The best we have is no fillings

Jan. 1, 2004
Anti-amalgamists become hysterical about their version of reality. They are zealots, spewing their data to anyone who'll listen (a very small number).

By Shirley Gutkowski

Anti-amalgamists become hysterical about their version of reality. They are zealots, spewing their data to anyone who'll listen (a very small number). They launch accusations of dunderheadism at dentists who practice dentistry the same way they did a hundred or more years ago. They continually badger dentists trying to help people via Internet newsgroups and list serves, using highbrow techniques such as name-calling, belittling, and nit-picking. Online newsgroup users kill-file or filter these maniacs. They're like niggling, maddening no-seeums flying around your head. Newsgroup participants can't get to information or enter into the discussions they want to for fear of coming up against these rabid pit bulls. Every topic, however benign, gets turned into a hysterical blathering about the toxicity of mercury.

Anti-amalgamists pitch fits and produce smoke from their ears when the ADA defends its position on heavy-metal-containing-body-part-replacements. They hurl green vomit at the duped dentists who toe the ADA line. They have Web sites and hate groups all over the Internet. They appear to have logic and mountains of science to support their claims.

According to the defenders of amalgam, the anti-amalgamists use flawed logic and unacceptable science. "They," the ADA, are a group of dentists who formed an association to support the use of a known toxin for body-part replacement, according to the anti-amalgamists.

Anti-amalgamists are people, after all — not DNA duplicates of Medusa. They're more like Prometheus, the mythical character who was sentenced by Zeus to have his liver eaten by an enormous eagle every day while helplessly chained to a rock. Many of these fanatics suffer physically and mentally. Their minds are racing, their bodies ache, and their sleep is disrupted with vivid, violent dreams. They repeatedly visit physicians with various symptoms, and the doctors can't find a cause. Modern medicine doesn't incorporate heavy metal poisoning in a differential diagnosis. Why would they? Amalgam is safe and the chances of someone accumulating enough mercury from the environment are slim.

Somewhere along the line, these people become disenchanted with the lack of progress from their traditional physicians. Test after test shows that they are not sick; they just feel sick with vague symptoms of lethargy, unclear and racing thoughts, and restlessness. Then someone says something or they read something that directs them to a hair analyst when the truth comes out. They have mercury poisoning.

They are given literature, which proves to them that mercury toxicity exists, and their malady — from MS to memory loss to atherosclerosis — is caused by the mercury vapor liberated from their amalgam restorations during daily functioning of their teeth. In some cases, they have occupational exposure, such as a laboratory somewhere, or perhaps a dental office before the 1990s when gloves were optional and squeeze cloths were used to soak up extra mercury after the ingredients were mixed. They are positive that they are sick, and, after an exhaustive search for a cause, they finally find someone who will give a name to an ailment that eluded regular medicine for years: mercury poisoning.

These people become angry with their dentist. They feel betrayed by the doctor's reassurances, by their insistence of using a safe heavy metal amalgam to replace a body part. The doctor retracts his own cheek to reveal amalgams. The dentist puts amalgam in his or her own children's teeth; it must be safe.

The kernel of truth is that the dentist thinks it's safe. Anti-amalgamists are enraged by the ADA's position, accusing the association of putting money before patient health. Even the ones who understand the true costs of restorative materials claim dentists are lazy for following the party line, not using research to further their own knowledge, and not providing options at a similar cost. They accuse dentists of punishing them, consciously or not, for ignoring their advice about home care.

Anti-amalgamists froth with anger, dismay, injustice, fear, and the crush of a betrayal caused by someone they trusted.

Betrayal is often the dominant emotion manifesting as all the rest. When one spouse betrays another, the resulting collateral damage can be as if worlds collide. The damage can spread to children, parents, or siblings. Betrayal between employers and employees can be almost as catastrophic. Usually, the fallout rains more on the immediate parties than extended family.

When an industry betrays their employees/customers they serve, the feeling is just as personal. The betrayal by the Ford Corporation in building the Pinto is an example. The cost-to-risk ratio for building a safer car leaned towards gambling with customers' lives. So Ford did.

With a simple rear-end collision, the Ford Pinto erupted into flames, engulfing passengers and burning them to death. The only thing worse than death was surviving the inferno. The corporation knew all of this and made no changes; it was less expensive to pay damages than retool or discontinue manufacturing the automobile.

Dental assistants, who in the past worked bare-handed with mercury and squeeze cloths, feel particularly betrayed when hair analysis reveals their vague symptoms are indeed mercury poisoning. Their first response is often to scream from the highest point about their betrayal. With strained voice, they take to the pen, then realize the futility of fighting the dental industry as well as the pod people graduating from dental school who toe the line — plugging people's teeth with a known neurotoxin.

All their huffing and puffing gets them nowhere. The ADA is not going to change its position. They claim that their research — the right kind of research — plus the very long history of amalgam use proves they're right. European countries have banned the use of amalgam restorations. In this country, we keep using it as a material of choice. Many dentists act as if they don't need to formulate an opinion and blindly follow the guidelines of their association.

If the anti-amalgamists would choose to put their collective energies into stomping out decay in the first place, they would make more headway, much more headway. If they put time and money into cariology studies, they would help move people away from surgical removal of decay and amalgam, and not be up against the immobile institution run by the very people who they think callously poisoned them.

Oral health-care providers can exploit this angle to impress upon uncompliant patients and may make more headway too. It may be too much to ask anti-amalgamists to support municipal water fluoridation, but we could try. Anything we can do to eliminate decay in the first place will allow everyone to be better off.

Composite resin material used in sealants and esthetic restorations are also under fire for disrupting estrogen levels.

Dental hygienists, the prevention specialists, can keep up with current research on caries eradication. Saliva quality tests, office procedures beyond calculus and biofilm removal, and home adjuncts besides a new toothbrush can be taught to patients to eliminate decay. Not all patients need to apply themselves more. Some people cannot beat their own physiology and it's our job to know it, and do more on our end to fight it.

Right now, the best dentistry has to offer a patient with decay is amalgam as determined by the overseeing authorities. The best dental hygienists can offer patients is determining who can and cannot beat dental decay on their own. We need to take on the responsibility handed to us with our diploma and help patients beyond teaching them to brush and floss.

The education of patients is only the beginning; we must educate ourselves too. Learning the process of demineralization, and what we can do from our chair to assist remineralization is part of this rally cry. If the goal can be eliminating decay, we're shooting at the right target. Look at the ads in this magazine; they are full of ways to help patients fight their own physical, psychological, and physiological limitations. Help those with propensity for high mercury retention by helping them avoid restorations in the first place.

Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected].