Drama will play in an unlikely forum
this afternoon when the Oregon Board of Dentistry
debates a rule that limits what dentists can tell
patients about the health benefits, real or imagined, of
removing their silver amalgam fillings.
Fillings regulation may sound dull. But for the dental
business, the debate over mercury-containing fillings is
just as divisive and loud as societal arguments about gun
control, the Vietnam War or scoring figure-skating
contests. It's the Protestant revolt -- questioning a
basic practice of dentistry for more than 150 years.
The more extreme members of each side accuse the other
of trying to defraud the public to make a fast buck. The
debate has led to lawsuits, a pending federal bill and the
firing of California's entire state dental board.
"Man, it's a really hot issue," said Fred
Berman, director of a toxicology resource center at Oregon
Health & Science University. "There's certainly
enough controversy and enough people on both sides of the
issue. Sorting it out is the problem."
The great majority of dentists, backed by the Oregon
and American dental associations, say silver amalgam
fillings are safe except for a very small group of people
with mercury allergies. The bulk of scientific research
backs that position. Last month, the Food and Drug
Administration released a review of research on fillings
that said "no valid scientific evidence has ever
shown that amalgams cause harm to patients."
"All the mainstream scientific literature that
I've read indicates that the silver filling -- even though
it contains about 50 percent mercury and even though it
does leach mercury vapor in small amounts -- has no
negative effect on human health," said Gordon Empey,
dental director for Multnomah County Health Department.
But a vocal minority of dentists and patients, called
"anti-amalgamists," think silver fillings pose
serious health risks. They point out that amalgam fillings
are half mercury by weight and that mercury is a toxic
metal. They also note that a few nations, including Canada
and Germany, have advised pregnant women and young
children to use other types of fillings.
"There's a strong and growing number of dentists
who are opposed to using mercury," said Charlie
Brown, a Washington, D.C., lawyer with Consumers for
Dental Choice, an anti-amalgam group that Brown said grew
out of "a national victims' group of people who have
gotten sick from mercury in their mouth."
A rule barring fraud What the nine-member dental board
will consider today is a 1990 rule that says "it is a
fraud and a violation of the Dental Practice Act for a
dentist to advocate to a patient the removal of"
properly working amalgam fillings, just to substitute a
filling material that doesn't contain mercury. Fraud is
grounds for the board to remove a dentist's license to
The board passed that rule to keep dentists from
selling expensive filling-replacement procedures by
claiming they would cure diseases, said Jo Ann Bones, the
board's executive director. Some anti-amalgamists claim
that the silvery fillings cause ills -- including asthma,
depression, diabetes, multiple sclerosis and Lou Gehrig's
disease -- and say that removing the fillings can cure
those diseases. There is almost no scientific evidence to
support such claims.
But the board's rule has a serious flaw, according to
Sandra Duffy, a Lake Oswego lawyer leading today's effort
to kill the regulation. By governing what dentists can
say, not what they do, it is "an unconstitutional
abridgment of free speech," she said.
The board never investigated or disciplined any dentist
for violating that rule. But at least a few Oregon
dentists said they feel it limits their speech.
"I have always been fearful to tell the patients
that mercury is not good for you," said Amy Khajavi,
a Portland dentist who doesn't use mercury fillings and
who plans to speak at today's hearing. Khajavi said she
has never heard from the board about her views.
"Nobody has approached me directly saying, 'Don't do
that.' But there was the fear that my license could be
Free speech At Duffy's urging, the American Civil
Liberties Union sent a letter to Attorney General Hardy
Myers saying the policy violates Oregon and U.S. free
speech protections. The ACLU also said the board adopted
the rule without following the right legal process,
including a public hearing.
The ACLU could get an easy win. Bones said the board's
lawyer already told members that they either need to
reword or rescind the rule to address those worries. The
lawyer will recommend rescinding the rule this afternoon,
she said. That's mostly because the board does not
"recommend what materials dentists should use,"
Bones said. She added that "there was no intention
for that to be a gag order."
Bones said the board could still discipline a dentist
who convinces patients to replace perfectly good amalgam
fillings by making bogus health claims. To do that, the
board would have to have a complaint and determine that
the dentist was not following "acceptable patient
care," as defined by standard dental teaching and
practice. "The bottom line is, would any reasonable
dentist have done this," Bones said.
The ACLU would be satisfied with that, said Julia
Markley, the lawyer who wrote Myers. The group is worried
about a policy limiting speech, not necessarily limits on
"I would hope the Board of Dentistry would protect
our health and prohibit dentists from doing certain
things," Markley said.
A matter of discipline But rescinding the rule while
still considering discipline for dentists who do pull and
replace amalgam fillings would not satisfy anti-amalgamists,
Brown said. If that happens, he said, there will still be
a de facto rule against replacing amalgam for health
reasons, and he'll urge the ACLU to pursue a lawsuit.
Brown added that he hoped to get the ACLU interested in
the issue in other states. It's part of a broader campaign
against mercury fillings. That effort's most notable
success has been in California, where the legislature
dissolved the state dentistry board last year after it
delayed issuing a warning about the health pros and cons
The legislator who led that effort, Diane Watson, is
now a member of the U.S. House. She has drafted a bill
that would phase out the use of amalgam fillings entirely
over five years, an idea that heartens Brown's group.
"We now feel we can move to our top goal, which is
to abolish mercury dental fillings," he said. You can
reach Andy Dworkin at 503-221-8239 or by e-mail at firstname.lastname@example.org.