Over the past year, a rush of legislative proposals and lawsuits targeting dental amalgam -- or "silver" fillings -- has raised concern that dentistry's longest-lived and most affordable restorative material could be on its way out. But if amalgam is banned, millions of low-income Americans would be stripped of the only restorative material covered by Medicaid and most private insurance programs, according to the October issue of AGD Impact, the monthly newsmagazine of the Academy of General Dentistry (AGD).
Anti-amalgam forces claim recent studies indicate the mercury in amalgam fillings is hazardous and directly related to diseases including Alzheimer's, autism and multiple sclerosis, among others. But a host of public health agencies and scientific organizations worldwide say these connections are based on faulty science and insist that 150 years of scientific research and real-world application prove amalgam is safe.
"Amalgam has been around for a very long time and has been used in millions and millions of patients, and they're all doing fine," says Myron J. Bromberg, DDS, chair of the AGD Council on Dental Care.
But if anti-amalgam forces are more effective than organized dentistry at getting their message to the people who vote in the elections and serve on the juries where the debate is likely to be decided, then the science may prove to be irrelevant.
"This debate is threatening to be decided based on emotion," says Ronald D. Giordan, DDS, MAGD, AGD Legislative and Governmental Affairs Council member and chair of the council's subcommittee on amalgam issues. "But dentists have a responsibility to make their treatment decisions based on the best current science."
Proposed legislation to restrict the use of amalgam exists in Congress and in more than a dozen states. Lawsuits have been filed against the American Dental Association and state dental associations in California, Georgia, Maryland and Ohio. In April, first-term Rep. Diane Watson (D-Calif.) introduced a bill (H.R. 4163) that would prohibit after 2006 any interstate commerce of mercury intended for use in dental fillings, effectively banning the material.
In her background statement on the bill, Rep. Watson makes many scientific statements that have been widely discredited, and she accuses the dental community of abusing low-income Americans who are "forced to have such a toxic material in their mouths." Yet Rep. Watson's bill contains no provision to protect Americans who would lose access to the only restorative material covered by government-funded plans.
"The absurdity of this position is that if her bill passes, access to dental care for poor Americans will be reduced dramatically," says AGD Legislative and Governmental Affairs Council Chair Cynthia E. Sherwood, DDS. "The costs associated with composite restorations are usually triple that of using amalgam. Any ban on amalgam would have negative consequences on access to dental care." The full article, "Amalgam On Trial" is available on the AGD Web site, www.agd.org.