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Operative Dentistry - Best Practices

Dental Amalgam

(last modified August 5, 2014)

SAFETY & EFFICACY:

  • 150+ year usage due to strength, durability and ease of manipulation
  • Minimal mercury exposure if handled appropriately
  • WHO, CDC, FDA and the ADA agree that, based on extensive scientific evidence, dental amalgam is safe and effective for patients.
  • EU Commission SCHER - Dental Amalgam is still a safe material to use with no evidence of systematic disease (March 2014)
  • Dental clinics should use amalgam separator devices
  • Follow ADA Best Practices: Handling and Disposables

CLINICAL INDICATIONS:

  • Large Posterior restorations
  • Adequate field control is not obtainable in non-esthetic regions
  • Foundations for crowns
  • Compromised posterior teeth when modifying factors preclude indirect cuspal coverage restorations
  • High caries risk patients

MINIMAL INVASIVE TREATMENT:

  • Encourage conservation of tooth structure by repairing dental amalgam restorations rather than replacing whenever possible
  • GENERAL RECOMMENDATIONS:
  • Dentinal liner (Superseal) to reduce sensitivity
  • Clinical trials have failed to show that bonded amalgams significantly reduce sensitivity

AMALGAM WASTE-POLLUTION:

  • "GRIT" actions in your practices to prevent mercury pollution:
  • Gray Bag It - Discard amalgam wastes into appropriate containers.
  • Recycle It - Select a responsible dental amalgam recycler who can manage your waste amalgam safely from the list of recyclers below.
  • Install It - Install an amalgam separator to capture up to 95% of the mercury going down the drain. This is the KEY to success.
  • Teach It - Educate and train staff about the proper management of dental amalgam.

REFERENCES:

  • European Commission: Scientific Committee on Emerging and Newly Identified Health Risks. The Safety of Dental Amalgam and Alternative Dental Restoration Materials for Patients and Users May 6, 2008. Accessed October 9, 2013.
  • ADA Council on Scientific Affairs. Dental Amalgam: Update on Safety Concerns. J Am Dent Assoc. 1998;129:494-503. Accessed October 9, 2013.
  • FDI Policy Statement/WHO Consensus Statement on Dental Amalgam. September 1997. Accessed October 9, 2013.
  • EPA Mercury in Dental Amalgam, Updated March 2014.