NYU goes “amalgam free”

Comments (11)

1. 

   Administrator Friday - 20 / 07 / 2012 Reply

   This is great news for dental students and patients alike. Especially considering amalgam cannot be made, placed, polished or removed without generating enormous amounts of mercury vapor and particulate matter that vastly exceed all known safety levels. The exposure from these routine dental procedures violate occupational safety regulations, manufacturer warnings and exceed air levels at which people are relocated from their residences. How many dental students have been taught about OSHA regulations regarding being exposed to high levels of a toxic substance? These dental students graduate with zero knowledge of how to protect themselves, staff and patients from mercury. Regardless of the true reasons of their decision, at least the dental school has now limited their liability by stopping these huge exposures. The OSHA permissible exposure limit (PEL) for mercury vapor is 100 micrograms per cubic meter of air as a ceiling limit and distinctively notes: "A worker's exposure to mercury vapor shall at no time exceed this ceiling level." yet here is what dental workers are routinely exposed to after trituration = over 2,000 ug/m3 placement (one filling) = over 400 ug/m3 polishing (one filling) = over 400 ug/m3 removal (one filling) = over 2,000 ug/m3 all of these levels are well established int eh scientific literature.
2. 

   Ashley Phares, contributing editor Friday - 20 / 07 / 2012 Reply

   I must strongly disagree with the previous comment that "this is great news for dental students and patients alike". I was shocked to hear about NYU's decision to go "amalgam free", though from this post, it seems as though the school is really just minimizing amalgam use, rather than completely eliminating it from new procedures. My first concern is for Medicaid patients. I have struggled numerous times in clinic with the Medicaid policy that only amalgams will be covered in posterior teeth. So, unless this differs from state to state, this patient population will have a very difficult time at NYU. Also, a large number of amalgams I have placed while at school have been because carious lesions extended so far gingivally, that good isolation was not possible. As amalgams, unlike composites, could almost be placed underwater and still be successful, this is an essential material for these clinical situations. Finally, I feel like without knowing the "pollution reason" behind this change, a very inaccurate message could be sent to the public. In a recent review, the American Dental Association Council on Scientific Affairs states that: “Studies continue to support the position that dental amalgam is a safe restorative option for both children and adults". The National Institute of Health-NIDR and FDA have also found that there is no basis for claims that amalgam is a significant health hazard. As long as proper precautions are taken to minimize mercury exposure from amalgam, such as using high speed suction during placement and removal, this material is an indispensible tool for dentists and dental students alike!
   • 

     toothdr Friday - 20 / 07 / 2012

     The NYU policy is actually based on the fact that composite preparations are lesion specific and considerably smaller than the amalgam preparation for the same size caries lesion. Further, current composite restorations have a life expectancy similar to amalgam restorations. Finally, keeping mercury out of the environment is important for future generations. Even with amalgam traps in the waste system, substantial mercury escapes into our waste stream. Avoiding placement of an amalgam restoration that can be successfully restored with a composite meets all the needs of a socially conscious patient centered care. NYU will continue to use amalgam where it is the best restoration for the patient.
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     Ododenta Saturday - 21 / 07 / 2012

     Let me make a suggestion. All you young students, go to the library and read Prof. Woods paper I spoke about earlier. He is not just anybody but a world leader in mercury toxicology from the University of Washington, http://depts.washington.edu/envhlth/news/profile.php?content_ID=1060 He and the team around him have a number of decades experience when it comes to mercury toxicology. For political or whatever reasons the ADA continuously say that mercury fillings are safe no matter what scientific papers are presented to them. Read more some sections down at http://www.mercuryexposure.info/ He held a presentation for the International Association for Oral Medicine and Toxicology, IAOMT, in 2009 on the safety of mercury fillings, http://www.youtube.com/watch?v=eW0kDV-jMF4 If you do not want to see the entire presentation jump 52 minutes into it and hear him talk about genetic sucetibility to mercury fillings. The Woods paper from July 2nd will have a profound impact on the amalgam issue.
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     Administrator Saturday - 21 / 07 / 2012

