Operative Dentistry - Best Practices
(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
- 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
- "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.
- 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.