Monday, July 30, 2012

NYU Dental School To Become Amalgam Free

Dental amalgam has been a successful restorative agent utilized for nearly 150 years. During this time, there have been many assaults on the safety of amalgam yet its functionality and safety remain essentially unquestioned. Certain other facts also remain unquestioned. Preparations, designed to retain amalgam restorations, are less conservative and more destructive of tooth structure than preparations designed for bonded restorations utilized to treat the exact same carious lesion. The current generation of bonded restorations permit lesion specific dental care to be administered in the most tooth conservative fashion rather than preparation designs created to retain dental amalgam. Today, and for the past seven years, we teach our students that tooth conservative, caries specific restorations are in the best interest of the long-term oral health of the patient and deliver the best care. Research worldwide, substantiates the need for these caries specific restorations and private practice based research has shown that even in extensive restorations bonded resin based composite performs as well or better than amalgam over a 12 year period (Opdam et al., 2010). Bonded restorations on molars and premolars show excellent results when followed for 22 years(Da Rosa Rodolpho et al., 2011).
Recently the United Nations Environmental Program, supported in part by the United States Department of State, has proposed a legally binding global treaty on mercury pollution and is recommending phasing out the use of mercury containing products including amalgam. If this treaty becomes reality all dentists may face a global mandate to stop the use of amalgam as a restorative material. Dental amalgam is cited as a major source of environmental mercury contamination. A 2002 study by the New York Academy of Sciences, Pollution Prevention and Management Strategies for Mercury in the New York/New Jersey Harbor, indicated that as much as 40 percent of total mercury loading in the New York/New Jersey harbor and watershed may have come from dental offices. In another study in 2002, the National Association of Clean Water Agencies (NACWA) estimated that nearly 40 percent of the mercury in the nation’s wastewater system came from dental offices, and that mercury discharged from dental offices far exceeded all other commercial and residential sources, each of which was below ten percent.
In addition, amalgam restorations represent fewer than one in ten posterior restorations in our own dental care facility. Students have difficulty convincing patients to have these procedures performed to complete our competency requirements.
In light of these recent developments NYU College of Dentistry has taken the initiative to become “amalgam free”.
Beginning immediately: All treatment plans should consider alternative restorative materials other than amalgam. Existing amalgam restorations that are deemed clinically acceptable should NOT be replaced. Amalgam will still be available at the supply area and will require justification by faculty for placement. Students will still receive pre-clinical training in the use of amalgam with special attention to the indications and contra-indications Strict mercury hygiene when using amalgam will be maintained in both the clinic and pre-clinical settings
The College of Dentistry will continue to seek the best alternative techniques and materials possible for the health of our patients and provide the highest quality of care.
References
Da Rosa Rodolpho PA, Donassollo TA, Cenci MS, Loguercio AD, Moraes RR, Bronkhorst EM et al. (2011). 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dental materials : official publication of the Academy of Dental Materials 27(10):955-963.
Opdam NJ, Bronkhorst EM, Loomans BA, Huysmans MC (2010). 12-year survival of composite vs. amalgam restorations. J Dent Res 89(10):1063-1067.

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