As the European Parliament votes to ban dental amalgam from 1 January 2025, the UK dental profession has shared its views on the decision.
James Goolnik – dentist and author Kick Sugar
Finally, the European Parliament prohibits the use of amalgam fillings. Used as a filler since 1826 – a mixture of mercury, silver, copper, tin and zinc. Amalgam was a cheap and easy filling material, but it is terrible for the body and the environment. This is great news for patients and doctors.
Amalgam fills a gap. It does not (by itself) bind or arrest tooth decay. it can crack teeth and should be disposed of very carefully. Once mercury is released into the air, soil and/or water, it can pose a threat to wildlife for centuries.
Gold is a significantly better restorative material, lasts longer and is biocompatible. Ceramic bonds chemically to the teeth, does not harm the environment and is more aesthetic. Composite also requires excellent moisture control and welding protocol and takes time to work well. However, our patients deserve skilled clinicians. With the advent of bulk filling composites, this is an educational opportunity for dentists and dentists.
I feel sorry for NHS dentistry but it’s time we put the patient first by practicing preventative dentistry starting with diet and nutrition and using more biocompatible materials that don’t harm the clinical team and the environment.
Chantell Fields – recruitment consultant – dentist at Consult
Personally, I welcome this ban with open arms.
I think it certainly reflects a commitment to environmental sustainability, moving away from mercury-containing materials, which is then pushing globally towards eco-friendly dentistry. Also, when it comes to the patient’s well-being, dentists can offer alternative materials that are not only safer but also more advanced.
However, I believe that for the UK dental industry, this ban will come with both challenges and opportunities. Adapting to new materials always comes with pressure and obstacles. As a former dental nurse, I am an advocate for enhanced safety, sustainability and state-of-the-art dental solutions for patients.
It’s like a dental renovation, isn’t it? A chance to shed the old and embrace the new.
Linzy Baker – dentist
In dental school we are taught to use all restorative materials, including amalgam, but at the same time we are taught to be minimally invasive. Cavity preparation for this type of restoration requires us to create retention in the incisions or use pins and slots. This often requires the removal of healthier tooth tissue, which in contrast when using adhesive dentistry is not required due to the bonding with the tooth structure that allows for minimal destruction.
Amalgam has had its place in dentistry for years and particularly in the NHS, however many materials have since overtaken it and it is rarely (if ever) seen in private practice. How do we justify using this in a group of patients purely because of its low cost?
In my daily practice I see many amalgam restorations that are now, after many years, beginning to wear down. Upon removal, many have fracture lines within the tooth structure, requiring further destruction to remove. If these are too large, he may change the refill plan to something lab-made.
The benefits outweigh the risks
It is often the case that these heavily filled amalgam teeth are the ones that fracture and can regularly be beyond repair for the patient, requiring extraction and, if necessary, an often expensive replacement.
There are concerns about how the NHS will continue if this material is removed from UK NHS practices, as it is the most commonly used posterior filling material due to cost and longevity. Advances in adhesives for me negate the longevity argument as, well, they have also been proven to last as long as I see the evidence in my daily practice.
The phase-out of amalgam began in 2018, where the NHS restricted the use of amalgam to primary teeth, pregnant and breastfeeding women or children under 15, unless clinically necessary. The next natural step will be to remove it completely. I welcome the change and believe the benefits outweigh the risks.
Hussein Shaffie – implant surgeon
We know that amalgam contains mercury and can have toxic effects on the nervous, digestive and immune systems, and on the lungs, kidneys, skin and eyes.
The problem is that the NHS allowed dentists to place amalgam and therefore we don’t know how many people have been affected by it. Studies show that mercury in the blood has a long-term effect on people. Another problem is removing the amalgam without the proper skills instead of just drilling it.
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