By Isaac Eranga - a Health Journalist
History was made when the West African Summit on Phasing Out Amalgam was held in Abuja on 20 May 2014, bringing together NGO leaders from the ECOWAS nations of Benin, Côte d’Ivoire, Ghana, Nigeria, and Senegal, and also from the North African country of Tanzania. They adopted the Abuja Declaration, then invited NGO leaders from across Africa to join as signatories.
Cognisant of the fact that mercury, which is used in dental amalgam, is a restorative material that is approximately 50% elemental mercury, and is a notorious heavy metal of global concern that is known to be a potent poison of the human nervous system.
Aware that dental mercury accounts for 10% of annual global mercury consumption and 260-340 metric tons of mercury pollution around the world each year.
Knowing that dental mercury enters the environment via many release pathways, polluting air via cremation, dental clinic releases, and sewage sludge incineration; water via human waste and dental clinic releases to septic systems and municipal wastewater; and soil via landfills, burials, and fertilizer.
Understanding that once dental mercury is in the environment, bacteria in soils and sediments may convert it to methylmercury, “a highly toxic form that builds up in fish, shellfish and animals that eat fish, thereby making fish and shellfish the main sources of methylmercury exposure to humans.
Aware of existence of significant literature that show that methylmercury can damage children’s developing brains and nervous systems even before they are born.”
Recognising that in the dental workplace, uncontrolled mercury vapours are a major occupational risk, especially to young women of childbearing age, and that amalgam is not consistent with modern dentistry; unlike less invasive mercury-free filling materials, amalgam placement requires the removal of a substantial amount of healthy tooth matter, which weakens the tooth structure and can lead to more expensive dental care later.
Recalling that throughout the Minamata Convention negotiations, the Africa Region worked very hard to make sure that reduction in dental amalgam use specifically be included in the treaty, forcefully arguing for the phase out of amalgam generally and for an end to amalgam in milk teeth specifically.
Recalling further that at the crucial Pretoria regional consultation, 9th May 2012, the African Region boldly adopted a plan for dental amalgam – the phase-down steps – that coupled with subsequent amendments was enshrined into the treaty.
Applauding that the newly-adopted Minamata Convention on Mercury, the world recognizes that dental amalgam is a major environmental pollutant and requires each participating nation “to phase down the use of dental amalgam.”
Considering the fact that Mercury-free dental restorative materials are far less expensive than dental amalgam when environmental and societal costs are factored in.
Considering further that the costs of using mercury-free glass ionomers for Atraumatic Restorative Treatment or ART (including retreatment) is about half the cost of amalgam without retreatment, making this mercury-free technique significantly more affordable in low-income communities, particularly in areas without electricity or dental clinics.
Noting that mercury-free dental restorative materials are effective according to the World Health Organization report Future Use of Materials for Dental Restoration, which says “recent data suggest that RBCs [resin-based composites] perform equally well” as amalgam – and offer additional oral health benefits because “Adhesive resin materials allow for less tooth destruction and, as a result, a longer survival of the tooth itself.
Noting further that, this Abuja Declaration falls fully within the spirit of the Libreville Declaration on Health and Environment in Africa (August 2008).
Encouraged by the WHO’s call for funding agencies to take the initiative and encourage the replacement of amalgam as the material of choice for posterior teeth with adhesive systems.”
Regretting the fact that pro-amalgam lobby groups view the Minamata Convention as the chance to profiteer in Africa by actually phasing up amalgam by promoting expensive amalgam equipment, such as separators.
Cognisant of the fact that, separators have no value in Africa as there is no infrastructure to collect and store the mercury from dental offices.
Seeing the dangers that is inherent in amalgam and in an effort to curtail it, a stakeholder forum was held in Benin City, Edo State in October, 2017. The forum was put together by Sustainable Environment Development Initiative (SEDI), represented by the Executive Director - Dr. Tom Aneni, with support from World Alliance for Mercury-Free Dentistry (WAMFD), represented by Barr. Charlie Brown. During the stakeholders forum, the following communique and attendant recommendations were made:
1. Mercury is a chemical of global concern owing to its long range atmospheric transport, its persistence in the environment once anthropogenically introduced and its ability to bio-accumulate in ecosystems.
2. Exposure to mercury can harm the brain, heart, kidneys, lungs, cardiovascular system and immune system, particularly in women, unborn children and infants.
3. Low level of awareness among Nigerians on the dangers of mercury in dental amalgam.
4. Dental amalgam is still widely used and is the most affordable dental filling material serving the restorative health needs of Nigerians.
5. The limited availability of oral health manpower, service facilities and materials for dental restoration, and the high cost of dental restorative treatment.
6. Limited number of dental clinics and centres to provide services for the Nigeria’s teeming population.
7. Recognition of the negative impacts of mercury on people’s health and the environment led to the adoption and signing of Minamata Treaty by over 128 nations of the world on the 10th October, 2013 at Minamata, Japan. Nigeria has signed but is yet to ratify and become a party to the convention. However, there are efforts to initiate programmes that will ensure significant reduction in mercury use.
8. The convention entered into force on 15th August, 2017 having been ratified by 84 countries.
9. Alternative direct restorative materials such as composites, compomers and ceramics can be used for restoration of carious and non-carious cavities involving anterior and posterior teeth based on specific selection criteria and indications.
10. Aware that the Federal Ministry of Environment, Federal Ministry of Health, UNIDO and other stakeholders have completed the Nigeria Minamata Initial Assessment (MIA) report to usher the national implementation of the convention.
Recommendations
1. In compliance with the provisions of the Minamata convention, government should initiate a coordinated multi-sectoral approach for an effective phase down of use of dental amalgam in Nigeria.
2. Updating dental schools training curriculum to emphasize mercury-free dentistry.
3. Implementation of a phase down work plan. This must also include legislative review and development of guidelines, gathering baseline data and developing the national overview.
4. Initiation of demonstration projects and application of best available technology and environmental practice in the management of dental amalgam.
5. Promotion of alternatives/transition to alternatives by a concession for imported alternative restorative materials.
6. Engaging the public and media as well as other stakeholders in awareness creation on the health impacts of mercury in dental amalgam and the need for prevention of caries.
7. An urgent need for Nigeria to domesticate the Minamata convention as soon as possible.
The above brought about the Edo State Resolution to end Dental Amalgam for children under 16, pregnant and breastfeeding women as of 1st July 2018.
