By Kathryn Kranhold
Staff Reporter of The Wall Street
Journal
May 10, 2001
The Wall Street Journal, Page B1
Dentists are suing state regulators over what they
contend is a gag order preventing them from discussing
with patients the potential health hazards of the most
common form of dental filling.
At issue are those silver-colored fillings that dot
most people's teeth. Referred to by the dental
profession as silver amalgam, the fillings are actually
about half mercury, with some silver, copper, tin and
zinc mixed in.
Mercury opponents argue that mercury vapor coming
from the fillings seeps into the body, contributing to a
range of health problems from fatigue and immunity
suppression to neurological diseases such as Parkinson's
and Alzheimer's. The dental establishment, including the
American Dental Association, argues that the low level
of vapor causes no harm and that raising such safety
issues with patients would unduly alarm them. The
science on the issue is inconclusive.
The suit was filed yesterday in federal court in
Greenbelt, Md., by five dentists and seven patients
claiming injury from the mercury in their fillings. The
plaintiffs argue that dental regulators use
"control of dental licenses to punish, or to
threaten punishment of, dentists who criticize mercury
amalgam," violating the dentists' First Amendment
rights. In 1999, for example, the suit claims that the
Maryland Board of Dental Examiners ordered dentist Bill
DeLong to stop testing his patients to determine whether
mercury vapor was coming off their fillings. (The case
was eventually dropped.)
The dentists' attorney, Charles Brown of Washington,
D.C., says the plaintiffs want the court to order
licensing boards to stop enforcing any policy that
"prevents, limits or intimidates dentists"
from discussing the controversy or advocating
"mercury-free" dentistry. The suit also seeks
certification as a defendants' class action naming 50 of
the country's 52 licensing agencies.
In a statement released yesterday, Maryland's
licensing-board administrator, Art Williams, said the
board "acted lawfully and has done so in order to
protect consumers."
The dental establishment maintains that some dentists
have used the controversy over mercury's safety to
encourage patients to remove amalgam fillings and
replace them with more expensive materials such as gold,
porcelain and a tooth-colored resin composite. Resin,
the least expensive alternative, costs as much as 25%
more than fillings containing mercury.
J. Rodway Mackert Jr., a professor at the Medical
College of Georgia who is an ADA spokesman, says that
discussing mercury when patients are in the dentist's
chair would be a disservice to them. "If you have
one side claiming it isn't safe, that doesn't mean that
side is right," he says.
Nevertheless, state legislatures in New York and
Maine are debating bills that would require dentists to
disclose to patients the makeup of their fillings. New
York Assemblyman Richard Brodsky's bill would also ban
dentists from filling cavities in pregnant women and
children with mercury. A Vermont bill would require
dental offices to track how much mercury they use in
fillings. And California's dental board is considering
spelling out the pros and cons of different fillings in
a consumer fact sheet.
Minnesota's dental board may also become more
amenable to alternatives to mercury. In 1999,
Minneapolis dentist Ronald King, who advertises
"dental care that integrates conventional and
alternative philosophy," was appointed to the board
by Gov. Jesse Ventura. He is now on a committee that
hears complaints about dentists, including mercury-free
dentists. Dr. King says other board members now see him
"as a colleague instead of a weird guy with his own
agenda."
The Amalgam Wars began in the mid-1800s, when dentists
first started using mercury-based material to treat
tooth decay. Originally, it was the dentists who used
mercury who came under fire from colleagues who didn't
believe it was as safe as gold or tooth extractions. But
soon, mercury became the material of choice, mostly
because it was cheaper and easier to use -- and it was
less painful than having hot gold poured into a tooth.
In 1976, when the U.S. Food and Drug Administration
began regulating medical devices, it grandfathered in
mercury-based fillings as an approved dental material.
The ADA, which once had a patent on mercury fillings,
maintains that mercury is safe once it is mixed with
other metals and set in teeth, but it warns dentists
about the "potential hazard of mercury vapor"
when they handle the material.
In a 1999 report, the Agency of Toxic Substances and
Disease Registry, a division of the U.S. Department of
Health and Human Services, concluded there is no
apparent health hazard but urged further study to
"determine the possibility of more subtle
behavioral or immune-system effects, and to determine
the level of exposure that may lead to adverse effects
in sensitive populations." Fillings could
contribute as much as 75% of a person's daily mercury
exposure, the report said, noting that the vapor is
released during chewing and because of corrosion.
Judith Baker, a South Bend, Ind., accountant and a
plaintiff in the Maryland suit, was so sick she had her
gallbladder removed in 1999. But another doctor later
diagnosed her with mercury poisoning stemming from a new
filling containing mercury and the replacement of two
old mercury fillings with a larger one. Ms. Baker says
she was skeptical and had her well water tested for
mercury and her house tested for fumes before asking a
dentist to remove her fillings earlier this year. She
says she is starting to feel better after going through
mercury detoxification treatment.
