"Accessing dental services, issues to do with choice and safe practices"

About: NHS Western Isles

(as the patient),

I was ‘forced’ to sign up to a private dental health scheme several years ago as my dental practice decided to withdraw from the NHS. I moved home to the Western Isles over two years ago and as my dental practice was a hundred and fifty miles away from my current residence on the Isle of Lewis, I decided to register with the NHS Dental Centre in Stornoway. I decided to remain with my private scheme until I was registered with the NHS. After several months I was accepted. I was however extremely surprised to learn that although amalgam was not used for front teeth it was the only option for other teeth. There was no choice. If I wanted fillings other than amalgam I would have to go to a private practice and because there were no available private practice places on the island I would have to go travel to the mainland.

As I have a number of existing amalgam fillings in my back teeth I had made an informed decision several years ago to replace them when the opportunity arose with other materials as I was very concerned by the health implications of having amalgam fillings. I understand that dental amalgam has been found to be a frequent contributor to oral lichenoid lesions and may well be associated with an increased risk of multiple sclerosis, lupus, thyroiditis and eczema. I have read some research that suggests that there is also a link to high blood pressure, infertility, and disorders of the central nervous system.

I believe that some countries have already banned the use of such fillings including Norway, Denmark, Sweden, Japan, Switzerland and some counties/cities in California. Finland and Japan have severe restrictions. I also understand that there are partial restrictions or prohibitions on the use of dental amalgam in Denmark, France, Italy, Russia, UK, Finland, Germany, Australia, Canada, Austria, and Catalonia in Spain. I also believe that dentists and patients in many Asian and Eastern European countries have dramatically favoured alternative filling materials in recent years and all EU countries predict a decrease in amalgam use, except the UK. Mandatory separators are now required to be fitted in dental practices in several countries including the UK. I believe that the United Nations, WHO, EU, Arab League, African Region and US Department of State all support an amalgam phase-out/down to be followed by a ban and that there are also environmental issues about using this material. So the issues are not only to do with health but also ethics.

I read that in 2008 the U. S. regulator dropped much of its previous reassuring language on the fillings from its website. It now states that: 'Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and foetuses. ' Informed consent is required in many states of America but not in the NHS.

I believe it is well known that mercury vapour is released when amalgam fillings are placed or removed, and during the chewing of food and small amounts are passed into the bloodstream and organs.

More than half of an amalgam filling is made up of mercury, which is more poisonous than lead and it is mixed with silver, copper and tin, forming a highly durable combination to lock in the mercury. I believe that dentists themselves have been found to have high levels of mercury in their bodies and 500 practices in Britain refuse to offer mercury.

There has been a considerable investment in dental treatment in the Western Isles, with excellent facilities and staff. The lack of choice for patients living on an island however concerns me. I can see no reasonable reason for the Western Isles Health Board not providing patients with choice and the best and safest methods of treatment. It also is very discriminatory in that the poorest in our society are unable to access these treatments elsewhere, the cost being prohibitive.

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Response from NHS Western Isles

The salaried dentists working for NHS Western Isles are covered by the national General Dental Services ( GDS ) rules and regulations and treatment plans and options are developed within the parameters of these regulations.

In terms of specific items of Dental treatment we advise patients to discuss this with their dentist, such that all options for treatment are considered.

John Lyon

Chief Administrative Dental Officer, NHS Western Isles

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Update posted by Little Mac (the patient)

I have not found this response very helpful. It has not addressed the issues raised. What does NHS Western Isles intend to do about the issues that have been raised? What is the view of NHS Western Isles on the use of amalgam? For someone who doesn't wish to have amalgam used in their treatment what do they do? Why can't they have the choice of having another substance used in its place by local NHS staff? These are just a few of the questions that you could have answered but failed to do so.

Response from Lillian Crichton, Patient Focus Public Involvement Development Officer, Clinical Governance, NHS Western Isles

Dear Little Mac

The dentists work to national rules and regulations. I would encourage you to discuss this with your dentist at your next appointment.

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