This draft document has been prepared on the basis of ......Amalgam has been replaced by composite...
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Transcript of This draft document has been prepared on the basis of ......Amalgam has been replaced by composite...
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ThisdraftdocumenthasbeenpreparedonthebasisofinformationreceivedfromregionalandnationalNGOsin2019,butalldetailshavenotyetbeenverifiedbytheEuropeanCenterforEnvironmental
Medicine.Afinalverifiedversionwithallappropriatereferencesisinpreparation.
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CountriesrestrictingtheuseofdentalamalgamAFRICABenin
• Militaryhospitalshavemercury-freedentalclinics• Nopopulationacceptingfreedentalamalgamrestorativecaresinthenorthernpartofthecountrybasedon
consumereducation• Government’sengagementindevelopingregulationbanningamalgaminchildrenandchildbearingwomen
Cameroon• AllBaptistshospitalsareMercury-freedentalclinics• Regulationbanningallhazardouschemicalsproductsincludingdentalamalgamenacted
Côted’Ivoire• Thegovernmentplanstoadoptaregulationprohibitingtheuseofamalgaminchildren,pregnantwomenand
nursingmotherssinceadraftdecreehasbeenapproved.• Openingofamercury-freedentalclinicinAbidjan.• Thecurriculafromdentalfacultyhavebeenmodified,givingprioritytotheuseofalternativesinrestorativecare.
Guinea• Institutionalsupportfromgovernmentanddentalboardtoachieveamalgamphaseoutatcountrylevel• Prioritygiventoalternativeuseforrestorativecaresincurriculaofdentalschoolsince2017
Kenya• Enactingregulationonmercury-freedentistryinprogress• Prioritygiventoalternativeuseforrestorativecaresincurriculaofdentalschoolsince2017• Developmentofcountymodelonmercury-freedentistryinMombasa
Madagascar• Militaryhospitalsareallmercury-freedentistry• Effectivechangeofcurriculaindentalfacultyprioritizingtheuseofalternativeinrestorativecaressince2015.
Mauritius• Changeofcurriculaindentalschool• Mauritiusislandbanamalgamforchildrenin2017• Amalgamimportbanatcountrylevel• Strongcollaborationwithgovernmentinstitutionstomonitorandenforcethenationalregulation
Nigeria• Changesinthecurriculaofallfacultiesofdentistryinfederaluniversities,givingprioritytotheuseofalternatives
inrestorativecare,• Modelstateestablishmentformercury-freedentistryinLagosStateandBeninCity,• Elaborationofafederalroadmapfortheeliminationofamalgamindentalrestorativecareby2021throughout
thecountry.Tunisia
• Apartnershiphasbeendevelopedwithdentalassociation,dentalschoolsandscholarmedicaldoctorstoachieveanomoreuseamalgaminchildrenandyounggirls/women
• NationalinstitutionalsupportfromthegovernmentandParliamentissecuredtoachieveamalgamphasedown.ASIABangladesh
• TheBangladeshDentalSocietydeclaredtobantheuseofdentalamalgaminthetreatmentofchildrenandpregnantmothersbyJune2018.
• BangladeshArmyDentalCorephasedoutdentalamalgamuseintheirtreatmentonJanuary10,2018.• Sixdentaleducationalinstitutionsdeclaredmercuryfree.• Morethan2000dentalsurgeonhasself-declaredMercuryFreeDentistrypractitioners.• ANationalAlliancewascreatedwiththeBangladeshdentalsociety,MinistryofEnvironment,ForestandClimate
ChangeandBangladeshArmyIndia
• Thegovernmentismovingforwardonchangeincurriculumaswellastorestrictusageinvulnerablepopulation.• Adraftgovernmentorderforremovalofoldamalgamrestorations,mercurywastemanagementanddisposalin
dentalclinicsisbeingprepared.Indonesia
• Thedevelopmentofatechnicalguidancetowithdrawmercurycontainingmedicaldevicesisintheprocessnow.
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PresidentialDecreeNo.21year2019isconcerningtheeliminationandphaseoutofmercurycontainingmedicaldevices,includingdentalamalgam,scheduledtobephaseoutby2020.
• InIndonesiathedentalamalgam-relatedcurriculumhasbeenregulatedsince2015.• TheNationalDentalAssociation(PDGI-IndonesianDentalAssociation)hasphasedouttheuseofdentalamalgam
since2017;theydidnotproviderecommendationsfortheuseofdentalamalgaminhospitalsorclinicsthroughoutIndonesia.
