AND WHY IT IS BANNED IN NORWAY Dental amalgam Anette & Jenny

Scandinavia ban the use of amalgam In 1998 proposed a law that would gradually discontinue the use of mercury No mercury in thermometers Discussion between patient and dentist, where dentist recommends plastic filling materials Amg. is only recommended in cases where patient cant take care of oral hygiene (old, downs syndrome etc..)

Total mercury ban In 2008, Norway, Sweden and Denmark implemented a total mercury ban, which also ment amalgam as a tooth filling material. The reason for that is that mercury is a poiseous material, and it accumulates in aninmals and people.

Amalgam Has been used for over 100 years Composition:  % mercury  % silver  9 – 16 % tin  9 – 16 % cupper

Properties Good - It is cheap, easy to work with, its strong, durable, abrasion resistant, doesn’t interact with biological fluids, antimicrobial etc. Bad - hydroscopic expansion, creep, brittle, amalgam only has a mechanical retention to the tooth, meaning you have to remove a lot more of the tooth substance than you would have for e.g. composite. Also, from an aesthetic point, it looks grey and silvery and will also discolour the rest of the tooth

Banning of dental amalgam 1st of January 2008 Most countries using amalgam find more advantages than disadvantages and do not understand the reason for the total ban of amalgam They call it ”The Scandinavian disaster” Lack of good arguments to stop the usage of amalgams

Amalgam vs. composite Wear characteristics as tooth tissue Corrosion - margin seal Bacteriostatic Do not require dry field (saliva, blood) Can be used for subgingival fillings Longer lasting (up to 30 years)

Toxicity Toxic for our body Release of free ions when reacting with other metals Mercury is being taken up by fish It can cross the placenta and be harmful to the fetus of pregnant women It can result in allergies. There has been talk of people experiencing symptoms of mercury poisioning

Can cause: Small doses – hard to measure the exact amount accumulated Accumulation mainly in the liver and kidney Frequent contributor to oral lichenoid lesions Autoimmune diseases

Mercury poisioning ▪ Tremors ▪ Emotional changes (e.g., mood swings, irritability, nervousness, excessive shyness) ▪ Insomnia ▪ Neuromuscular changes (such as weakness, muscle atrophy) ▪ Headaches ▪ Disturbances in sensations ▪ Changes in nerve responses

Mercury poisioning Impairment of the peripheral vision Disturbances in sensations (”pins and needles” feelings, usually in the hands, feet and around the mouth) Lack of co-ordinated movements Impairment of speech, hearing Muscle weakness

Effects for the dentist: Mild effect when compared to general population According some research, dentists lagged behind in some areas, as:  Memory  Co-ordination  Motorspeed  Concentration  Increased urinary mercury level  Kidneydisorders compared to normal population Unknown if this is linked to amg

How it can affect the dentist: Important to use a low speed handpiece with cooling when polishing a new amalgam filling If temperature is above 60 °C, the properites of amalgam are destroyed and it releases mercury

Most important is its harmful effect on the environment. It is a poisenous material that is unwanted in the nature. It finds its way back to nature via sewers from dental offices, cremations, industry etc.

= Mercury release 2008

WHO conclusion – mercury toxicity 2003 Dental amalgam - most common form of exposure to mercury in the general population Intestinal absorption varies greatly among the various forms of mercury (dental amalgam is the least absorbed type) Absorption varies according bruxism Less fillings due to improved hygiene No relationship was observed between the mercury release from amalgam fillings and the mercury concentration in basal brain Even at very low mercury levels, subtle changes in visual system function can be measured MS patients with amalgam fillings, red blood cells, haemoglobin, hematocrit, thyroxine (T4) and T-lymphocytes levels are significantly lower, while blood urea nitrogen and hair mercury levels are significantly higher

Our conclusion Considering all the advantages using amalgam and the lack of good reasons why we should ban this filling material, we don’t support this decision. Since Norway is a small country, the environmental consequenses of us not using amalgam will not make a big difference world wide

Sources age2.htm age2.htm Norwegian dentistry journals