The gradual reduction in the use of dental amalgam must be supported by investment in strategies to prevent tooth decay, particularly in England and Northern Ireland, where no national oral health improvement schemes for children currently exist. That's the verdict of the BDA in its response to the Department for Environment Food and Rural Affairs (DEFRA) consultation on the UK's implementation of the EU Regulation on Mercury, which comes into force next January.
The BDA believes this is necessary to support the requirement for countries to have a national plan in place by July 2019 on the measures they will employ to phase down the use of amalgam in restorations. The BDA believes that the scale of the phase down is such that it also needs to be supported by investment in research and development into alternative materials to amalgam.
By July 2018, the EU Regulation stipulates that placing amalgam restorations in under-15s and pregnant/breastfeeding women should be restricted to instances when it is "deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient".
The BDA has strongly argued against plans proposed for Wales to define a restricted list of clinical scenarios in which the placement of an amalgam filling would be acceptable. The best interests of each individual patient are paramount and such a list could not possibly cover all situations in which a clinician might find it necessary to recommend the use of dental amalgam.
While prohibitions on specific drugs or medical procedures in pregnancy are often based on the precautionary principle, the BDA is concerned that the proposed restrictions are not based on any evidence of health risks. The BDA draws DEFRA's attention to the comprehensive review of the safety and efficacy of amalgam by the European Commission's Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR), which concluded that the current evidence does not preclude the use of either amalgam or alternative materials in dental restorative treatment to children or pregnant/breastfeeding women.
By 1 January 2019, dental amalgam will only be permitted in pre-dosed encapsulated form and dental facilities will have to be equipped with an amalgam separator.
Commenting, BDA Chair Mick Armstrong said:
"We support an environmentally-responsible phase down of amalgam in dental restorations, but are concerned that government is setting a tone that is more reflective of unfounded health scares rather than any genuine evidence based health risks.
"Individual dentists are best placed to make clinical decisions on the most appropriate materials to use to restore damaged or decayed teeth in the best interests of each patient, and that includes amalgam. There are well recognised situations where amalgam restorations may be preferable, if not the only realistic solution to ensure long lasting and durable solutions for our patients.
"The phasing down of amalgam is substantial and needs to be thought through carefully and mustn't be done on a whim or prayer. UK governments need to develop proper, funded strategies for prevention, especially in England and Northern Ireland, to deliver the scale of phase down required."