Amalgam filling (the dark-coloured mercury tooth filling) is hardly being used these days by dentists in Jamaica. But, Dr Tanya Perry, president of the Jamaica Dental Association, said that the decline in use of the controversial mercury filling, is not so much for its health risks, as for cosmetic reasons.

"Patients (in Jamaica) want a cosmetically appealing filling. They prefer the tooth-coloured filling which is not as obvious when they laugh or smile," Perry said.

It is perhaps just as well that the use of mercury fillings is declining in popularity here as, after years of controversy, lobbying pressure from various groups and deliberations, the US Food and Drug Administration (FDA) in July shifted this type of filling from class one (low risk) to class two (moderate risk).

However, Dr Perry said that the reclassification "reaffirms the views that dental amalgam is a safe filling material". She also indicated that gold and tooth-coloured composite filling materials which are commonly used in the mouth are also found in the class two category.

Reclassification allows proper use

"A class two classification simply means that the material needs to be used as recommended and follow certain guidelines. Most medical and dental materials fall under this classification to allow proper usage and regulation of the products. Patients can rest assured if they have amalgam fillings or intend to get them in the future, that amalgam fillings are safe and strong with a proven track record," Dr Perry said.

It is believed that dental amalgam fillings produce mercury vapour but the FDA, even while stepping up the classification, still states that the mercury vapour level is too low to pose a health risk. While elemental mercury has been associated with adverse health effects at high exposures, the FDA said that the levels released by dental amalgam fillings are not high enough to cause harm in patients.

The FDA states in its July 28, 2009 report that it "has reviewed the best available scientific evidence to determine whether the low levels of mercury vapour associated with dental amalgam fillings are a cause for concern. Based on this evidence, the FDA considers dental amalgam fillings safe for adults and children ages six and above. The amount of mercury measured in the bodies of people with dental amalgam fillings is well below levels associated with adverse health effects."

The FDA now recommends specific labelling on the product to include:

A warning against the use of dental amalgam in patients with mercury allergy.

A warning that dental professionals use adequate ventilation when handling dental amalgam.

A statement discussing the scientific evidence on the benefits and risk of dental amalgam, including the risks of inhaled mercury vapour. The statement will help dentists and patients make informed decisions about the use of dental amalgam.

There are alternative products to amalgam filling, but the latter has been popularly used to treat cavities because it is the least-expensive filling product and is strong and long-lasting when compared to the other products. Despite these benefits, there had been an ongoing concern by special groups about the possible health risks of placing mercury in the mouth.

The FDA now says that dental amalgam, which contains elemental mercury, releases low levels of mercury vapour that can be inhaled. High levels of mercury vapour exposure are associated with adverse effects in the brain and the kidneys. The FDA said that the low levels of mercury vapour released by dental amalgam have not been associated with health problems in adults and children over six years old.

Alternatives

The FDA further states that "there is limited clinical information about the potential effects of dental amalgam fillings on pregnant women and their developing foetuses, and on children under the age of six, including breast-fed infants. However, the estimated amount of mercury in breast milk attributable to dental amalgam is low and falls well below general levels for oral intake that the Environmental Protection Agency considers safe."

Alternatives to dental amalgam (which also have advantages and disadvantages to use) include:

Composite resin fillings

Glass and plastic ionomer fillings

Gold foil fillings.

Eulalee Thompson is health editor and a professional counsellor; email: eulalee.thompson@gleanerjm.com.