The new regulations on dental amalgam use
Regulation (EU) 2017/852 on Mercury contains the following provisions relating to dental amalgam:
Article 10(1): from 1 January 2019, dental amalgam shall only be used in pre-dosed encapsulated form.
Article 10(2): from 1 July 2018, dental amalgam shall not be used for dental treatment of deciduous teeth, of children under 15 years and of pregnant or breastfeeding women, except when deemed strictly necessary by the dental practitioner based on the specific medical needs of the patient.
Article 10(3): by 1 July 2019, each Member State shall set out a national plan concerning the measures it intends to implement to phase down the use of dental amalgam.
Article 10(4): from 1 January 2019, operators of dental facilities in which dental amalgam is used or dental amalgam fillings or teeth containing such fillings are removed, shall ensure that their facilities are equipped with amalgam separators for the retention and collection of amalgam particles, including those contained in waste water.
The advice in a nutshell
Prevention is at the core of many national policies and it is estimated that every £1 spent on prevention leads to £3 saved on later restorative work. The guidance refers to current UK guidelines around the prevention of caries in children, which make recommendations including behaviour change, dietary and toothbrushing advice, and the use of fluoride varnish and sealants.
Use of alternative techniques and materials
The advice recommends the use of alternative techniques and materials in the treatment of dental caries and restoration. For children and deciduous teeth this includes the use of methods such as the Hall Technique, sealant or infiltration and preventive only interventions. The advice states that many of the same approaches and principles can be used for caries management in adults and permanent teeth. It discusses the use of alternative materials such as resin composites and glass-ionomers. The advice is clear that extraction should not be considered as an alternative to the use of dental amalgam.
Minimum intervention dentistry (MID)
MID is an approach that aims to prevent and control oral disease and encompasses oral health promotion, prevention and minimally invasive operative interventions.
Words: Sarah Allen