In the recent decades, the awareness and recognition of the human health and
environmental implications of mercury has increased. The World Health
Organization (WHO) and the United Nations Environment Programme (UNEP)
have strengthened the work for reduction of the mercury releases, including mercury
release related to the use of dental amalgam.
In response to the global initiatives on mercury reduction WHO supported
by UNEP organized a two-day meeting in Geneva, Switzerland to discuss
the implications to dental care of reduction in mercury release and usage.
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Oral Health Programme
The aims of the meeting were to assess the scientific evidence available on
dental restorative materials, and the practical and public health implications
of using alternatives to amalgam for dental restorative care. The meeting
aimed to share country experiences on dental care practices and the
opportunities and barriers in relation to phasing-down the use of dental
amalgam and the introduction of alternative dental restorative materials.
The following observations were made during the Geneva meeting:
Dental amalgam, a compound of mercury and silver-based alloys, has been
widely used in dental care for some 150 years. Meanwhile, for many reasons
restorative materials alternative to dental amalgam are desirable.
There is a need to prepare for a treaty on mercury use. The Geneva meeting
encourages a global “phasing-down” of the use of dental amalgam and
actively supporting the introduction of dental materials alternative to
amalgam. A global “phasing-down” of dental amalgam will contribute
considerably to reduction of mercury use and release; meanwhile, a
complete ban is not yet appropriate. The issue of equity in dental health
care needs to be carefully considered.
The Geneva meeting highlighted country experiences in dental care and
certain challenges to countries in “phasing-down” the use of dental
amalgam were noted. In particular, the challenges to low and middle income
are important as these countries have shortage of oral manpower, trouble
in supply of dental materials, problems as to affordability of materials
for dental restoration, and limitations as regards dental care facilities,
appropriate equipment, and infrastructure.
In high income countries dental caries is generally under control as the
population at large enjoys the benefits of preventive strategies and have
accessto dental care. Significant proportions of people participate in regular
dental care and may receive restorative dental care in case of manifest dental
caries. However, dental care is less accessible to underprivileged population
groups, in consequence poor dental conditions are often noted in people
having received suboptimal dental care.
In some high income countries the use of dental amalgam has decreased
while the use of alternative dental materials has increased. Emphasis on oral
health promotion and disease prevention are major reasons of these trends
in dental restoration practices. Tooth-coloured dental restorative materials
have also become increasingly more popular for aesthetic reasons.
In middle and low income countries, public health policies on oral health
promotion and disease prevention may not exist and low economic
resources may preclude implementation. Access to dental care is low due
to shortage of dentists and other dental personnel and due to the fact that
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Future Use of Materials for Dental Restoration
the cost of dental care is extremely high. People often suffer from pain or
discomfort related to dental caries, and the seeking of health care is mostly
prompted by symptoms. Problems by teeth and costly dental treatment
may often lead to tooth extractions rather than tooth restoration.
Third-party payment systems for dental care exist in several countries.
Very often such systems do not consider dental materials alternative to
amalgam and it is therefore needed to incorporate these materials into
reimbursement schemes.
Materials alternative to dental amalgam are available and particularly used
in certain patient groups mainly of high income countries. Alternative
restorative materials of sufficient quality are available for use in the
deciduous dentition of children. However, current evidence indicates that
the quality of materials alternative to amalgam is lower than for dental
restoration based on use of amalgam. Materials such as glass ionomers or
composites are promising in future dental care but there remains a need to
promote the development of quality dental restorative materials for use in
public health programmes.
All types of materials may have adverse side-effects; components of
amalgam as well as other alternative dental restorative materials may, in rare
instances, cause local side-effects or allergic reactions. Reporting systems
on adverse side-effects of dental materials are important for dental care.
The Geneva meeting discussed important ways forward in the work for
continuous reduction of exposure to mercury. The responsibilities of the
research community, the dental profession, public health authorities, thirdparty
payers, industry, UNEP, and WHO were emphasized.
A multi-pronged approach with short-, medium- and long-term strategies should be
considered. In order to prepare for phasing-down of amalgam several actions must
be undertaken by stakeholders.