     What Ashley Phares chose to disagree with was my opinion. Please note she did not acknowledge that amalgam cannot be made, placed, polished or removed without exposing staff and patients to astronomical levels of mercury vapor and mercury contaminated particulate matter. So while she can certainly make a case where amalgam might be more beneficial to use in rare instances she chooses to ignore the fact that in order to do so she must expose staff and patients to large bolus doses of a toxic substance, which cannot be ethically justified. It is a sad day for dentistry when they continue to ignore the enormous exposures to such a toxic substance when other alternatives are readily available. The eventual outcome of this denial is inevitable, loss of patient trust, loss of employee trust, open to government fines and litigation from both patients and staff. Ashley, perhaps you should be asking why your dental school is not teaching you about occupational safety requirements when working around mercury. The answer is that if you were to take the appropriate action to protect yourself, no patient in their right mind would believe this toxic substance is safe, because you'd have to be outfitted in a custom hazmat suit with respirator. Ms Ashley should read up on OSHA's Hazard Communication requirements before commenting further. You might also look at the following OSHA reg codes and then ask yourself, If you are truly being taught what you should in order to protect yourself. 1910.132(d)(1) - 1910.132(d)(1)(i) - 1910.132(d)(1)(ii) - 1910.132(d)(1)(iii) - 1910.132(d)(2)
3. 

   Ododenta Saturday - 21 / 07 / 2012 Reply

   Perhaps it will not be long until the justification will be for health reasons. On July 2nd Prof. James Woods et al published a groundbreaking paper that will turn the amalgam issue upside down and it will have implications for furore safe levels of mercury exposure. From this date investigations on the safety of amalgam filling that has not looked at the genetics of patients will be of very limited value, http://www.ncbi.nlm.nih.gov/pubmed/22765978 A few citations: "Abstract Mercury (Hg) is neurotoxic, and children may be particularly susceptible to this effect. A current major challenge is the identification of children who may be uniquely susceptible to Hg toxicity because of genetic disposition. We examined the hypothesis that CPOX4, a genetic variant of the heme pathway enzyme coproporphyrinogen oxidase (CPOX) that affects susceptibility to mercury toxicity in adults, also modifies the neurotoxic effects of Hg in children. Five hundred seven children, 8-12 years of age at baseline, participated in a clinical trial to evaluate the neurobehavioral effects of Hg from dental amalgam tooth fillings in children. Subjects were evaluated at baseline and at 7 subsequent annual intervals for neurobehavioral performance and urinary mercury levels. Following the completion of the clinical trial, genotyping assays for CPOX4 allelic status were performed on biological samples provided by 330 of the trial participants. Regression modeling strategies were employed to evaluate associations between CPOX4 status, Hg exposure, and neurobehavioral test outcomes. Among girls, few significant CPOX4-Hg interactions or independent main effects for Hg or CPOX4 were observed. In contrast, among boys, numerous significant interaction effects between CPOX4 and Hg were observed spanning all 5 domains of neurobehavioral performance. All underlying dose-response associations between Hg exposure and test performance were restricted to boys with the CPOX4 variant, and all of these associations were in the expected direction where increased exposure to Hg decreased performance. These findings are the first to demonstrate genetic susceptibility to the adverse neurobehavioral effects of Hg exposure in children. The paucity of responses among same-age girls with comparable Hg exposure provides evidence of sexual dimorphism in genetic susceptibility to the adverse neurobehavioral effects of Hg in children and adolescents." “These findings have important public health implications, inasmuch as mean urinary mercury levels among boys in this study ranged from 1.4 (1.3-1.6) g/g creatinine at baseline to a maximum of 2.2 (1.8-2.5) g/g creatinine at Year 2 of follow-up in the dental amalgam clinical trial.” “While there clearly are strong correlations between performances on various behavioral tests, the consistency of these results is nonetheless highly compelling.” ” However, when controlling for CPOX gene status as performed here, Hg exposure was strongly associated with diminished performance across a wide range of the same tests, among boys with the CPOX4 variant.” “In conclusion, the present studies demonstrate significant adverse effects on neurobehavioral functions associated with chronic Hg exposure and the CPOX4 genetic variant among children, with effects manifested predominantly among boys. These findings are the first to describe a genetic polymorphism that modifies the effects of Hg exposure on neurobehavioral functions in children, and suggest directions for future research to define mechanisms underlying differential sensitivity to mercury between boys and girls”.
4. 

