The Dental Amalgam Phase Down Training Manual Developed and Implemented.

Abstract

Thistraining programmeis intended to serve as a quick reference in modern dental practice as the implementation of dental amalgam phase down continues virtually in all countries. Dental amalgam phase downis embodied in the Minamata convention on mercury (MCM)1, a global treaty that was signed on 10th January 2013 and came into force on 17th August 2017. Kenya is a signatory tothe MCM, whose objective is to protect human health and the environment from effects of mercury (Hg) existing as pure mercury and in the myriad of Hg containing products one of which is dental amalgam. The mercury content and the lack of best waste management practice makes dental amalgam (DA) contribute to the worlds’ anthropogenic mercury (Hg) release to air, soil and water. Kenya is advanced in ratifying the convention,the cabinet has recently considered and approvedthe convention document for consideration by parliament,after which Kenya willjoin the 137 party countries. Phasing down the use of dental amalgam enjoins a paradigm shift from the traditional dental amalgam model, towards adhesiverestorations and dental caries preventive approaches, that include minimally invasive dentistry employingalternative restorative dental materials.As a dentist, considering the efficacy of dental amalgam for over 150 years as a posterior restorative,perhaps brings to memory howits scientific principles and clinical application were drummed to you as a dental student. On the contrary todaysome dentists may firstly lack adequate knowledge and skills to execute quality alternative restorations particularly in posterior teeth, and secondly may be unaware of the dental caries preventive, non-invasive and micro-invasive model. Therefore, it is conceivable one may be bound to select, manipulate and place certaindental amalgam alternative restorative while lacking requisite competence. The Kenya’s National Oral health survey 2015 revealed an unmet dental caries burden of 46.3% and 35.5% among children and adults respectively, hence the need for use of restorative dental materials is with us2. You may rightly view this training programme as a continuous professional developmenttool, as it takes cognizance of corporeal literacy and focusses only new dental materials, and novel prevention techniques made possible by dental amalgam alternative restorative dental materials. As you may have gathered, the use of dental amalgam alternative restoratives (DAARs) has increased steadily due to patients demanding foraesthetic restorations, therefore adding dental amalgam phase down (DAPD) catalyses the eclipse of dental amalgam which at last has dawned3, ushering the need for all dentists to master new techniques. Module I covers dental amalgam phase down as it is stipulated in Article 4 of the Minamata convention text and summarises its impact on dental practice today. In Module II the dental amalgam alternative restorative materials are discussed with attention being given to new biomaterials, categorized under resin composite and glass ionomer and related biomaterials. Module III demonstrates the selection and manipulation techniques. This programme has designed module IV to highlight the congruence of theuse of adhesive alternative restorative materials and the novel restorative philosophy that prioritizes prevention, early detection, and noninvasive and microinvasive treatment. Thus, steering away from the ‘drill and fill’ dental amalgam approach. The overall gains of dental amalgam phase down and minimally invasive dentistry include reduced dental caries burden, smaller cavity sizes and reduced need for restorative materials. Subsequently, reduced expenditure thus improvementof oral health of the population, which is the holy grailof global prevention of dental caries in populations. As a dentist you have a significant role in deciding between using dental amalgam or its’ alternatives. Nonetheless that should be moderated by patients’ decision, availability of quality alternative materials, clinic setting and of your capacity to utilize the DAARs. Though dental amalgam has served and still continues to serve the profession well, the neglected ingress of its’ waste into the environment has led to a global phased down of its’ use. Furthermore,the need to manage dental amalgam waste will remain with the profession for a long time. Since replacements of defective amalgam fillings and disposal of extracted teeth with dental amalgam fillings will persist beyond its phase out.