Amalgam use in dentistry is not a simple topic to traverse, but Jason Wong, Interim Chief Dental Officer for England, and Chris McConnell, Past President of the BACD and Director / Co-Founder of Real Dentist Academy, came together to do so for an engaged audience at the BDIA Dental Showcase in London.
Together, they presented ‘The Big Amalgam Debate: What is the truth currently?’, which was chaired by Edmund Proffitt, Chief Executive of the BDIA. It was a timely conversation that needed to be had. Following the fifth meeting of the Conference of the Parties to the Minamata Convention (COP-5) in October / November of 2023, there was an agreement to phase-down the use of dental amalgam, and not allow mercury use in cosmetics from 2025.[i]
Whether dentists are for or against the plan, there was still some uncertainty both about the requirements of dentists in England and the UK at large, as well as some of the alternatives available to clinicians. Jason and Chris tackled these topics and more in their 45-minute session within the Clinical Theatre.
“Phase-down has always been the position”
With some palpable confusion surrounding the obligations of dentists at present, Jason set out to clarify the legal position of the UK. Amalgam was the most “controversial topic” at COP-5, with initial plans to cut out amalgam use by 2030. A few weeks before the conference, in a move that was “slightly surprising” to the Interim Chief Dental Officer, a proposal was made to bring the phase-out forward, with allowances for medical exceptions as per a clinician’s judgement.
Jason was clear that he stood by the idea of a phase-down rather than an immediate phase-out of amalgam use. He acknowledged previous considerations by a former Chief Dental Officer on whether a stance leaning towards phase-out should be taken, but he was adamant, “Phase-down has always been the position.”
The focus on reducing amalgam use comes after a development in knowledge about its environmental impact, and that of mercury in particular. However, Jason felt there is still a space for amalgam in dentistry.
“Whilst the Minamata Convention was about the environmental impact of amalgam, we have very little data on the alternatives,” he said. “There is insufficient research for us to move from one material, when we have not done the research on the other.”
Jason encouraged further research on the environmental impact of glass ionomers and composites as part of the UK’s move towards an amalgam phase-down.
On the implications of Brexit, Jason emphasised, “The EU position will not affect the position of England as far as dental amalgam is concerned.”
“You can do NHS dentistry without amalgam”
The alternatives to amalgam and their use in modern dentistry, especially with regards to NHS dental care, was clearly of significance. Chris was in favour of not using amalgam wherever possible. “No amalgam in dentistry is more about tooth preservation,” he said to the audience.
He asked the all-important question, are there suitable alternatives to amalgam? “100%,” he stated, “it’s called composite, and more specifically bulk fill composite.”
Chris discussed clinical studies that found a recurrent complication in some composite restorations – secondary caries. However, he insisted that this was largely preventable in many cases. “It is the skill of the operator that is causing the issues of secondary caries,” he said, and spoke further on how clinicians can optimise their restorations for an effective and reliable restoration.
After recalling the development of composites, he displayed the differences between each solution, and how a dentist can make the most of what they have to hand. One part of the workflow in particular is not looked at hard enough according to Chris, which is that of light curing.
“When is the last time you checked the output of your light?” he posed to the audience, as he reiterated the importance of consistently checking your systems.
Where some clinicians may note the potential economic ramifications of replacing amalgam use with solutions such as composite, Chris was quick to warn against how this argument is framed. He cited the GDC principle 1.7.1, which states that patients’ interests must be put before any financial gain.[ii]
Open to the floor
Towards the end of the session, members of the audience posed questions to the panellists. Topics such as allowing medical exemptions for amalgam use and the implementation of amalgam phase-down into reform plans created essential discussions for all involved.
Delegates left the debate with a greater understanding of the current position on amalgam, and how the future may look for their care. Ian Mills of Torrington Dental Practice had engaged in the Q&A section of the debate, and said:
“I really enjoyed it, it was informative. The speakers complemented each other, and covered a good range of political and clinical points.
“A lack of time is always an issue with these sorts of things, and you just wish it could go on for longer!”
The future use of dental amalgam is yet to be definitively set upon, but it’s with the help of professionals like Jason Wong and Chris McConnell that dentistry will be in an environmentally-safe and clinically-effective place in the years to come.
Save the date
BDIA Dental Showcase 2025
14th-15th March
ExCeL London
[i] UN Environment Programme, (2023). Minamata Convention COP-5 takes crucial steps in its mission of eliminating mercury pollution. (Online) Available at: https://www.unep.org/news-and-stories/press-release/minamata-convention-cop-5-takes-crucial-steps-its-mission [Accessed March 2024]
[ii] General Dental Council, (2013). Standards for the Dental Team. (Online) Available at: https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf [Accessed March 2024]
