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Dental amalgam controversy

Premolar tooth with amalgam filling
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This discussion of the dental amalgam controversy outlines the debate over whether dental amalgam (the mercury alloy in dental fillings) should be used. Supporters claim that it is safe, effective and long-lasting, while critics argue that amalgam is unsafe because it may cause mercury poisoning and other toxicity.[1][2][3]

Supporters of amalgam fillings point out that it is safe, durable,[4] relatively inexpensive, and easy to use.[5] On average, amalgam lasts twice as long as resin composites, takes less time to place, is tolerant of saliva or blood contamination during placement (unlike composites), and is often about 20–30% less expensive.[6] Consumer Reports has suggested that many who claim dental amalgam is not safe are "prospecting for disease" and using pseudoscience to scare patients into more lucrative treatment options.[7]

Those opposed to amalgam use suggest that modern composites are improving in strength.[8] In addition to their claims of possible health and ethical issues, opponents of dental amalgam fillings claim amalgam fillings contribute to mercury contamination of the environment. The World Health Organization (WHO) reports that health care facilities, including dental offices, account for as much as 5% of total waste water mercury emissions.[9] The WHO also points out that amalgam separators, installed in the waste water lines of many dental offices, dramatically decrease the release of mercury into the public sewer system.[9] In the United States, most dental practices are prohibited from disposing amalgam waste down the drain.[10] Critics also point to cremation of dental fillings as an additional source of air pollution, contributing about 1% of total global emissions.[11]

The World Health Organization recommends a global phase out of dental mercury in their 2009 report on "Future Use of Materials For Dental Restorations, on the basis of aiming for a general reduction of the use of mercury in all sectors, and on the basis of environmental impacts of mercury product production."[12]

It is the position of the FDI World Dental Federation[13] as well as numerous dental associations and dental public health agencies worldwide[14][15][16][17][18][19][20] that amalgam restorations are safe and effective. Numerous other organizations have also publicly declared the safety and effectiveness of amalgam. These include the Mayo Clinic,[21] Health Canada,[22] Alzheimer's Association,[23] American Academy of Pediatrics,[24] Autism Society of America,[25] U.S. Environmental Protection Agency (EPA),[26] National Multiple Sclerosis Society,[27] New England Journal of Medicine,[28] International Journal of Dentistry,[29] National Council Against Health Fraud,[30] The National Institute of Dental and Craniofacial Research NIDCR,[31] American Cancer Society,[32] Lupus Foundation of America,[33] the American College of Medical Toxicology,[34] the American Academy of Clinical Toxicology,[34] Consumer Reports[7] Prevention,[35] WebMD[36] and the International Association for Dental Research.[37]

The U.S. Food and Drug Administration (FDA) formerly stated that amalgam is "safe for adults and children ages 6 and above"[38] but now recommends against amalgam for children, pregnant/nursing women, and other high-risk groups.[39]

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  7. ^ a b Cite error: The named reference consumerreports.org was invoked but never defined (see the help page).
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  12. ^ "Future Use of Materials for Dental Restoration". World Health Organization.
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  34. ^ a b "Five Things Physicians and Patients Should Question". Choosing Wisely: an initiative of the ABIM Foundation. American College of Medical Toxicology, American Academy of Clinical Toxicology. February 2013. Retrieved 5 December 2013.
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  37. ^ Ajiboye, A.S.; Mossey, P.A.; Fox, C.H. (1 July 2020). "International Association for Dental Research Policy and Position Statements on the Safety of Dental Amalgam". Journal of Dental Research. 99 (7): 763–768. doi:10.1177/0022034520915878. ISSN 0022-0345. PMID 32315245. S2CID 216072888.
  38. ^ Cite error: The named reference fda.gov was invoked but never defined (see the help page).
  39. ^ Commissioner, Office of the (24 September 2020). "FDA Issues Recommendations for Certain High-Risk Groups Regarding Mercury-Containing Dental Amalgam". FDA. Retrieved 18 April 2023.

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