Japan• Sincethe1980sJapanhasmovedalmostcompletelyawayfromamalgamforaestheticandenvironmentalrea-
sons.Amalgamhasbeenreplacedbycompositeresin,glassionomerandgold/silver/palladiumalloy.Amalgamwasusedinapproximately11%ofalldentalrestorationsinthe1980s,decliningtolessthan4%inthe1990s.In2010only20kgofmercurywereusedindentistry.
Malaysia• by2030Malaysiawouldphaseouttheuseofdentalamalgamuponhavingtherightsubstituteforit.• TheMalaysianDentalAssociationiswillingtocollaboratewithCAPinphasing-downamalgaminthedentistry
field.Mongolia
• Mongoliahastakenstepstolimitprocurementofamalgam,effectivelyphasingdownitsuse.• JointOrderofTheMinisterofHealthandTheNationalEmergencyManagementAgencyofMongolia(11January
2011)Nepal
• On21August2019,DeputyPrimeMinisterandMinisterofHealthandPopulationhasdecideduponmovingMercuryFreeDentistryforbanningmercurydentalamalgaminchildren(<15year),pregnantandbreastfeedingmothersfirstandthenmovetothegeneralpublicanddentalschoolcurriculumrevision/improvements.
• On19thMarch2019,NepalDentalAssociationhasdeclaredtheBharatpurMetropolitanCityasFirstMercuryFreeCitywithrespecttoMercuryFreeDentistry.
• KathmanduUniversitieswithaffiliationof6DentalCollegesoutof12DentalCollegesinNepalhasalreadyrevisedtheirdentalcurriculainlightofMercuryFreeDentistry.
Philippines• EnvironmentalManagementBureauoftheDepartmentofEnvironmentandNaturalResources(DENR-EMB)arein
theprocessofrevisingtheChemicalControlOrder(CCO)forMercuryandMercurycompounds.• 6thdraftforthe“JointAdministrativeOrderonDentalRestorationusingMercury-addedAmalgam”iscompleted,
andfinalrevisionsareunderwaySriLanka
• MinistryofHealthagreedtosendoutacircular,limitingtheuseofamalgamandconsidersfurtherprovisions,tophasedowntheuseofamalgam.
Vietnam• MinistryofHealthissuedadirectivetostopusingdentalAmalgamforchildrenunder15,pregnantand
breastfeedingwomenbyApril1st,2019;anddevelopedaroadmaptostopusingdentalAmalgamindentistryfromJanuary1st,2021.
• OnMay23,2019,NationalHospitalofOdonto-Stomatology(NHOS),theleadingdentalhospitalinVietnam,declaredtobeMercury-freeDentalhospitaland45dentistsinthishospitalsignedaregistrationformtobecomeMercury-freedentists.
IntheformerSovietUnion,theuseofdentalamalgamwasnotpermittedforchildrenuptotheageof18Years.Membersdidnotdevelopanysignificantlyusesince1991.Theuseofglassionomeriswidespread.
• Countries:Armenia,Azerbaijan,Belarus,Estonia,Georgia,Kazakhstan,Kyrgyzstan,Latvia,Lithuania,Moldova,Russia,Tajikistan,Turkmenistan,Ukraine,Uzbekistan
Georgia• TheuseofDentalAmalgamisprohibitedunderthenationalhazardouswasteregulation
Moldova• Fortheprotectionofhealthandtheenvironment,theproduction,placingonthemarketanduseofDental
Amalgamisprohibitedby15.02.2020.MIDDLEEASTSyria
• Banontheuseofdentalamalgamforchildren,pregnantandbreastfeedingwomen
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GRULACBolivia
• InSeptember2019adecreecamefromtheMinistryofHealthandMinistryofEnvironmentinwhichtheuseofdentalamalgamisbanned.
Chile• hasanexcellentoralprogrammeforchildrensincemanyyears,aimingatdentalcariespreventionandhealth
promotion,verylittleindeedofmercuryisused,mainlyunderexceptionalclinicalcircumstances.• AtthefacultyofdentistryfromUniversidaddeChileandUniversidadCatólica,themostimportantones,donot
longerteachtheuseofdentalamalgam,formanyyears.Colombia
• Theuseofdentalamalgamisallowed,66.9%ofchildrenaged1to5years;60.5%ofthosebetween5and12yearsold;and98.6%ofpeoplewhohavepermanentdentition,havecarieslesionsofvaryingdegreesofseverity.Thesepercentagesarehigherinruraldispersedpopulations,andinchildren.
