Dental News - Ban on dental amalgam in the Philippines must be enforced, watchdog says

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Ban on dental amalgam in the Philippines must be enforced, watchdog says

The Philippines banned the use of dental amalgam in pregnant women, breastfeeding mothers and children three years ago and the ban now applies to all dental patients in the country. (Image: leungchopan/Shutterstock)

MANILA, Philippines: The safety of the use of amalgam in the mouth is one of the most controversial topics in modern dentistry, and the widely ratified Minamata Convention on Mercury is already reducing its global usage in dental restorations. Dentists in the Philippines are now prohibited from using amalgam as a restorative material, and the environmental group BAN Toxics has urged regulators to be vigilant and to enforce the new rules.

Philippine regulators signed an order in 2020 to ban the use of dental amalgam with immediate effect in pregnant women, breastfeeding mothers and children under 14 years of age. The importation of amalgam for use in dental settings was also banned, and a period of three years was given to completely phase out its use in the country. The grace period ended in May, meaning that penalties now apply to dentists who place amalgam restorations.

Jam Lorenzo, a policy and research associate at BAN Toxics, said in a statement that the end of the phase-out period provided cause for vigilance. “[The] use of dental amalgam for dental restorative procedures in dental clinics and schools should no longer be allowed, and the exclusion of dental amalgam and its capsules, as well as liquid mercury, from the list of registrable medical devices in the Philippines should be properly observed,” he said.

According to Lorenzo, the use of dental amalgam in the Philippines had dropped significantly since the ban came into place, and he said that BAN Toxics was continuing to urge distributors and clinicians to comply with the ban, as well as conducting a study to assess its effectiveness.

The new law stipulates that educational authorities should incorporate training in the use of amalgam-free composites into Philippine dental curricula and that best-practice guidelines and information should be made available to practitioners and patients.

The Children’s Amendment to the Minamata Convention entered into force in June 2022. (Image: BeautifulPicture/Shutterstock)

The end of “silver” fillings?

The main catalyst of reduction in the global use of dental amalgam is the Minamata Convention, a United Nations treaty that was first signed in 2013 and has since been ratified by 128 parties. The treaty recognises dental amalgam as a leading use of mercury in products and aims to phase out its global use, but parties have differed in their opinions on how and when to do so in dental settings.

Recent milestones in the global reduction of the use of dental amalgam include the following:

  • a dramatic decline in New Zealand, where study results in 2020 showed that its use had decreased from 52.3% of fillings in 1998 to 7.1% in 2017;
  • the US Food and Drug Administration updating its guidance in 2020 to recommend that the use of dental amalgam be avoided “whenever possible and appropriate” in women who are pregnant, breastfeeding or planning to become pregnant; children; people with pre-existing neurological disease, such as multiple sclerosis, Alzheimer’s disease and Parkinson’s disease; and people with impaired kidney function;
  • the adoption of the Children’s Amendment to the Minamata Convention in 2022, which requires parties to ban or recommend an end to the use of dental amalgam in patients under 15 years of age and in pregnant or breastfeeding women; and
  • meetings held in April in Lomé in Togo, in Lusaka in Zambia and in Cairo in Egypt to implement the Children’s Amendment in African countries.
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