Boyd Haley, a University of Kentucky chemist who has
published several studies using rats and human brain
samples, says his work shows that brain tissue exposed
to mercury develops the same biochemical defects seen in
Alzheimer's disease. But even Dr. Haley doesn't theorize
that the fillings cause significant adverse health
effects in everyone. "Certain patients, due to
genetics or illness or other toxic exposures, could be
more sensitive to the amount of mercury normally
released from dental amalgams," he says.
The ADA responds by pointing to a study published in
its journal that concluded that mercury in fillings
"does not appear" to be a factor in the
development of Alzheimer's disease. But one of the
study's authors, chemist Charles Cornett, is wary of
that conclusion. He says the study failed to evaluate
how different people process mercury, among other
factors.
Two large clinical trials sponsored by the National
Institutes of Health are now under way with the goal of
determining how school children with and without mercury
fillings develop. Results of those studies won't be
known until at least 2005.
Meanwhile, the Maryland board is proposing a new rule
that states that removing "serviceable mercury
amalgam restorations" is unprofessional without
informed consent that includes telling the patient that
"there are no verifiable systemic health benefits
resulting from the removal."
Dr. DeLong strongly disagrees. After he removes their
mercury-base fillings, he says, patients "report
not only feeling better but having whatever problems
they came in with disappear over time."
http://www.ada.org/prof/govt/dentistryworks/letters/010511amal.html
Amalgam
ADA Letters
May 11, 2001
The Honorable Dan Burton
Chairman
Committee on Government Reform
U.S. House of Representatives
Washington, D.C. 20515
RE: Autism - Why the
Increased Rates? A One Year Update
Dear Mr. Chairman:
The American Dental Association
(ADA) requests that the Committee on Government Reform
accept this letter as a statement for the record for the
committee's hearing on April 25, entitled "Autism
-- Why the Increased Rates? A One Year Update."
During the hearing, Dr. Boyd E.
Haley stated in his testimony that elementary mercury
from dental amalgams could work synergistically with
other ethyl-mercury sources and have a cumulative toxic
affect on the body. Dr. Haley postulated that this could
be a potential cause of autism and Alzheimer's disease.
There is no scientifically valid
evidence linking either autism or Alzheimer's disease
with dental amalgam. And there is no scientifically
valid evidence demonstrating in vivo transformation of
inorganic or mercury vapor into organo mercury species
in individuals occupationally exposed to amalgam mercury
vapor. (Chang, S.B. et al., Factors Affecting Blood
Mercury Concentrations in Practicing Dentists; Journal
of Dental Research 1992, 71(1) 66-74).
Based on currently available
scientific evidence, the ADA believes that dental
amalgam is a safe, affordable and durable material for
all but a handful of individuals who are allergic to one
of its components. It contains a mixture of metals such
as silver, copper and tin, in addition to mercury, which
chemically binds these components into a hard, stable
and safe substance. Dental amalgam has been used for
more than 150 years and, during that time, has
established an extensively reviewed record of safety and
effectiveness.
Issued in late 1997, the FDI World
Dental Federation and the World Health Organization
consensus statement on dental amalgam stated, "No
controlled studies have been published demonstrating
systemic adverse effects from amalgam
restorations." The document also states that, aside
from rare instances of local side effects of allergic
reactions, "the small amount of mercury released
from amalgam restorations, especially during placement
and removal, has not been shown to cause any … adverse
health effects."
The ADA's Council on Scientific
Affairs' 1998 report on its review of the recent
scientific literature on amalgam states: "The
Council concludes that, based on available scientific
information, amalgam continues to be a safe and
effective restorative material." The Council's
report also states, "There currently appears to be
no justification for discontinuing the use of dental
amalgam."
In an article published in the
February 1999 issue of the Journal of the American
Dental Association, researchers report finding
"no significant association of Alzheimer's disease
with the number, surface area or history of having
dental amalgam restorations" and "no
statistically significant differences in brain mercury
levels between subjects with Alzheimer's disease and
control subjects."
The U.S. Public Health Service
issued a report in 1993 stating there is no health
reason not to use amalgam, except in the extremely rare
case of the patient who is allergic to a component of
amalgam. This supports the findings of the Food and Drug
Administration, the National Institutes of Health
Technology Assessment Conference and the National
Institute of Dental and Craniofacial Research, that
dental amalgam is a safe and effective restorative
material.
There have been several peer
reviewed scientific studies concerning the safety of
dental amalgam. These studies disprove any link between
dental amalgam and various medical conditions. We have
listed some of them below:
Dental
Information
