AND WHY IT IS BANNED IN NORWAY

Dental amalgam

Anette & Jenny

Scandinavia ban the use of amalgam

In 1998 proposed a law that would gradually discontinue the use of mercury

No mercury in thermometersDiscussion between patient and dentist,

where dentist recommends plastic filling materials

Amg. is only recommended in cases where patient cant take care of oral hygiene (old, downs syndrome etc..)

Total mercury ban

In 2008, Norway, Sweden and Denmark implemented a total mercury ban, which also ment amalgam as a tooth filling material. The reason for that is that mercury is a poiseous material, and it accumulates in aninmals and people.

Amalgam

Has been used for over 100 yearsComposition:

45-50 % mercury 20-40 % silver 9 – 16 % tin 9 – 16 % cupper

Properties

Good- It is cheap, easy to work with, its strong,

durable, abrasion resistant, doesn’t interact with biological fluids, antimicrobial etc.

Bad - hydroscopic expansion, creep, brittle,

amalgam only has a mechanical retention to the tooth, meaning you have to remove a lot more of the tooth substance than you would have for e.g. composite. Also, from an aesthetic point, it looks grey and silvery and will also discolour the rest of the tooth

Banning of dental amalgam

1st of January 2008Most countries using amalgam find more

advantages than disadvantages and do not understand the reason for the total ban of amalgam

They call it ”The Scandinavian disaster”Lack of good arguments to stop the usage of

amalgams

Amalgam vs. composite

Wear characteristics as tooth tissueCorrosion - margin sealBacteriostaticDo not require dry field (saliva, blood)Can be used for subgingival fillingsLonger lasting (up to 30 years)

Toxicity

Toxic for our bodyRelease of free ions when reacting with

other metalsMercury is being taken up by fishIt can cross the placenta and be harmful to

the fetus of pregnant womenIt can result in allergies. There has been

talk of people experiencing symptoms of mercury poisioning

Can cause:

Small doses – hard to measure the exact amount accumulated

Accumulation mainly in the liver and kidneyFrequent contributor to oral lichenoid lesionsAutoimmune diseases

Mercury poisioning

▪ Tremors▪ Emotional changes (e.g., mood

swings, irritability, nervousness,excessive shyness)

▪ Insomnia▪ Neuromuscular changes (such as

weakness, muscle atrophy)▪ Headaches▪ Disturbances in sensations▪ Changes in nerve responses

Mercury poisioning

Impairment of the peripheral visionDisturbances in sensations (”pins and

needles” feelings, usually in the hands, feet and around the mouth)

Lack of co-ordinated movementsImpairment of speech, hearingMuscle weakness

Effects for the dentist:

Mild effect when compared to general population

According some research, dentists lagged behind in some areas, as: Memory Co-ordination Motorspeed Concentration Increased urinary mercury level Kidneydisorderscompared to normal population

Unknown if this is linked to amg

How it can affect the dentist:

Important to use a low speed handpiece with cooling when polishing a new amalgam filling

If temperature is above 60 °C, the properites of amalgam are destroyed and it releases mercury

Most important isits harmful effecton the environment.It is a poisenousmaterial that isunwanted in the nature.It finds its way back tonature via sewers fromdental offices, cremations,

industry etc.

= Mercury release 2008

WHO conclusion – mercury toxicity 2003

Dental amalgam - most common form of exposure to mercury in the general population

Intestinal absorption varies greatly among the various forms of mercury (dental amalgam is the least absorbed type)

Absorption varies according bruxism Less fillings due to improved hygiene No relationship was observed between the mercury release

from amalgam fillings and the mercury concentration in basal brain

Even at very low mercury levels, subtle changes in visual system function can be measured

MS patients with amalgam fillings, red blood cells, haemoglobin, hematocrit, thyroxine (T4) and T-lymphocytes levels are significantly lower, while blood urea nitrogen and hair mercury levels are significantly higher

Our conclusion

Considering all the advantages using amalgam and the lack of good reasons why we should ban this filling material, we don’t support this decision. Since Norway is a small country, the environmental consequenses of us not using amalgam will not make a big difference world wide

Sources

http://www.medicinenet.com/mercury_poisoning/page2.htm

http://www.denpro.no/amalgam-forgiftning.html

Norwegian dentistry journals