Minamata Convention confirms amalgam to be gradually phased out
The final ratification of the Minamata Convention on Mercury has been agreed confirming that individual nations can work gradually to scale down the use of amalgam. The Convention is an international legally-binding treaty which is designed to protect human health and the environment from the adverse effects of mercury. The use of amalgam in dentistry is leading to mercury in waterlines which is very difficult to treat with normal water filtering processes. This is resulting in toxic mercury accumulation in the soil and water which can leach into agriculture land and accumulate in wildlife such as fish which becomes increasingly concentrated in species higher up the food chain.
The news has been welcomed by the BDA (British Dental Association), FDI (Federation Dentaire Internationale) and CED (Council of European Dentists) who have been lobbying to ensure that a complete phase-out within a short time period was avoided. Their arguments are that there is no viable replacement material for amalgam and that restrictions on its use would damage the financial stability of the dental health system and would impact patients' ability to afford dental care. This view point is also supported by the WHO who advocate the phasing down rather than phasing out of amalgam and suggest that the quality of alternative materials must be further improved for use in public dental care.
The phasing down highlights some important considerations such as the requirement for further training (both undergraduate and as CPD) in the application of composites, and the lack of training in placing amalgam restorations in certain dental schools despite it not being phased out yet. Other considerations draw on evidence from Norway which suggests that strong leadership from the Directorate of Health, acceptance of the need to change by the profession, and effective collaborative working with all stakeholders (including patients) were paramount to their success in phasing out of amalgam.
It will be interesting to see the time frame that will be suggested for the phasing down of amalgam in the UK, especially given what appears to me as a reluctance of the profession as a whole to embrace the idea. Will they follow a similar approach to Norway with a complete ban on amalgam where dentists can apply for exemptions or will this appear to be too controversial?