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Dentists advised to stop use of amalgam for children

Dentists should stop using amalgam in children, under new regulations that have come into effect in the UK from 1 July 2018.

The BDA has issued an alert to the profession over use of dental amalgam. It is highlighting a European Union (EU) directive, which now insists amalgam should not be used in the treatment of deciduous teeth, in children under 15 years old, and in pregnant or breastfeeding women, unless it is deemed strictly necessary by a dentist based on the specific medical needs of the patient.

The union said the law has been passed on the basis of environmental concerns about mercury pollution, and did not reflect any evidence-based concerns about adverse effects of amalgam on human health.

Dentists have been advised to:

  • Follow guidance1 from the SDCEP (Scottish Dental Clinical Effectiveness Programme) on putting the restrictions into practice, which is relevant for dentist in all of the four UK countries

  • Print out leaflets2 provided to give to patients

  • View the 'Discussion Points'3 document to inform conversations with patients.

The BDA has been lobbying globally for over ten years regarding the move towards phasing down the use of dental amalgam. Several EU countries called for a blanket ban on using dental amalgam when the EU Mercury Regulation was debated, but the BDA has sought a slower phasing in, arguing that it was not practical for UK dentists, nor necessarily in patients' best interests to implement an immediate ban.

The BDA has argued that it should be up to dental practitioners to recommend the best restorative option for their patients on a case by case basis. As a result, the wording of the new regulation leaves scope for dentists to exercise clinical judgement.

In answer to some practitioners' concerns about the increased time required and extra costs of using other materials, particularly those who are working under a NHS or health service contracts, the BDA said it was pressing the devolved government departments to address these concerns and to find a workable solution to ensure dental practitioners were not financially disadvantaged. The union is seeking a meeting with NHS England on the issue and is doing similar lobbying work in Wales.

In Northern Ireland, four new fees for the provision of non-amalgam fillings for under 15-year-olds and pregnant/breastfeeding women have been agreed and the Scottish government has introduced relevant fees for children under 15 years old with a review of the fees in 12 months time.

From January 2019, dental amalgam must be used only in pre-dosed encapsulated form and amalgam separators will be mandatory – something that most dental practices in the UK already conform to under existing compliance requirements.

By July 2019, the UK must have a national plan in place to outline its intended measures to reduce dental amalgam use.

References

  1. 1

    NHS Education for Scotland. Restricting the Use of Dental Amalgam in Specific Patient Groups: Implementation Advice. Available at http://www.sdcep.org.uk/wp-content/uploads/2018/06/SDCEP-Dental-Amalgam-Implementation-Advice.pdf (accessed 4 July 2018).

  2. 2

    NHS Education for Scotland. Scottish Dental Clinical Effectiveness Programme. Restricting the Use of Dental Amalgam in Specific Patient Groups. Available at http://www.sdcep.org.uk/published-guidance/dental-amalgam/ (accessed 4 July 2018).

  3. 3

    NHS Education for Scotland. Restricting the Use of Dental Amalgam in Specific Patient Groups: Discussion Points. Available at http://www.sdcep.org.uk/wp-content/uploads/2018/06/SDCEP-Dental-Amalgam-Discussion-Points.pdf (accessed 4 July 2018).

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Dentists advised to stop use of amalgam for children. Br Dent J 225, 107 (2018). https://doi.org/10.1038/sj.bdj.2018.607

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