Sir, the European Commission Scientific Committee on Health and Environmental Risks (SCHER) has published an updated opinion on the environmental risks and indirect health effects of mercury from dental amalgam at http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_165.pdf. The opinion seeks to cover three areas: Are mercury releases from amalgam a risk to the environment? Does mercury from amalgam which is then released into the environment harm human health? How does environmental risk from mercury in amalgam compare with risks from alternative restorative materials?

The report paints pictures of best to worst case scenarios and concludes that in the local extreme examples of its worst case scenario: maximal dentist density, maximal mercury use and absence of separator devices, the risk of mercury poisoning to fish-eating vertebrates cannot be excluded. Similarly in the extreme worst cases they conclude that mitigation measures might be needed to protect humans from eating contaminated fish. Looking at alternative restorative materials they acknowledge that more information is needed to inform assessments of risk to both environments and to humans. So, until we get a true replacement for amalgam, how as a profession do we respond to this report which acknowledges some risk of harm and some uncertainty?

There are some clinical circumstances where amalgam is still the only appropriate restorative material. If we wish to continue having access to the most appropriate material for those who really need it then we must place ourselves outside the worst case scenario. Amalgam separation is here to stay and we must accept that it is part of the price of using or removing old amalgam. We should also regard amalgam as a restorative material to be avoided unless there is no alternative, yet at the same time we should argue for continued ability to use amalgam when it is the only realistic treatment option. Not perhaps the message we wanted to hear, but a response which gives us a fighting chance of keeping amalgam until a true replacement is developed.

1. Penarth