Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation

Abstract

BackgroundData from countries that have implemented a complete phase out of dental amalgam following the Minamata agreement suggest increased costs and time related to the placement of alternatives with consumers absorbing the additional costs. This aim of this study was to investigate the impact of a complete phase out of dental amalgam on oral health inequalities in particular for countries dependent on state run oral health services.MethodsA mixed methods component design quantitative and qualitative study in the United Kingdom. The quantitative study involved acquisition and analysis of datasets from NHS Scotland to compare trends in placement of dental amalgam and a survey of GDPs in Yorkshire, UK. The qualitative study involved analysis of the free text of the survey and a supplementary secondary analysis of semi-structured interviews and focus groups with GDPs (private and NHS), dental school teaching leads and NHS dental commissioners to understand the impact of amalgam phase down on oral health inequalities.ResultsTime-trends for amalgam placement showed that there was a significant (p < 0.05) reduction in amalgam use compared with composites and glass ionomers. However dental amalgam still represented a large proportion (42%) of the restorations (circa 1.8 million) placed in the 2016–2017 financial year.Survey respondents suggest that direct impacts of a phase down were related to increased costs and time to place alternative restorations and reduced quality of care. This in turn would lead to increased tooth extractions, reduced access to care and privatisation of dental services with the greatest impact on deprived populations.ConclusionAmalgam is still a widely placed material in state run oral health services. The complete phase down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. Our data suggest that a complete phase out is not currently feasible unless appropriate measures are in place to ensure cheaper, long-lasting and easy to use alternatives are available and can be readily adopted by primary care oral health providers.

Perceptions of dental therapy students regarding the teaching and training with dental amalgam, in a dental school in KwaZulu-Natal, South Africa

“…The complete phase-down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. 33 This factor was iden tified by the participants in this study as well when they responded that dental amalgam was still being used in developing countries (South Africa and Brazil). Emphasis must be placed on preventing dental caries and promoting good oral health to minimise the need for restorations.…”

Should dental amalgams be used in dental training? The perspectives of dental academics at a university in South Africa

“…Some of the key objectives of the convention included adopting national objectives aimed at minimising mercury usage; promoting the use of cost-effective mercury-free alternatives, the promotion of research and development of mercury-free materials for dental restoration; promoting the use of best environmental practices in dental facilities to reduce the release of mercury and mercury compounds to water and land. 26 However, all participants were aware of the phase-down of dental amalgam. Their choice towards composite restoration was not guided by the Minamata Convention but rather by the need for aesthetics and minimal tooth removal.…”

Amalgam und Alternativen – Diskussionen zur Quecksilberreduktion in der Umwelt

“…Hinzu kommen die höheren Kosten für Restaurationen mit alternativen Werkstoffen (siehe oben). Dies kann zu einer Zunahme von Extraktionen und damit zu einer erhöhten sozialen Ungleichheit (Inequality) führen, insbesondere bei Menschen aus sozioökonomisch schwachen Gebieten, auch weil diese zusätzlich unter einem erhöhten Kariesaufkommen leiden [ 53 ]. Erfahrungen aus Norwegen nach dem dort verhängten Phase Out zeigten, dass Füllungen mit Amalgamalternativen zeitaufwendiger, teurer und weniger langlebig waren [ 54 , 55 ].…”