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Staff Reporter of The Wall
Street Journal
May 10, 2001. By Kathryn Kranhold. Page B1.
Dentists are suing state regulators over what they contend is
a gag order preventing them from discussing with patients the
potential health hazards of the most common form of dental filling.
At issue are those silver-colored fillings that dot most people's
teeth. Referred to by the dental profession as silver amalgam,
the fillings are actually about half mercury, with some silver,
copper, tin and zinc mixed in.
Mercury opponents argue that mercury vapor coming from the fillings
seeps into the body, contributing to a range of health problems
from fatigue and immunity suppression to neurological diseases
such as Parkinson's and Alzheimer's. The dental establishment,
including the American Dental Association, argues that the low
level of vapor causes no harm and that raising such safety issues
with patients would unduly alarm them. The science on the issue
is inconclusive. The suit was filed yesterday in federal court
in Greenbelt, Md., by five dentists and seven patients claiming
injury from the mercury in their fillings. The plaintiffs argue
that dental regulators use "control of dental licenses to
punish, or to threaten punishment of, dentists who criticize mercury
amalgam," violating the dentists' First Amendment rights.
In 1999, for example, the suit claims that the Maryland Board
of Dental Examiners ordered dentist Bill DeLong to stop testing
his patients to determine whether mercury vapor was coming off
their fillings. (The case was eventually dropped.)
The dentists' attorney, Charles Brown of Washington, D.C., says
the plaintiffs want the court to order licensing boards to stop
enforcing any policy that "prevents, limits or intimidates
dentists" from discussing the controversy or advocating "mercury-free"
dentistry. The suit also seeks certification as a defendants'
class action naming 50 of the country's 52 licensing agencies.
In a statement released yesterday, Maryland's licensing-board
administrator, Art Williams, said the board "acted lawfully
and has done so in order to protect consumers." The dental
establishment maintains that some dentists have used the controversy
over mercury's safety to encourage patients to remove amalgam
fillings and replace them with more expensive materials such as
gold, porcelain and a tooth-colored resin composite. Resin, the
least expensive alternative, costs as much as 25% more than fillings
containing mercury. J. Rodway Mackert Jr., a professor at the
Medical College of Georgia who is an ADA spokesman, says that
discussing mercury when patients are in the dentist's chair would
be a disservice to them. "If you have one side claiming it
isn't safe, that doesn't mean that side is right," he says.
Nevertheless, state legislatures in New York and Maine are debating
bills that would require dentists to disclose to patients the
makeup of their fillings. New York Assemblyman Richard Brodsky's
bill would also ban dentists from filling cavities in pregnant
women and children with mercury. A Vermont bill would require
dental offices to track how much mercury they use in fillings.
And California's dental board is considering spelling out the
pros and cons of different fillings in a consumer fact sheet.
Minnesota's dental board may also become more amenable to alternatives
to mercury. In 1999, Minneapolis dentist Ronald King, who advertises
"dental care that integrates conventional and alternative
philosophy," was appointed to the board by Gov. Jesse Ventura.
He is now on a committee that hears complaints about dentists,
including mercury-free dentists. Dr. King says other board members
now see him "as a colleague instead of a weird guy with his
own agenda."
The Amalgam Wars began in the mid-1800s, when dentists first
started using mercury-based material to treat tooth decay. Originally,
it was the dentists who used mercury who came under fire from
colleagues who didn't believe it was as safe as gold or tooth
extractions. But soon, mercury became the material of choice,
mostly because it was cheaper and easier to use -- and it was
less painful than having hot gold poured into a tooth. In 1976,
when the U.S. Food and Drug Administration began regulating medical
devices, it grandfathered in mercury-based fillings as an approved
dental material. The ADA, which once had a patent on mercury fillings,
maintains that mercury is safe once it is mixed with other metals
and set in teeth, but it warns dentists about the "potential
hazard of mercury vapor" when they handle the material. In
a 1999 report, the Agency of Toxic Substances and Disease Registry,
a division of the U.S. Department of Health and Human Services,
concluded there is no apparent health hazard but urged further
study to "determine the possibility of more subtle behavioral
or immune-system effects, and to determine the level of exposure
that may lead to adverse effects in sensitive populations."
Fillings could contribute as much as 75% of a person's daily mercury
exposure, the report said, noting that the vapor is released during
chewing and because of corrosion. Judith Baker, a South Bend,
Ind., accountant and a plaintiff in the Maryland suit, was so
sick she had her gallbladder removed in 1999. But another doctor
later diagnosed her with mercury poisoning stemming from a new
filling containing mercury and the replacement of two old mercury
fillings with a larger one. Ms. Baker says she was skeptical and
had her well water tested for mercury and her house tested for
fumes before asking a dentist to remove her fillings earlier this
year. She says she is starting to feel better after going through
mercury detoxification treatment. Boyd Haley, a University of
Kentucky chemist who has published several studies using rats
and human brain samples, says his work shows that brain tissue
exposed to mercury develops the same biochemical defects seen
in Alzheimer's disease. But even Dr. Haley doesn't theorize that
the fillings cause significant adverse health effects in everyone.
"Certain patients, due to genetics or illness or other toxic
exposures, could be more sensitive to the amount of mercury normally
released from dental amalgams," he says.
The ADA responds by pointing to a study published in its journal
that concluded that mercury in fillings "does not appear"
to be a factor in the development of Alzheimer's disease. But
one of the study's authors, chemist Charles Cornett, is wary of
that conclusion. He says the study failed to evaluate how different
people process mercury, among other factors. Two large clinical
trials sponsored by the National Institutes of Health are now
under way with the goal of determining how school children with
and without mercury fillings develop. Results of those studies
won't be known until at least 2006. Meanwhile, the Maryland board
is proposing a new rule that states that removing "serviceable
mercury amalgam restorations" is unprofessional without informed
consent that includes telling the patient that "there are
no verifiable systemic health benefits resulting from the removal."
Dr. DeLong strongly disagrees. After he removes their mercury-base
fillings, he says, patients "report not only feeling better
but having whatever problems they came in with disappear over
time."
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Heavy Metal Detox
