Health Center » Healthy Dentistry

 

In Part I of this article, I recounted the history of silver-amalgam (mercury) fillings through the last few decades of the twentieth century. Amalgams were invented in Paris in 1820. They were introduced and soon abandoned in America in the decades to come due to mechanical problems placing them as well as health concerns about their high mercury content. The anti-amalgamists won this, the First Amalgam War. Around the turn of the twentieth century, when these mechanical problems were solved, American dentists forgot these health concerns and started using amalgam fillings regularly. The amalgamists won this, the Second Amalgam War.

 

Then, in 1981, the Third Amalgam War began. Famed Swedish neurobiologist Mats Hansen, reviewing a series of studies of the early and mid twentieth century, sent a letter to the Swedish National Board of Health demanding an unprejudiced evaluation of the hazards of dental mercury amalgam. Due to Hansen and others' efforts, Sweden banned the use of amalgams in pregnant women in 1987.

 

Now the United States, Canada, and other European countries are all actively engaged in the Third Amalgam War. If it boldly started in Sweden, then we Americans are marching forward, striving for consumer protection, against not only harm, but also the prohibition of our rights to choose.

 

Although the cause of the anti-amalgamists in America began slowly in the middle 1980's, it gained momentum in the 1990's. In the late 1990's, advances were happening so rapidly that I wasn't sure whether I would see their full effects in my lifetime, even though I'd been practicing general dentistry since 1966 and stopped using mercury fillings in the mid 1970's.

The political battle in America against dental amalgam began on 4 November 1986 when California voters passed their state's Proposition 65, the "California Safe Drinking Water and Toxic Enforcement Act of 1986." This act, now a part of the state's health and safety code, states: "No person in the course of doing business shall knowingly and intentionally expose any individual to a chemical known to the state to cause cancer or reproductive toxicity without first giving clear and reasonable warning to such individual" (California Health and Safety Code #25249.6). "No person" includes dental amalgam manufacturers, suppliers, and dentists. Penalties for violations accrue at a rate of $2,500/day, until the violations are corrected.

How did the American Dental Association (A.D.A.), the professional organization of dentists in this country, respond to Proposition 65? In 1985, while Proposition 65 was being debated in the California state senate, J.M. Coady, D.D.S., the executive director of the A.D.A., issued a formal notification stating that "as a voluntary professional organization, it [the A.D.A.] has no legal authority to regulate the use of any dental material." Further, in 1990 in the Journal of the American Dental Association, the division of scientific affairs of the A.D.A. published an article entitled: "When Your Patients Ask About Mercury in Amalgam" (120:395-8). In this peer-reviewed journal sent to all members of the A.D.A., the A.D.A. leadership admitted that there is no scientific documentation establishing the safety of dental amalgam and that the defense of safety is based only on its having been used for over 150 years. In actuality, as I explained in Part 1 of this article and above, dental amalgams have been consistently used for only about 100 years.

After Proposition 65's passing in 1986, the next noteworthy date in the Third Amalgam War occurred in October 1992. At that time, a civil lawsuit was filed in the Superior Court of the State of California, Santa Clara, as case no. 718288: W.H. Tolhurst v. Johnson & Johnson Consumer Products, Inc., Engelhard Corp., ABE Dental, Inc., American Dental Association, et al. The plaintiff was a patient claiming his exposure to mercury from his dental amalgam fillings deteriorated his health. That the A.D.A. was sued along with the dentist responsible for placing the mercury filling gave the dentist confidence that "Big Brother" would protect him. To his dismay, however, attorneys for the A.D.A. presented the following argument in court: "[T]he A.D.A. owes no legal duty of care to protect the public from allegedly dangerous products used by dentists. The A.D.A. did not manufacture, design, supply or install the mercury-containing amalgams. The A.D.A. does not control those who do. The A.D.A.'s only alleged involvement in the product was to provide information regarding its use. Dissemination of information relating to the practice of dentistry does not create a duty of care to protect the public from potential injury." The judge dismissed the A.D.A. as a defendant in the case, leaving the accused dentist to fend for himself.

Responding to the lawsuit, California State Sen. Diane Watson authored, and Gov. Gray Davis signed, Senate Bill #934 in 1992. That bill required that a mercury amalgam fact sheet be given by the dentist to the patient, and that the patient read it before any mercury fillings are placed. Also responding to the lawsuit, the Environmental Law Foundation, a California nonprofit watch-dog group, in 1993 issued a directive to amalgam manufacturers to provide health warnings concerning their products.

In an unrelated move, in May 1994, the U.S. Department of Health and Human Services updated their "Toxicological Profile for Mercury," a compendium issued every three or four years by their Agency for Toxic Substances and Disease Registry. Page 5 of their 366-page book reads:

1.3 How might I be exposed to Mercury?
 
A most likely form of exposure is by absorbing mercury vapors released from dental fillings. Most silver-colored dental fillings are about 50% metallic mercury.

Two years later, on 5 August 1996, California's Ninth Circuit Court of Appeals mandated the posting of a specific sign in all dental offices using amalgam. The wording of this warning conforms to the requirements of Proposition 65 and is as follows:

By 2001, dentists in California were not the only ones required to post warnings about amalgam fillings. Arizona, Maine and Colorado also had passed laws requiring that similar warnings be posted at dental offices using amalgam. What about the rest of the world? During the last decade, Germany, Austria and Canada joined Sweden in prohibiting placing mercury fillings in pregnant women.

As I write this article, more than a dozen state dental boards are being pressured into restricting the use of amalgams, and Congressional bills are also pending against the use of mercury in dentistry. Mercury is already restricted in medical uses, including thermometers, disinfectants and vaccines. Don't you think mercury should be banned from human use entirely?

Subsequent legal action has been taken against the A.D.A. and the state dental associations of California, Maryland, Georgia and Ohio. Charles Brown, former West Virginia State Attorney General, and head council for Consumers for Dental Choice, another consumer watch-dog group, repeatedly raised concerns regarding failures of the California Dental Board to adopt the mercury-amalgam fact sheet ordered in 1992 with the passing of Senate Bill #934, sponsored by Diane Watson. Due to Brown's efforts, on 5 October 2001, in an unprecedented move, all members of the California Dental Board were dismissed.

In November 2001, anti-amalgamists organized a press conference for in-coming U.S. Congresswoman Diane Watson to discuss HR 4163, a bill which she is sponsoring in the House of Representatives to prohibit interstate commerce of mercury intended for use in dental fillings by 2006. What was once a state issue has now moved to the federal stage.

Now, what about the access argument? Since amalgam alternatives are at least three times as expensive as amalgams themselves, pro-amalgamists claim that low-income Americans will not be able to afford them. Further, Medicaid only pays for amalgam fillings. Our crusader Rep. Watson, in promoting HR 4163, accused organized dentistry of abusing the indigent who are "forced to have such a toxic material in their mouths." HR 4163, still pending in Congress, caught the attention of the National Black Caucus of State Legislators who presented a resolution including a stipulation that Medicaid and private insurance plans cover alternative restorative materials. So far, in 2001, Rhode Island passed a law requiring dental insurance companies with state contracts to pay for composite fillings at no extra charge for covered state workers. Also last year, the Medicaid program in Maine started covering composite fillings as well.

 

One outspoken dentist, Thomas E. Baldwin, D.D.S., M.A.G.D., of Towson, Maryland, said, "It's good that dentists are not heart surgeons. We'd use cheap valves if they alone were covered by insurance."

 

 

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