Another important step toward a mercury-free future was taken last week: The EPA formally proposed its long-awaited rule on mercury discharges from dental offices. It would require dentists “to cut their dental amalgam discharges to a level achievable through the use of the best available technology (amalgam separators); and the use of other Best Management Practices.”
“This is a common sense rule that calls for capturing mercury at a relatively low cost before it is dispersed into the POTW [publicly owned treatment works],” said Kenneth J. Kopocis, deputy assistant administrator for EPA’s Office of Water.
Of course, the ideal thing would be to quit using this outdated material – mercury amalgam – all together so, eventually, separators won’t be needed at all. But so long as there are dentists who continue to use it and so long as it remains in anyone’s mouth, the requirement is an important safeguard for the health of the environment and natural resources on which we depend.
And it’s a simple thing to do, really. As NYPIRG’s Laura Haight put it,
Setting a pretreatment requirement for dental offices is a cost effective method of keeping mercury out of our environment…. Amalgam separators are widely available, straightforward to install, operate without electricity or chemical addition, have low installation and maintenance costs, and facilitate easy recycling of mercury from dental fillings.
The EPA notes that their proposed rule “represents one way that the United States is meeting the goals of the Minamata Convention on Mercury.”
Meanwhile, the European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) has released the follow-up to its 2008 report – a report which insisted that mercury is a-ok to put into teeth, posing no risk human health. The many problems plaguing that report were addressed brilliantly by Dr. Joachim Mutter in a 2011 paper published in the Journal of Occupational Medicine and Toxicology.
Presumably, many of those problems persist in the panel’s new report, which at time tends to echo the previous one. Both amalgam and composite are fine, they say. Both note possible toxicity concerns with some amalgam alternatives.
But due in part to the Minamata Convention – which has forced the conversation toward an actual phase-out of mercury amalgam: what it might involve and how it might be brought about – SCENIHR now suggests that at least in some cases, “alternative materials to amalgam should be the first choice.”
The choice of the restorative material for treating dental cavities depends on a large number of variables, e.g. the size of the defect, the technical circumstances for restoration placement, and individual health problems like allergies, material properties, or the available funds. Therefore, the final decision on which material should be used in the individual case can only be made in the single situation between the dentist and the patient, based on informed consent.
Though the “first choice” recommendation extends only to children and pregnant women, European health scientists lauded the stance.
Many EU countries – including Sweden, Finland, and Denmark, among others – have virtually phased out amalgam use, indicating that the alternatives are more than adequate.
Dr. Bent Christiansen, a dentist from Denmark’s Jutland, said “Amalgam alternatives are now used in the overwhelming majority of cases. From a dentist’s perspective, the alternatives are plainly superior to amalgam, which requires invasive removal of good tooth matter. By contrast, alternatives are minimally invasive.”
And there’s another thing to appreciate about SCENIHR’s statement about choosing materials based on the individual case. It’s the same idea that informs our insistence on biocompatibility testing for each patient. That testing is critical in determining which materials we use – which will be safest, most durable and most functional. It necessarily excludes any composites, ceramics or cements that the individual may react to. Biocompatibility testing helps us find the best options.
Mercury amalgam is biocompatible for exactly no one.
SCENIHR’s report is now open for public comment. Instructions for doing so are available here.
As for the new EPA rule, the agency will accept public comments on the proposal for 60 days following publication in the Federal Register. A public hearing is also scheduled for November 10 at 1 p.m. in the William J. Clinton East Building, Room 1153. The agency expects to finalize the rule in September 2015.
We installed our first amalgam separator more than 20 years ago – because it was a good idea. We’re very glad that the EPA has now acted on the issue, because it is as good an idea as ever. The overdue movement toward the end of mercury fillings now has the groundwork in place.
“Frankly,” adds Dr. Glaros, “I never thought I would still be in practice to see these changes. Wow! And a big thank you to Charlie Brown for all his work in making them happen!”