AND WHY IT IS BANNED IN NORWAY Dental amalgam Anette & Jenny
Jan 19, 2016
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