• Nationalhealthsystemisthelargestuserofamalgams,privatedentistrynolongerusesit.• Itisallowedfordentistrytoimportmercurytoproducerawmaterials,however,adeadlinewassetuntil2023for
themtomaketheirtransitionandafterthattime,nomoremercurywillbeused.Ecuador
• MinistryofHealthunderthestrengtheningoftheregulatoryframeworkinrelationtowastemanagementwithmercury,updatedthedentalprotocolsfororalhealthwascarriedout,inwhichthedescriptionoffillingproceduresandrestorationofdentalpieceswithamalgamwaseliminated.
• TheMinistryofHealthpreparedanddisseminated,written,radioandtelevisionadvertisingspotstosensitizeandinformthepopulationofthecountry,abouttheadvantagesofchangingdentalamalgamsforresinsorothermaterials.
Guyana• Guyanaisnolongerpurchasingdentalamalgamforthepublicsector.Thestockwillbeusedoutin2020/2021• Aregulationtophaseouttheuseofdentalamalgamintheprivatesectorisontheway.
Mexico• hasworkedwithGreenHospital,abouttenhospitalsinthepublicsectorhavesignedapubliccommitmentto
eliminatemercury,includingtwoNationalInstitutesofHealthandothersfromtheMexicanSocialSecurityInstitute(IMSS).
• Inthepublicsectordentalamalgamisusedinencapsulatedform,intheprivatesectornearlynoneusesdentalamalgam.
• ThemunicipalityofChihuahuaadoptedacommitmenttoeliminatemercuryinthehealthsector.Panama
• TheMinistryofHealth,hasalreadybeenworkingformanyyearsontheeliminationoftheuseofdentalamalgamsinthepublicsector.Thecountryhasalreadydevelopedaregulationtodoso.
• ThePrivatedentalsectornolongerusesit.Peru
• MinistryofEnvironmentandtheMinistryofhealthareworkingtodevelopadecreewiththeaimofbanningtheuseofmercuryinchildren.
• Privatesectordoesnotuseitanylonger.• Dentistryschoolsattheuniversitiesencouragestudentsontheuseofmercury-freedentalrestoration
alternatives.Suriname
• Asfarastheuseofmercuryamalgamindentistryisconcerned,discussionstookplacein2013withtheDentistsAssociation.BasedontheirinformationithasbeenestablishedthatmercuryamalgamispracticallynolongerusedinSurinamesedentistry.Nevertheless,togetherwiththeDentistsAssociationandtheFoundationforYouthDentalCare(JTV)aprogramwillbesetuptocompletelyhalttheuseofmercuryamalgaminthedentistry.
• Bytheendof20l8incollaborationwithDentistsAssociationandFoundationforYouthDentalCaretocompletelybantheusemercuryamalgam.
• Nowadays,under(5%)ofdentalamalgamisused.St.KittsandNevis
• InOctober2018,attheNationalFinalResultsMeetingfortheProject“DevelopmentofMinamataInitialAssessmentintheCaribbean(Jamaica,SaintKittsandNevis,SaintLucia,TrinidadandTobago)”,itwasdeterminedthatthemajorproblemwastheconsumptionofproductswithintentionaluseofmercurythroughouttheiruseanddisposal.Itaccountedfor72.4%ofmercuryreleasedinSaintKittsandNevisduring2015.
• SubsequentlyStKittsandNevishasphasedouttheuseofalldentalamalgam
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Uruguay• setanationalschoolprogrammein2005aimingatdentalcariespreventionandhealthpromotion.Underthe
NationalPublicHealthSystem,whereavastpopulationisattending,verylittlemercuryisused.• Since2007theDentistrySchoolfromtheUniversidaddelaRepublica,mainuniversityinthecountry,teachesthe
useofmercury-freedentalrestorationalternativesandpromotethebestpractices.Theuseofmercuryforrestorationistaughtastechnique,usedinthepast.Atitsclinic,whereagreatamountofpeopleisattending,itisafree-mercurydentalassistance.
