the public’s awareness of the importance of oral health and linkage to general health through

    • (i)
      promoting education towards the understanding that oral health is integral to general health; and
    • (ii)
      encouraging cooperation between members of health professions, governments, inter-governmental organizations, non-governmental organizations, and the media, to promote the widespread understanding that most oral diseases and their consequences can be prevented with simple interventions.
  • •
    Increase emphasis on the three basic public health principles of needs assessment, disease prevention and health promotion by

    • (i)
      advocating national health policies and programmes that include oral health promotion and preventive measures at population, community, individual and professional levels; and
    • (ii)
      promoting organised collaboration between stakeholders at all levels and the adoption of replicable, reliable and affordable approaches to the integrated prevention of oral disease as part of prevention of other chronic, non-communicable diseases.⁴
  • •
    Ensure that health and the environment are protected through health-care providers’ safe handling practices, effective waste management and the appropriate disposal of dental-restorative material (environmentally sound life-cycle management) through awareness of

    • (i)
      occupational risk to oral health personnel. A potential health risk to oral health personnel from exposure to mercury exists if working conditions are not properly organised. The application of proper hygiene requirements and procedures for using mercury in dental clinics will significantly reduce exposure to mercury.³ Recommendations for handling and disposal of dental amalgam are provided in FDI Policy Statement, Mercury Hygiene Guidance, adopted by the FDI General Assembly in 2007; and
    • (ii)
      environmental concerns. Mercury used in dentistry may contaminate the environment via the disposal of waste products from dental clinics. Equipment is available to collect metallic waste generated during dental amalgam placement and removal. Appropriate collection and recycling technology is also available to reduce mercury pollution of the environment, including pollution from crematoria,³ by installing emission filters. Recommendations on the disposal of dental amalgam are detailed in FDI Policy Statement, Amalgam Waste Management, adopted by the FDI General Assembly in 2009.
  • •
    Ensure that dentists have the full complement of techniques, procedures and dental-restorative materials available
    The FDI:

    • (i)
      supports the concept of collaborative research groups within and between countries;
    • (ii)
      encourages the funding of dental research;
    • (iii)
      encourages the use of non-mercury-containing filling material when appropriate;
    • (iv)
      encourages research programmes in all of the sciences related to dentistry;
    • (v)
      encourages academic and industrial scientists to promote the development and standardisation of high-quality equipment, instruments, materials and therapeutic agents; and
    • (vi)
      requests national dental associations and health authorities to support or initiate research programmes and procedures that promote these objectives.⁴
  • •
    Work with the dental profession in establishing a comprehensive global dental materials research agenda, alongside expanded preventive approaches
    The FDI:

    • (i)
      encourages the close co-operation between the dental profession and the research community;
    • (ii)
      encourages the concept of practice-based dental research in order to apply scientific findings in the practice environment and to stimulate the interests of science in the issues and problems relevant to dental practice; and
    • (iii)
      encourages the practicing profession to keep abreast of advances in science.³