American Dental Association 25-Jun-96
ADA: Ethics of Removing Amalgam
Description: Can a dentist ethically remove serviceable amalgam (silver) fillings?
That question is posed in the May issue of the Journal of the American Dental
Association (JADA).
FOR IMMEDIATE RELEASE: May 1996
CONTACT: Chris Martin, martinc@ada.org Jann Ingmire, ingmirej@ada.org 312/440-2806
Ethical Considerations of Removing Serviceable Amalgams
CHICAGO -- Can a dentist ethically remove serviceable amalgam fillings? That
question is posed in the May issue of the Journal of the American Dental Association
(JADA).
The JADA article, authored by ADA general legal counsel Peter Sfikas, asks the
question as stories surface regarding the safety of dental amalgam (silver fillings).
Interest in the topic of whether removing serviceable amalgams has any health
benefits heightened recently with the case of Colorado dentist Hal Huggins, a
proponent of the theory that dental amalgam is a source of mercury toxicity. The
Colorado Board of Dentistry recently revoked Dr. Huggins's dental license.
"The scientific community agrees that amalgam is a safe and durable tooth filling
material," Mr. Sfikas said. "The ADA's ethics policy clearly states that 'no dentist shall
remove an otherwise serviceable amalgam filling for the sole purpose of curing a
systemic disorder,'" he added. The ADA believes that when such treatment is
performed only on the recommendation or suggestion of the dentist, it is unethical
and improper, since removal of dental amalgam has not been shown to have any
beneficial effect on the general health of the patients or their specific medical
conditions.
"What's unfortunate is that patients with serious, uncurable diseases are the most
vulnerable to these reports of supposed miracle cures, like the removal of
serviceable amalgams," Sfikas commented. "There is absolutely no scientific proof
that removing amalgams for the alleged purpose of eliminating toxic substances from
the body is beneficial, unless, of course, the person is allergic to the mercury."
What should a dentist do if a patient asks him or her to remove their serviceable
amalgams? Mr. Sfikas provides the following guidelines:
* A dentist is not ethically obligated to remove serviceable dental amalgams from the
non-allergic patient at the patient's request or even the recommendation of the
patient's physician.
* The dentist has the professional obligation to use his or her independent judgment
about the dental treatment that is best for the patient.
* The dentist is free to suggest that the patient seek dental care elsewhere.
If a dentist agrees to remove serviceable amalgam restorations from the non-allergic
patient at the patient's request:
* The dentist should take special care to obtain the patient's informed consent to the
procedure and thoroughly document that consent in the patient's records.
* The dentist should review with the patient the current scientific thinking on the
safety of dental amalgams -- that there is no evidence that amalgams pose a
significant health risk to non-allergic patients and that no known health benefits
result from removal of dental amalgams.
* The patient should be informed of the risks involved in replacing amalgam
restorations, including potential damage to healthy tooth structure and the loss of
sound tissue in the process.
* The patient should also be informed of the risks and benefits of the replacement
materials and the cost.
* Finally, the dentist should clearly state that he or she promises no health benefits to
the patient by removing serviceable amalgam restorations.
Mr. Sfikas answers the question posed in the article's title by saying that serviceable
amalgams can ethically be removed by a dentist but only under very limited
circumstances and only if the patient provides informed consent to the procedure.
TOP BACK
