Abstract

Health and Environmental Risks from Mercury in Dental Amalgams

Mark Mitchell, MD, MPH George Mason University

APHA 2022 Annual Meeting and Expo

Dental amalgam is a material used to fill cavities caused by tooth decay. It is composed of 50% mercury—a well-known neurotoxicant that is bioaccumulative and persistent in the environment. Exposure to the mercury occurs not only during placement and removal of the amalgam fillings, but throughout its use and disposal. The entire life cycle of dental amalgam contributes significantly to the overall physical and environmental load of mercury pollution. In September of 2020, the U.S. Food and Drug Administration (FDA) issued a safety communication that called for dentists to cease use of dental amalgam in children, most women of childbearing age, and people with either kidney impairments or neurological disorders.

Unfortunately, federally-operated and funded dental care programs offered by the Indian Health Service (IHS), the Federal Bureau of Prisons, The Centers for Medicare & Medicaid Services, and other agencies are still allowing use of amalgam in their patients, many of whom are high-risk. BIPOC children are at disproportionate risk of exposure to mercury from amalgams because they are more likely to receive dental care via IHS and Medicaid. In addition, women of color are overrepresented in the incarcerated population, and approximately three out of four incarcerated women are of childbearing age. An amalgam filling placed in a pregnant prisoner prenatally exposes the fetus to mercury during critical periods of neurodevelopment. Many families served by these programs are either not offered a filling choice, or they are not provided accurate, accessible health and safety information about amalgams versus alternatives.

Dr. Mitchell will present information about the risk of mercury toxicity from dental amalgams and the relevant health concerns, with a focus on pregnant women and children. He will present on the latest science about the bioavailability of mercury in amalgam, the absorption and conversion of amalgam mercury within the body, and prenatal exposures. Dr. Mitchell will also highlight how amalgam contributes to the overall environmental load of mercury pollution, which presents additional exposure routes.

Abstract

Ethics, Social Justice and Amalgam

Rueben Warren, DDS, MPH, Dr. P.H., MDiv National Center For Bioethics in Research and Health Care at Tuskegee Universityskegee University

APHA 2022 Annual Meeting and Expo

Ethics, Social Justice and Amalgam
Rueben C. Warren DDS, MPH. Dr. P.H., M.Div.
This presentation discusses the ethics problematics of amalgam use in susceptible populations, particularly Black, Hispanic and Native American children/youth. Much has been documented and published on ethnic and racial health disparities particularly, related to people of color generally, and specifically African Americans. The 1985, Report of the Secretary’s Task Force Report on Black and Minority Health coined the term excess deaths. Excess deaths are the number of age/sex adjusted preventable deaths experienced by Black Americans compared to their non-Hispanic white counterparts. In 1985, 6 age/sex adjusted causes resulted in 60,000 excess deaths among Black people. By 1992, a 7th cause was added. In 2005, and the number of excess deaths had risen to 83,000. All of these causes have oral and system health associations. Dental caries, while not a cause of death is the most prevalent chronic disease among children/youth, particularly among Black, Hispanic, Native Americans and all low-income children/youth of all races/ethnicities. Historically, amalgam was the major restorative material used to treat dental caries, which is composed of 50% mercury, a well-known neurotoxicant. There are safer alternative materials available. Unfortunately, for a variety of reasons, dentists continue to use amalgam, which creates ethical, moral, and social justice challenges. In 2020, the U.S. Food and Drug Administration issued a safety communication that called for dentists to cease using amalgam on selected venerable and susceptible populations. The continued use of amalgam creates an ethical dilemma for the dental, medical and public health professions. While the research on the adverse health effects of amalgam on systemic health is evolving, there is a moral imperative adopted during the Environmental Justice Movement that, “when in doubt operate in the best interest of the public. The presentation argues that for racial/ethnic, economic, pedagogical, as well as ethics, moral, equity and social justice reasons it is just and right to eliminate amalgam use, immediately.

Abstract

Opportunities for the U.S. to eliminate a preventable, inequitable exposure to mercury

Sylvia Dove, JD Consumers for Dental Choice

APHA 2022 Annual Meeting and Expo

Federally-operated and funded dental care programs offered by the Indian Health Service (IHS), the Federal Bureau of Prisons, the Centers for Medicare & Medicaid Services, and other agencies still allow use of amalgam in their patients despite environmental, environmental justice, and health concerns. Dental amalgam is composed of 50% mercury—a well-known neurotoxicant that is bioaccumulative and persistent in the environment. Exposure to the mercury occurs not only during placement and removal of the amalgam fillings, but throughout its use and after its disposal. Lower-income communities and communities of color are often disproportionately affected. However, four developments present opportunities for the federal government to take a whole of government approach towards environmental justice as it relates to dental amalgam.

First, the U.S. Food and Drug Administration (FDA) issued a safety communication in September 2020 that called for use of mercury-free alternatives instead of amalgam in high-risk populations including pregnant women, women who are planning to become pregnant, nursing women, children, people with pre-existing neurological disease, people with impaired kidney function, and people with known heightened sensitivity (allergy) to mercury or other components of dental amalgam.

Second, the fourth conference of the parties to the Minamata Convention on Mercury (COP 4.2) amended the Convention to require parties, including the United States, to “Exclude or not allow, by taking measures as appropriate, or recommend against the use of dental amalgam for the dental treatment of deciduous teeth, of patients under 15 years and of pregnant and breastfeeding women, except when considered necessary by the dental practitioner based on the needs of the patient.

Third, the World Health Organization has recognized the availability, cost-effectiveness, and other benefits of mercury-free alternatives to amalgam in its latest reports. As WHO explains, the 2021 informal global WHO consultation with policymakers in dental public health shows that phase-down - and even phase-out – of the use of dental amalgam is achievable.

Fourth, other countries’ experiences phasing out amalgam either entirely (like Sweden) or in specific programs (like Bangladesh) or for use in high-risk populations (like the European Union) can help inform the U.S.’s approach.

Federally-operated and funded dental care programs that still allow amalgam use can learn from these four developments, implementing policies that both protect high-risk patients and ensure that low-income communities and communities of color are not disproportionately exposed to mercury from amalgam.