Over the past decade, the use of amalgam has declined because of a decrease in dental caries and improvement in alternative materials. Nevertheless, dental amalgam continues to play an important role in the dental restorative process. Recently, a number of public health concerns regarding mercury in dental amalgam have been raised. Although no controlled clinical studies have shown adverse human health consequences associated with chronic low-dose exposure to mercury, public concern has been seen. For example, in a 1991 survey commissioned by the American Dental Association, 20 percent of those responding had considered having their amalgam restorations removed or had actually had them removed because of concern over the potential health risks. The lack of a definitive educational initiative by Federal health agencies may be a contributory factor in the anxiety experienced by the public.
The CCEHRP Subcommittee on Risk Management charged the Education Work Group to consider whether new consumer and professional educational efforts were needed. The Work Group reached the following conclusions:
- The public and the health care community must be properly informed about the risks and benefits of dental amalgam. However, this will be difficult in view of the diverse nature of the intended audiences and their varying perceptions of risk.
- Dentists, physicians and other health professionals need accurate information about the risks and benefits of all dental restorative materials in order to provide patients with the information necessary to make informed and intelligent choices in regard to dental restorative material selection or removal. (At present, available scientific data do not support the need for removal of otherwise sound dental amalgam restorations.)
- Third party payers should be educated on relevant topics of tooth conservation techniques and materials such as sealants and preventive resin and appropriateness of restoration repair in specific cases to assure reimbursement.
- In order for any educational program on dental restorative materials to be credible, it must be frank about the uncertainties involved. A program developed with the involvement of consumers, manufacturers and dental professionals would likely have balance as well as credibility, and could be more easily accepted by all communities.
- The U.S. Public Health Service is a logical source for educational campaigns on national health issues, such as
amalgam. The Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention have the combined responsibility for national education about health matters, as well as the contacts and prestige to make nationwide educational campaigns successful.
For a detailed discussion of these recommendations and their rationale, see the Education Work Group report (Appendix V).
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