Home > Uncategorized > A Smile to Risk: The Continuous Use of Amalgam Filling (Investigative Report)
A Smile to Risk: The Continuous Use of Amalgam Filling (Investigative Report)
A Smile to Risk: The Continuous Use of Amalgam Filling
Tesnado, Fatima Abegail H.
Tobongbanua, Aljon F.
Ylarde, Tabitha Andrea V
Dentistry, one of the noblest professions in the world which offers a chance for its practitioners to touch, treat and even do up one of many people’s asset and obsession – teeth. Many people go to dentists to have their teeth cleaned and fixed, put braces, add dental fillings, etc. But an alarming issue has already started to startle the field of dentistry – the issue concerning the practice of dentistry in the country has something to do with the use of amalgam filling in the restoration processes of our teeth.
Dental fillings are used to prevent the removal or extraction of teeth affected by cavities. There are three kinds of dental fillings that dentists use. These are: Glass Ionomer filling, Light Cure filling, and lastly, Amalgam Filing.
Photo retrieved from http://www.uib.no/rg/biomaterial/en/research/clinical-studies-of-oral-restorations/effects-of amalgam-removal on October 19, 2012.
Glass Inonomer filling is made up of silicate glass powder which is combined with water-soluble polymer to produce a cement-like mixture that is used to fill in the spaces acquired through the removal of cavities from the teeth. It is said to be the most expensive among the three dental fillings. It releases fluoride ions which are believed to improve the strength of our teeth. Also, it has the same colour of our teeth that makes it looks natural.
Like Glass Ionomer filling, Light Cure filling or commonly termed as White Composite Dental filling has the same colour of our teeth. Composite cement is treated with light so that the composite filling placed on the teeth will dry faster.
Compared to Glass Ionomer and Light Cure filling, Amalgam filling is silver in colour. It is made up of pounded silver alloy that is mixed with Mercury (Hg) which binds the silver alloys altogether – a process called trituration. In present, dentists use Amalgamator, a machine used to prepare Amalgam in a faster and easier way. Among these three, Amalgam is the cheapest and most durable. It is said to last up to three years or more.
As the cheapest amongst the three dental fillings, Amalgam filling ranges from P200-P300 pesos per surface of teeth compared to Light Cure and Glass Inonomer filling that range from P500 to P1, 500 per teeth surface.
Amalgam filling is said to bring harmful effects to the human body because of its mercury content. It is assumed to affect the mind processing of people, especially on children. Likewise, it can also cause Alzheimer’s disease and is harmful to pregnant women. The big question now is that, does the public know of this issue? And how do the dentists across the country cope up with this concern?
Rodelio Garcia, 24 years of age and a native of Balete, Batangas, is one of the many patients who undergone amalgam restorations. He said that it was October last year 2008 when he went to a dentist at the town of Balete to put fillings on the two surfaces of his teeth. He let his dentist put Amalgam filling on his teeth as it is the cheapest among the three dental fillings that his dentist offered him. He was caught unaware of the effects that amalgam may cause to him.
Garcia however said in a one on one interview that he hasn’t experienced anything wrong or any side effects of the amalgam fillings used in his teeth. But he wanted it replaced immediately right after he knew about its harmful effects to human health to avoid any complications.
Six dentists were interviewed and asked about their opinion and insights about Amalgam filling.
“Even now, I still use Amalgam fillings to my patients,” said Dr. Immacculate Venus Tesnado, a dentist in Sto. Tomas, Batangas. She graduated from Centro Escolar University in 1995 and has been a private practitioner for 11 years.
“Silver filling (Amalgam filling) is much cheaper compared to composite filling (white dental filling) that’s why people prefer to use it,” Dr. Tesnado said when asked why a lot still use amalgam. She said that for eleven years, she still prefers using amalgam because it is more durable than any other dental filling, and it lasts for a long time.
Dr. Tesnado did hear about the controversy of amalgam filling but she never encountered any case about amalgam causing certain diseases to her patients yet. “Even in licensure exams, the government still requires the use Amalgam filling,” she added.
“Aesthetically wise, it is better to use Composite filling (white dental filling) and Glass Inonomer filling since it has the same color of our teeth. Mostly, yung tumatangkilik ng Light Cure tsaka Glass Ionmer ay yung mas tinitingnan yung aesthetics. Katulad nung mga stewardess na patients namin, mas gusto nila yung kakulay ng ngipin para daw malinis tingnan,” Tesnado said. “But when it comes to durability and strength, mas ginagamit ko talaga yung Amalgam,” Tesnado added.
Same as Dr. Tesnado, Dr. Anthony Kim Dian M. Ong Jr., a dentist from Oriental Mindoro, said that he still uses amalgam. In his 27 years of private practice, he said that he knew the issue about Amalgam filling bringing harmful effects on human health, but he objects and said that it is not yet proven.
“I prefer Amalgam filling because it is easy to prepare and handle. At the same time, it is long lasting as to dental restoration is concerned,“ Ong said. “If amalgam is used in proper ratio, it is not harmful and hazardous to our health,” he added.
