NZ too slow to act on banning the use of amalgam in children
New Zealand is too slow to act on banning the use of amalgam in children
A New Zealand dentist and a leader in dental laser technology practices, Dr Hisham Abdalla thinks the New Zealand government needs to act now and follow the European Union lead and ban the use of amalgam in children.
The European Union has agreed to enact a ban on dental amalgam fillings use in children under 15 years old and in pregnant and breastfeeding women. The ban takes effect on July 1, 2018.
The amalgams have been condemned as a risk for ‘secondary poisoning’ by a European Commission scientific advisory board due to its presence in several fish species many people consume.
Dr Hisham Abdalla (Dr Hisham) is a New Zealand dentist and operates an advanced dental clinic, Laser Life Care Institute in Auckland. He was New Zealand’s first dentist to introduce laser use in dentistry for its non-invasive and healing properties. His dental philosophy is always looking at better, safer and less invasive ways of doing things. He was the youngest graduate Doctor in the history of his University in 1998, starting medical school at 14 and graduating with honours at 21.
He has been a long-term opponent of the use of amalgam and believes the New Zealand government should ban amalgam now due to increased quality and durability of alternative materials.
Dr Hisham says “New Zealand needs to realise amalgam is now considered an inferior product. We need to set objectives for the phase down aimed at minimising or banning amalgam use. I would also like to see the NZ Dental Association actively promote the use of cost-effective and clinically-effective mercury-free alternatives instead of supporting amalgam as a safe tooth restoration material.”
Common reasons cited for justifying the sustained use of amalgam is the relative cheap cost versus porcelain and composite.
Dr Hisham says this simply isn’t the case. “What the government is really saying is that it’s cheaper for them to continue to use amalgam in children. Dental services are free for children in New Zealand until they leave high school – but once they are adults, they have to deal with the corrosion of amalgam in their teeth which is a very expensive exercise.”
Amalgam has been the most common tooth restoration material for the past 100 years. The mercury content in metal amalgams can be up to 46-50%. Mercury emissions from these amalgams occur both during the fitting of the filling and during wear within the mouth. Emissions also occur during restoration of broken amalgam fillings.
Currently the use of mercury amalgam in fillings is considered safe by the Ministry of Health and there is no conclusive evidence to say that amalgam is a health risk. Dr Hisham says there is also no evidence to say there is no health risk from the use of amalgam and the disposal of the toxic material is an issue. Much of the mercury absorbed into the body will be excreted and end up in the wastewater systems in towns and cities, with much of that, in turn, being adsorbed on sewage sludge or biosolids.
The Minamata Convention on Mercury is a global treaty to protect human health and the environment from the adverse effects of mercury. The Minamata convention advocates a phase-down of the use of dental amalgam, in line with the domestic circumstances of each country and in tandem with recommendations for prevention programmes and increased research into alternative materials.
The Convention is named after the Japanese city Minamata. This naming is of symbolic importance as the city went through a devastating incident of mercury poisoning. It is expected that over the next few decades, this international agreement will enhance the reduction of mercury pollution from the targeted activities responsible for the major release of mercury to the immediate environment – of which dental amalgam is one such use.
Dr Hisham says there is no signs of the government acting to reduce the use of amalgam.
“Continuing to use amalgam on children creates issues of disposal in the years to come. It increases the risks of secondary poisoning and the use of amalgam also exposes New Zealand dentists, their patients and the environment to the toxic effects of mercury. It is irresponsible to keep using it with its known environmental effects”.
Dr Hisham maintains that amalgam doesn’t last a life time and he sees plenty of baby boomers and Gen Xers through the doors of Laser Life Care Institute, whose teeth are cracking from the corrosion of their amalgam fillings.
“When amalgam fails the entire tooth fails, often at a much higher cost to the patient who then requires root canals, crowns or extractions – it’s a complete fallacy to say amalgam is cheaper when ultimately the patient pays many years down the track.”
Dentists then have to take the amalgam out and safely dispose of it so it doesn’t find its way into the environment.
In New Zealand there is no national standard for the disposal of amalgam. Instead it is regulated by local territories and Dr Hisham says he has never been contacted about how he disposes of amalgam and suspects some dentists who don’t have amalgam separators like he and many other dentists do, could still be flushing it into the waterways.
Dr Hisham says if New Zealand banned amalgam and started using composites in children there wouldn’t be this problem of mercury disposal and potential poisoning of the environment. He has been using composites and porcelain since leaving dental school 19 years ago.
“Composite and porcelain are very good restoration materials if the technique to place them is done correctly. It is a more complex procedure than using amalgam and dentists have to advance their training to use them successfully. If it’s not done correctly then there can be problems.”
Dr Hisham believes there needs to be stricter regulation to ensure no amalgam is getting into waterways. He says the handling of mercury by dentists should be a central government regulation, not left to territorial authorities to enforce.
“The longer the government takes to move on this issue, the longer we as a nation continue to poison the environment with a product in the same league of toxicity as lead. The use of amalgam remains protected by the government - meanwhile the side effects of handling the product and disposing of it is extremely damaging”.