Dear Ms Stewart- Taylor ,
Thank you for your email of 20 September to the Department of Health about the use of dental amalgam containing mercury for fillings. I have been asked to reply. I should first explain that the information you have requested is freely available in the public domain and that the Department will therefore not be processing this query under the Freedom of Information Act.
In the UK, the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) issued a statement on the toxicity of dental amalgam in 1997 which concluded that the use of dental amalgam is free from risk of systemic toxicity and that only a very few cases of adverse reactions occur, despite its widespread use over the past 150 years.
The general view amongst experts remains that dental amalgam is the most convenient and durable material for filling cavities in back teeth. ‘White’ fillings are available for restoring front teeth but the use of white fillings on back teeth is more for cosmetic reasons than for clinical effectiveness.
NHS dentists can, however, use white fillings on back teeth, providing this is clinically necessary, such as when exceptionally a patient is allergic to mercury.
As a precautionary measure, it is advised to avoid the placement or removal of amalgam fillings during pregnancy unless clinically necessary, although there is no evidence of any harm to unborn children from the use of amalgam.
Other studies confirm the Department’s policy of the use of dental amalgam, including a 1997 assessment by the World Health Organisation (WHO) which concurred with COT’s review. WHO stated that dental amalgam restorations are considered safe, but components of amalgam and other dental restorative materials may, in rare instances, cause local side-effects or allergic reactions. The small amount of mercury released from amalgam restorations, especially during placement and removal, has not been shown to cause any other adverse health effects.
In 1998, a report by an expert group working on behalf of the European Commission concluded, on the basis of currently available data, that mercury from dental amalgam restorations does not cause an unacceptable health risk to the general population. All dental restorative materials, including dental amalgam and its alternatives, have the potential for causing some adverse reactions, and most contain components that might be toxic, but only at much higher doses than is obtained from dental use.
In February 2002, the United States Food and Drug Administration reported evidence that came to similar conclusions to the EC, namely that no valid scientific evidence has ever shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy.
More recently, in May 2008 the European Commission Scientific Committee (SCENHIR) produced a report on safety of dental amalgam. This concluded that, the current use of dental amalgam did not pose a risk of systemic disease. It further continued to advise caution when considering placement of any dental restorative material in pregnant women. The link to the website is
http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_016.pdf
The Department of Health concurs with the conclusions of the SCENHIR report. It will, however, continue to ensure that our advice on the use of amalgam reflects the best available international evidence.
In your email, you ask about the availability of NHS dental servcies in England . I should explain that the NHS Primary Care Trsuts are responsible for commissioning NHS dental services for local populations, just as they are responsible for commissioning the services of GPs. Although nationally, the data from the NHS information centre shows that access to NHS dentistry is growing, the Government knows that there are still areas of the country in which people are unable to access an NHS dentist as quickly as they would like to. Increasing access to NHS dentistry is a top priority for both the Government and the NHS, and all ten Strategic Health Authorities have set themselves the aim of achieving access for all who seek it by March 2011 at the latest.
In your email you ask if it lawful to extract healthy teeth. Under both the current and previous arrangements for NHS primary dental care services, dentists are required to carry out treatment that is clinically appropriate in order to maintain good oral health. It is the responsibility of a dentist to determine what treatment is deemed clinically necessary and the responsibility of the then the patient to decide whether or not they wish to go ahead with the proposed treatment.
Finally, you ask if gold jewellery is collected from undertakers and turned into gold fillings. Such trade would be illegal. Gold fillings are made in a laboratory by dental technicians, and the materials for use in dentistry must be licensed, ie carry the Conformité Européenne (CE) mark. The CE denotes that the materials meet conformity assessment requirements acceptable across Europe
for their safety, quality and performance.
The Department is unaware of any such crime, such as the one you suggest, having taken place.
Yours sincerely,
Stephen Atkinson
Customer Service Centre