Dr. Celestine Mogol Jr., a dentist, also from Oriental Mindoro, also claimed that he still uses and chooses to use Amalgam Filling. He said that he only read the Amalgam controversies over newspapers and has no much knowledge about it. “I prefer Amalgam because it is durable and it lasts for years not like Composite Filling,” he said.
While Dr. Rizza Cruz, a dentist in Balete, Batangas, who has been a private practitioner for eleven years, said, that she stopped using it a year after she started her practice and Amalgam Filling had been pulled out to her clinic since year 1996.
She said that Amalgam filling is said to contain Mercury which may cause unwanted side effects to her patients.
“Mercury is a heavy metal and it is very possible that it may bring harm to my patients,” Said Dr. Cruz. However, she said that there are a lot of people who prefers amalgam filling than white dental fillers since it’s stronger and cheaper. “When I was still on training (OJT), our Head Dentist doesn’t use Amalgam. From there, I also stopped using Amalgam when I started my practice,” she added. “Tsaka, I don’t want to risk my profession, syempre kahit na wala pang proven na effects yung Amalgam, mas mabuti na yung sigurado,” she explained.
Like Dr. Cruz, Dr. Joyce M. Ng, 42, a dentist from Oriental Mindoro,is no longer using Amalgam filling anymore. “I actually didn’t stop (using amalgam) immediately, but I started shifting from Amalgam to Light Cure filling since 2003,” said Ng. “Nabasa ko sya dati sa isang newspaper,” she added.
“I use Light Cure filling because its strength is comparable with Amalgam. Sabi nga nila, pinakamatibay yung Amalgam, pero halos ganon na rin naman yung durability ng Light Cure,” Ng added.
Dr. Marites Mercene – Custodio, 50, also from Oriental Mindoro, discontinue using Amalgam filling since 1992. She explained that she knew the issue of Amalgam. She also added that Light Cure is better in use than Amalgam, specially, in its aesthetic components where Light Cure feeling looks like a real teeth.
Last 2008, the Department of Health (DOH) released an Administrative Order No. 21 about the Gradual Phase-out of Mercury in all Philippine Health Care Centre.
Health Care Centres covers hospitals, infirmaries, birthing home, clinics including Medical, Ambulatory, Dialysis, Health Centres and Dispensaries, Surgical, Alternative Medicine, and Dental.
It described Mercury as highly-toxic that may cause harmful effects to the nervous, digestive, respiratory, immune systems and to the kidneys and lungs. Exposure to mercury can also cause tremors, impaired vision and hearing, paralysis, insomnia, emotional instability, developmental deficits during fetal development, and attention deficit and developmental delays during childhood.
As stated in the Administrative Order, as early as 1991, several European countries like Sweden, France, Denmark and Norway already banned the use of mercury-containing thermometers.
Administrative Order No. 21’s General Provisions are the following:
1. All Hospitals shall immediately discontinue the distribution of mercury thermometers to patients through the distribution of hospital admission/discharge kits.
2. All Hospitals shall follow the guidelines for the gradual phase-out of mercury in health care facilities described in this document in the timeline specified.
3. All new Health Care Facilities applying for a License to Operate shall submit an inventory of all mercury-containing devices that will be used in their facilities and a corresponding mercury elimination program.
4. All other Health Care Facilities other than hospital shall make a Mercury Minimization Program based on the guidelines set by this administrative order.
This order from DOH gave six months of preparation to all health care facilities to gradually eliminate any materials containing mercury. And within twenty-four months from the order’s effectivity, health care centres should remove/minimize these mercurial materials.
As Amalgam filling is known to contain Mercury, its usage is still common in dental restoration, nowadays. Here, Amalgam filling falls under those mercury-containing materials that AO No. 21 prohibits.
During an interview with Engr. Gaudencio T. Twing of DOH, he said that Amalgam filling is the most commonly used mercury-containing material in dental clinics here in the Philippines. “As much as possible, Administrative Order No. 0021 prevents the use of these mercurial products in dental restoration,” he said. “Pati yung mga Amalgamators na ginagamit nila para gawin yung Amalgam filling, kasama dun sa dapat i-phase-out,” he added.
He also mentioned that Mercury was already banned as a tool for mining. Here, he disclosed that small-scale miners even get mercury supplies from dentists and dental clinics.
As DOH already released an order of phasing-out materials containing Mercury since 2008, a lot of health care facilities/facilitators should have known about this order. If so, why do a lot of dentists still use Amalgam filling in dental restorations in present?
In this, phasing-out of Amalgam fillers had already started since 2008, but until now, not all Filipinos are aware that the use of Amalgam fillers is hazardous and poisonous to us.
The government should take this issue into consideration as this creates a big impact on the health of every Filipinos. Information dissemination and a stricter government should take action on this matter. As they say, “Health is wealth.” So, why risk our health into Amalgam Fillings?