What factors do dental practitioners need to consider in light of the new rules surrounding the provision of amalgam?
At the beginning of July 2018, new EU regulations were brought into effect surrounding the use of amalgam. This means that dental amalgam should not be used for the treatment of deciduous teeth, children under 15 years old, and pregnant or breastfeeding women, except when it is deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient. As well as this, further restrictions on the disposal of amalgam are due to come into force next year.
The implications of these new rules for dental professionals extend beyond simply ceasing to provide one type of treatment. For example, as patients become aware of the new regulations, it's possible that some may ask if they can have these fillings removed or replaced.
According to figures from the Oral Health Foundation, more than four fifths of adults in the UK have at least one filling, meaning that amalgam will be present in the mouths of a large proportion of these patients. As David Lauder from the DDU's dento-legal team points out, while this shouldn't be a cause for concern, it may mean that some patients raise questions about their existing fillings.
'The material has been used effectively for more than 150 years, and the new restrictions don't mean amalgam fillings need to be replaced,' he says. 'However, due to the publicity surrounding the new regulations, more patients may ask about the safety of existing amalgam fillings and ask that they are replaced as a precaution.'
In these instances, it's important to communicate clearly and effectively with patients about the levels of risk of both amalgam fillings themselves and any steps taken to replace them. As David explains, 'Fortunately there are modern alternatives to dental amalgam readily available, but dentists and therapists need to consider if replacing old fillings would be in the patient's best interests. As the process of drilling out an old amalgam filling releases more mercury vapour than leaving the filling in place, it may be difficult to argue that the benefits outweigh the risks, unless the filling is already compromised.'
As well as this, it's possible that the treatment could itself cause more tooth tissue loss. It could also lead to pulp inflammation, potentially leading to pain and the possible need for further treatment or extraction. This in turn could lead to the patient making a complaint or claim for compensation.
'Dental professionals should try to reassure the patient about the long-term safety of amalgam and the risks involved in replacing fillings and then make a detailed note of these discussions in the dental records,' says David. 'If the patient is still unhappy and they want their fillings replaced, it might be wise to suggest they seek a second opinion from another dental professional.'
Ultimately, says David, any decisions you make should be in line with principle one of the GDC's Standards for the dental team: put patients' interests first. 'All treatment should be in the patient's best interest and in line with current accepted practice and teaching, as would be supported by a responsible body of dental opinion.'
If you're a DDU member and you have questions about a dento-legal issue, our free helpline provides an on-call service for dento-legal emergencies or urgent queries, 24-hours a day, 365 days a year.
David qualified from Newcastle Dental School in 2002. His post-graduate training included qualifications from the Eastman Dental Hospital and the Royal College of Surgeons, after which he worked in a number of dental settings in the UK and abroad. He has always pursued an interest in the legal aspects of dentistry and has a Master of Laws degree in the Legal Aspects of Medical Practice.
See more by David Lauder