D6

Elsie Hambrook
A woman's view

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I would not stray into a minefield like the pro and anti mercury dental filling issue if there were not particular concerns for women.

The web is full of sites like "toxicteeth.com" and "MomsAgainstMercury.com" and of statements by organized dentistry that mercury amalgam - sometimes called "silver" fillings - is safe. There are surveys of female dental assistants with mysteriously low fertility rates and endless debates about what the science says.

Recently, mercury dental fillings have been banned in some countries, in a move to protect both patient's health and the environment from mercury. Some cities in the United States have ordered that dentists tell patients about the dangers of mercury dental fillings and about the non-mercury alternatives.

Also last year, the United States Food and Drug Administration settled a lawsuit, brought by several groups including Moms Against Mercury, that had challenged the FDA's failure to regulate mercury amalgam. As part of the settlement, the FDA website now states that mercury in dental amalgams may pose health risks - gone are the claims that science has not proven that amalgam is unsafe. United States government health advisers recently rejected a report that concluded mercury-laden dental fillings are safe, saying further study is needed before that claim can be made.

Mercury amalgam is a commonly used material to fill cavities - it is durable, cheap and easy to use - and is especially favoured in cases where costs are being kept down.

The New Brunswick Dental Society says that dental amalgam is used in children and adults for small-to-medium-sized cavities and for teeth that absorb the intense stress and pressure from chewing.

Its use is higher among patients with limited income, which is mostly women and children. As a witness for the NAACP (National Association for the Advancement of Colored People) said to a U.S. government hearing this spring, "It's time to end mercury for the poor and choice for the rich."

Environment Canada says that the main ways that humans take in mercury are through the consumption of food, especially fish, and the application of dental amalgams. Mercury fillings contribute significantly to mercury body burden in people with such fillings, according to studies from the World Health Organization.

It is known that mercury vapour from fillings is released during chewing, tooth brushing or grinding, as well as when amalgam is placed or removed from teeth. Because of the toxicity of mercury, there are strict standards for removal and disposal of mercury amalgam. The Canadian Dental Association says that no harmful effects are known to be caused by the average levels of mercury exposure from amalgam fillings.

If mercury dental fillings are a major source of mercury in people and in the environment, then that is of concern. The risks posed by mercury to health and the environment, even at low levels, are well documented. It can be absorbed through the skin during handling and by inhalation, can accumulate in the body and can cross the placenta. Mercury in the environment is of particularly concern for children.

Health Canada does not require pre-approval of dental amalgam since it is classified as "restorative material", but it says it is a good idea to reduce exposure to mercury and recommends non-mercury fillings for the primary teeth of children, for pregnant women and anyone with kidney disease, or if fillings would be next to metal braces.

Health Canada says that dental amalgam contributes detectable amounts of mercury to the body but the levels do not approach those recognized to cause illness. It says dentists should provide patients with sufficient information to make an informed choice, including information on the risks and benefits of the material and alternatives, and should acknowledge the patient's right to decline treatment with any dental material.

Earlier this year, government ministers from around the world agreed to negotiate a treaty to control global mercury pollution, an agreement made possible by the dramatic shift in the United States position by the Obama administration. The United Nations has been calling for the elimination of the release of all mercury -- the World Health Organization says that 53 per cent of the total mercury emissions come from dental amalgam and laboratory devices.

What to do?

Evidently, the cautions issued by Health Canada should be strictly followed and groups in the population for which Health Canada recommends alternatives to mercury amalgam should be allowed by government programs and health insurance plans to obtain mercury-free fillings.

Health Canada recommends that pregnant women not have existing mercury fillings removed because of exposure to mercury vapour during removal. The Canadian Dental Association says that amalgam should not be removed unless the patient has a real -- not just a perceived -- health need, or the patient requests removal of serviceable amalgam restorations and the dentist knows that the patient has been provided with sufficient information for the removal to proceed.

Obviously, patients need to exercise their right to participate in dental care decisions. As the New Brunswick Dental Society Patients' Bill of Rights says "You have a right to ask about treatment alternatives and be told, in language you can understand, the advantages and disadvantages of each. You have a right to ask your dentist to explain all the treatment options regardless of coverage or cost."

* Elsie Hambrook is chairperson of the New Brunswick Advisory Council on the Status of Women. Her column on women's issues appears in the Times & Transcript every Thursday. She may be reached via e-mail at acswcccf@gnb.ca.