   anita tiabau - International Advocate Saturday - 21 / 07 / 2012 Reply

   I applaud Dr. Wolff on this announcement. As an NGO stakeholder in the United Nations Environmental Programme's negotiations, dental mercury is of a major concern for the delegates, particularly in developing countries... It is completely unbelievable how anyone, specifically in the dental sector, not support a ban on mercury in dentistry. The 300- 400 tones used globally in the dental industry will become an environmental problem in the future through human waste, cremation, burial, respiration and dental waste from installation. Anyone that says that this is a problem only outside of the human body and say it is safe once implanted in teeth is ignorant of the volumes of peer reviewed science that exists on this subject... We must acknowledge that several countries have already banned mercury in dental fillings! I hope the end is sooner than we think.
5. 

   Robin Haward Monday - 30 / 07 / 2012 Reply

   Most of cosmetic dentists in Costa Mesa feels that this guidelines is much more political and unsubstantiated. Amalgam and composite are foreign materials which have been established to be safe and effective. Personally I believe that amalgam is dependable than composite, and more durable. However, there are treatments that I choose composite as it looks more competitive and it has the benefit of being at full strength immediately.
6. 

   Sandra A. Hermann-Courtney, CMT Wednesday - 08 / 08 / 2012 Reply

   Kudos to Dr. Wolff for this decision. As a patient who became seriously ill from an "allergic reaction" to the mercury contained in amalgam fillings over 20 years ago, I want to see amalgams banned in the United States. If this is the way it can be accomplished, by citing other concerns, so be it.
7. 

   Caryn Niedringhaus Thursday - 09 / 08 / 2012 Reply

   There is a trust that exists between a patient and his or her doctor. Medical and dental services are not free, and payment for services rendered is required. That suggests a business arrangement as well. We pay our medical and dental professionals with the assumption that they will in return for payment, give us truthful information and advice which they gained through education and experience in their field of expertise. After all, we want to be healthy and make the best decisions in behalf of ourselves. But sadly, medical and dental information is manipulated by incentives. Take my experience. In 2008 I was told that no one had ever healed a skin cancer lesion without having it removed surgurically. The location of my skin cancer lesion was above my left lip and any form of surgery was going to be disfiguring. In good health and mind I found the answers and treatment options I received from conventional doctors to be unsatisfactory - at best. Determined to learn more about my disease, I took time and did my own research to educate myself. During a three year span I did a simple and pure organic cleansing diet, fasted, exercised, did heavy metal detoxing, and numerous other holistic and natural supports - yet nothing had an impact on the lesion. Healing occured two weeks following a complete dental clean up. What did my dental 'clean up' include? I had a qualified dentist remove all implanted toxic material in my mouth - my mercury amalgams were 'safely' removed and replaced with biocompatible non metallic composites, I had my last root canal extracted, a cavitation in my jaw bone was opened and cleaned out ( right under the skin cancer lesion), and four mercury tatoos inbedded in my gum were removed! The dental work took four days, and the lesion began to dry up in two weeks. It took about two months for a tender and delicate little scar to form on my face. Today my friends and family say they can't even see the scar. The skin cancer lesion is completely healed. It was so miraculous that I went back to learn more about toxic dentistry and learned that it has been known for over 100 years that there are health risks and links to degenerative diseases to mercury, toxic materials, and these dental procedures. This is not new information. It has been investigated and documented by the leading immunologists, dentists, and medical research scientists who published their peer reviewed findings in medical papers and books that anyone can find and read on the internet. These facts have been duplicated and advancements on these topics have been made today! But the AMA and ADA is covering up and not using this data to make dental and medical advancements. The reason for that can only be explained in terms of liability, financial incentives, power, and corruption. After all, I had to pay to get this toxic material out of my mouth, just as I unknowingly paid to have it put in years ago. Can you imagine the liabilites? What is really needed is dedicated, honest, and skilled doctors and dentists who put people before profits. In conclusion, my life has been handed back to me thanks to a good dose of self reliance, access to information, an immune system that was up for the task, available financing, and the existence of a dentist who was skilled and knowledgeable enough to do the work. I also had the time, but some cancer patients don't have time.