Dental amalgam is a safe, affordable and durable material that has been used to restore cavities in teeth for more than 100 years.

The World Dental Federation and the World Health Organisation concluded in their landmark 1997 consensus statement that “No controlled studies have been published demonstrating systemic adverse effects from amalgam restorations.”

This statement has since been supported by published material by the American Dental Association Council on Scientific Affairs, 1998, by numerous other scholarly scientific articles in the Journal of the American Dental Association, 1999, the New England Journal of Medicine, 2003, and the Journal of Toxicological Reviews, 2004.

Amalgam is a mixture, or alloy, of several metals including silver, tin and copper in addition to mercury. It is the mercury in amalgam that has been controversial. Minamata Bay in Japan was one of the first places where the highly toxic nature of mercury in the environment was uncovered in the 1950s.

Minamata disease, as it was known, was the result of mercury poisoning and is a condition with a host of symptoms, including paralysis and other neurological disorders. The disease resulted from consumption, by people, of the fish and shell fish from the bay which had been polluted by industrial wastewater contaminated with methylmercury, a particularly toxic compound of mercury.

It is important to note that, based on the available evidence, mercury bound up in amalgam does not have any of these toxic side effects. Nevertheless, in the years following the discovery of the effects of mercury poising at Minamata, a large body of scientific evidence has developed supporting the desirability to reduce the amount of mercury released into the environment by human activities.

As a consequence, and under the auspices of the United Nations Environmental Programme, the Minamata Convention on Mercury was developed and adopted in 2013. This global treaty which, to date, has 94 countries, including Jamaica, as signatories, aims to reduce environmental mercury by such measures as reducing the mining of mercury and reducing the emission of mercury into the air.

Specifically, with regard to dental amalgam the convention in part II article 4 recognises the continued importance of amalgam to dentistry, especially in developing countries. However, in an effort to reduce the whole chain of mining, extraction and refining necessary to produce amalgam the protocol seeks to reduce the use of amalgam by prevention of dental caries and promoting the development and use of cost-effective mercury-free restorations and environmental practices in dental facilities to reduce the release of mercury into the environment.

Most importantly, the Minamata Protocol does not require or request that dental amalgam should be banned from any country. In its recommendations, the Convention recognises that less than one per cent of environmental mercury is derived from the manufacturing chain which results in the use and disposal of dental amalgam.

Dentistry has always been an enlightened profession. The proof of this statement is demonstrated in the worldwide fluoridation campaign which placed professional objectives above profit.

The Jamaica Dental Association (JDA) wholeheartedly supports the objectives of the Minamata Convention and we hope in this generation to develop a true substitute for amalgam in every way. Unfortunately, at this time we have no substitute which can match the low cost and versatility of amalgam in many situations.

So we expect dental amalgam to be important for several more years, especially in delivering cost-effective dentistry in a public health setting.

Despite earlier confusion within the Ministry of Health it seems that the exceptional position of dental amalgam within the Minamata Protocol has finally been recognised as the JDA has received communication from the chief medical officer that amalgam has not been, and will not be, barred from importation.

While this is good news for dentistry in the short term, the longer term position of the JDA is that we need to develop, adopt and utilise mercury-free materials to completely eliminate mercury contamination of the environment.

Dr Jeffrey Meeks is president id the Jamaica Dental Association

drmeeks@gmail.com