The April 2015 edition of GDC Update, the General Dental Council’s monthly newsletter to registrants, was published recently and buried in the middle was an important section on dental amalgam.
It’s worth noting that this has come about due to the efforts of the Good Thinking Society, a charity set up to promote rational thinking and fight pseudoscience, a cause which the dental profession should be embracing
The GDC remind registrants that, ‘whilst some patients may choose to opt for mercury-free dentistry, patients should not be led to believe that the use of dental amalgam is unsafe.’ They also say that, ‘The “Standards for the Dental Team” make it clear that registrants must not mislead patients. This would include making misleading claims about the safety of mercury in dental amalgam, encouraging or pressuring patients to have treatment that is more expensive and not in their best interests, and putting financial gain before the needs of the patient.’
The Council are not the only body to take a stance on the safety of dental amalgam.
The American Dental Association have a well referenced statement on the safety of amalgam restorations where they conclude that ‘based on available scientific information, amalgam continues to be a safe and effective restorative material.’
The BDA have their own stance on the safety of amalgam (PDF), saying that it is ‘a safe material to use in restorative dentistry with respect to patients’ while recognising the need (PDF) to phase down usage due to the environmental effects, as agreed in the Minamata Convention on Mercury.
SCENIHR have just published their report (PDF) into the safety of dental amalgam and alternative dental restoration materials for patients and users. They agree with the basis of the Minamata Convention but conclude that ‘current evidence does not preclude the use of either amalgam or alternative materials in dental restorative treatment’ and ‘there is no general justification for unnecessarily removing clinically satisfactory amalgam restorations, except in those patients diagnosed as having allergic reactions to one of the amalgam constituents,’ although they do also suggest further research into possible health effects.
The American Food and Drug Administration state that ‘The weight of credible scientific evidence reviewed by FDA does not establish an association between dental amalgam use and adverse health effects in the general population.’
The WHO have a 65 page paper detailing current and future use of dental material where they note the FDI statement (PDF) that ‘amalgam is a safe, widely used and affordable dental filling material and currently serves the oral health needs of the majority of communities around the world, particularly those most disadvantaged and in need of dental treatment’ and the IADR stance that ‘scientific evidence indicates that currently used restorative materials, including dental amalgam, cause no or very few significant side-effects.’
For my own personal take on the safety of amalgam, take a look at this previous post on some of the wilder claims that are out there.
In the update the GDC reinforced a number of standards of care including:
7.1 You must provide good quality care based on current evidence and authoritative guidance
These statements may sound fairly obvious, but they’re important.
There are a number of dentists and ‘health experts’ out there making wild health claims regarding the removal of amalgam fillings — from rather vague ‘improved wellness’ to much more specific claims regarding preventing or curing conditions including Alzheimer’s disease and cancer.
The majority of dentists will agree that these claims are not evidence based, and will hopefully agree with the recommendations of the Council.
The recommendations may have much wider repercussions, though. The GDC are here reinforcing the ‘evidence-base dentistry’ approach to practise. A lot of dental practise is based on flimsy evidence, but in the last 10-15 years publications such as the BDJ’s Evidence Based Dentistry supplement have moved this forward in leaps and bounds.
There is, however, a fringe of the dental world which recommends such ‘complementary’ therapies as homeopathy, chiropractic and other ‘holistic’ dentistry. These dentists will specialise in things like treating lesions that probably don’t exist, as well as recommending treatment such as ozone therapy, where the evidence for clinical efficacy is poor.
The GDC have reinforced the need to practise evidence-based dentistry wherever possible, and surely now the registrants promoting such evidence-less practice are open to fitness to practise proceedings, with little in the way of defence.
The GDC statement will not affect the vast majority of the profession, but this should act as a reminder to dentists to practise within the boundaries of available evidence. It should also give patients the confidence to challenge poor advice.