By Karen Brandon
Chicago Tribune national correspondent
Published August 22, 2001

http://chicagotribune.com/news/local/chi-0108220248aug22.story?coll=chi%2Dne

SAN DIEGO -- Mercury, used to fill tooth cavities for 14 centuries, is at the center of a political and legal debate over its use in modern dentistry.

An estimated 100 million U.S. residents have fillings made of amalgam, a silver-colored alloy containing about 50 percent mercury. The American Dental Association says amalgam is safe and is the least expensive, most durable way to fill cavities. But opponents say dentists are downplaying the potential risks of using mercury, a highly toxic metal that can damage the brain and senses, particularly in developing fetuses.

The fillings slowly release tiny amounts of odorless, colorless mercury vapor. Their effect on health has been the subject of scores of conflicting studies, and no federal agency has moved to prohibit the fillings.

"You can't say mercury fillings are bad for you," said Dr. Myron Bromberg, a dentist in Reseda, Calif., and spokesman for the Academy of General Dentistry, an industry group. "You can't say it because it's inaccurate. ... I have silver fillings in my mouth. I have silver fillings in my kid's mouth. If there were any problems with them, I wouldn't use them."

Yet in the past year, Maine and Arizona have passed laws requiring dentists to give patients more information about the potential risks of mercury, mirroring a measure passed several years ago in Colorado. Rhode Island this year began requiring insurers to cover more expensive alternative fillings that do not use mercury.

Several countries, including Germany, Sweden, Austria and Canada, have found no widespread problems with amalgam fillings but recommend they not be used in treating pregnant women and young children.

The California State Assembly was so irritated by the state dental board's nine-year failure to comply with a law requiring it to prepare a fact sheet about potential health risks from mercury that it voted in July to oust the board.

The Democratic state senator who wrote the dental fact sheet law, Diane Watson, is now in Congress, and she plans to introduce national legislation to force Medicaid to pay for more expensive alternative fillings, a move driven mainly by her concern over the potential health risks of mercury-based fillings.

Lawsuits filed

Recently, an advocacy group opposed to amalgam fillings has filed lawsuits in California and Maryland, contending that the dental profession has deliberately minimized the potential risk to patients and has in effect gagged dentists who advocate mercury-free fillings by revoking or threatening to revoke their licenses.

The Chinese first used mercury to fill decayed teeth in the 7th Century. But its use in dentistry has been controversial since the mid-1800s, when one dental society's decision to require its members to pledge not to use it led to the organization's demise and the rise of the ADA.

The present debate comes as environmental organizations are questioning the use of mercury where alternatives exist, such as replacing mercury thermometers with digital ones in hopes of keeping mercury out of the environment.

At the same time, the popularity of amalgam fillings is waning in favor of natural-appearing fillings made of resins and glass. Dentists say that these composite fillings are more popular for cosmetic reasons but that they do not last as long, are more expensive and are more difficult to put in teeth.

Though research into amalgam fillings is continuing, it is difficult to measure its impact. Patients can be exposed to mercury by a wide variety of sources, such as contaminated fish and other seafood.

Conflicting studies

Mercury opponents point to studies linking the metal's presence in fillings to an array of ailments, such as increased resistance to antibiotics, impaired kidney function, heart attacks, Alzheimer's disease and fetal abnormalities.

But amalgam supporters question the procedures used in many of those studies and point to other studies rebutting their results. Defenders of amalgam say that if there were any health problem from the fillings, they would be obvious by now.

A national panel convened by the U.S. Public Health Service to study amalgam fillings found no pattern of problems, except for rare allergic reactions.

"For the last six years, the U.S. Public Health Service has fixed its sights on the issue of potential health risks from the use of dental amalgam," wrote Elizabeth Jacobson, the panel's chairwoman, in its 1997 report. "One can and perhaps should ask the legitimate question of why."

But a 1999 report by the Agency for Toxic Substances and Disease Registry, an arm of the U.S. Department of Health and Human Services, concluded that more research is warranted, especially into how fillings might affect pregnant women or young children.

Fillings called outdated

Charles Brown, the lawyer for Consumers for Dental Choice, a coalition that filed the suits in California and Maryland, contended that mercury fillings are outdated.

"What other aspect of the industry of medicine is still using the same basic manufactured material that they used 150 years ago?" he asked.

He charged that many patients are confused when dentists refer to the fillings as silver and do not mention mercury's presence.

The ADA insists there is no gag order prohibiting dentists from explaining the benefits and risks of types of fillings. But the group does prevent dentists from suggesting that a patient remove their amalgam fillings to cure health problems.

"There have been some notorious dentists who made quite a bit of money by suggesting to patients every ill they had was created by amalgam fillings," said Peter Sfikas, the ADA's general counsel, adding that many of them rightfully lost their licenses.

But Michael Ziff, a retired dentist in Orlando, said he endured a nearly four-year legal battle in the mid-1990s with the Florida dental board because two other dentists complained he was misleading people about mercury's risks.

"It is my belief that patients have to be told that there's mercury in the fillings and the mercury comes out," he said. "I was not claiming that it would cause [multiple sclerosis] or that patients should get all their [amalgam] fillings removed."