EUROPEEuropeanUnion+Monaco(useofmercuryfordentalamalgamin2010:~75t/Year)Mercury-Regulation2017:
• From1July2018,dentalamalgamshallnotbeusedfordentaltreatmentofdeciduousteeth,ofchildrenunder15yearsandofpregnantorbreastfeedingwomen,exceptwhendeemedstrictlynecessarybythedentalpractitionerbasedonthespecificmedicalneedsofthepatient.
• By1July2019,eachMemberStateshallsetoutanationalplanconcerningthemeasuresitintendstoimplementtophasedowntheuseofdentalamalgam.
EU-NationalActionPlans2019:Cyprus(useofdentalamalgamin2012:30%)
• From1January2025theuseofdentalamalgamisprohibitedinpersonsundertheageof18unlessthedentistconsidersitstrictlynecessarybecauseofthepatient’sspecificmedicalneeds.
• Until1January2025Cyprusassessthepossibilityofprohibitingtheuseofdentalamalgamsthroughoutthepopulationunlessthedentistdeemsitabsolutelynecessarybecauseofthepatient’sspecificmedicalneeds.
CzechRepublic(useofdentalamalgamin2012:92%)• TheCzechRepublicdoesnotexpectanabsolutephaseoutofamalgamin2030buttheobjectiveisareduction
below1%oftheinitialfillstate.-atthelatestin2025(from1January)itshouldbepossibletostartuniformpaymentsfordentalfillingsregardlessofthematerial.
• from2030onwards,amalgamfillingswillonlybereimbursedinexceptionalindicationswherenoalternativesareavailableandthepatientwishestohaveanamalgamfilling.
Finland(currentuseofdentalamalgam:<1%)• Thelong-termobjectiveistophaseouttheuseofamalgamcompletelyby2030.• Short-termgoals:Reduceamalgamconsumptionbyatleast25%by2022from2019;50%by2025and75%by
2028.• Sincetheuseofamalgamisinfluencedbythepublicfundingmodel,themodelshouldbereviewedinthecoming
yearsandrenewedfromthisperspective.Ireland(currentuseofdentalamalgam:20%)
• Irelandsupportsaphasedowntowardsphaseout/banofamalgamacrossallagegroupsby2030.• Theuseofdentalamalgamwillbeallowedonlyinexceptionalclinicalcircumstances.Theongoingneedforclinical
exemptionswillbereviewedperiodically.• Thepublicpaymentsystemwillberevisedtosupportmercury-freealternativesforeligiblepersonsacrossallage
groups.Germany(currentuseofdentalamalgam:<10%)
• TheFederalGovernmenthassetitselfthegoalofworkingtowardsfurtherreducingtheuseofamalgamindentaltreatmentandlimitingittoindispensablespecialcases.
• ThefirstNationalPlanisfocusingonfurtherstrengtheningthepreventionofcaries,butwillbeperiodicallyupdatedinsubsequentyears.
Lithuania• TheMinisterofHealthpreparesadraftorderstipulatingthattheuseofdentalamalgamfillingsandtheremoval
ofteethfilledwithdentalamalgamfillingsmaybeperformedonlyindentalcare(aid)institutionsbelongingtotheLithuanianNationalHealthSystem.
• TheMinisterofHealthpreparesadraftorderobligingdentalcareinstitutionstoreporttheusedamalgamforthetreatmentofmilkteeth,teethofchildrenunder15yearsofage,pregnantandbreastfeedingmothersandmedicalindicationsofthesepatients;mandatorypatientinformationandwrittenconsenttousedentalamalgamfordentaltreatment;establishproceduresfortheprovisionofthisinformationandreporting.
TheNetherlands(theuseofdentalamalgamwasfallingintheyears2015-2018from1%to0.55%)• Assoonastheuseofamalgamwillincreaseabove1%,theNetherlandswillevaluateactionshowtofurther
reducetheuse.
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Romania(useofamalgamcomparedtoalternativefillingmaterialsin2012:71%)• Immediatelybanontheuseofamalgamforchildrenupto18Years• Useofdentalamalgamonlypermittedinaselectedlistofmedicalclinics• Patientsobligationtocompleteaninformedconsentbeforeusingdentalamalgam
Slovakia(currentuseofdentalamalgam:30%)• Slovakiaanchoredabanonamalgamfrom1.January2031inthenationallegislationActno.578/2004Coll.The
competentregionalauthoritymaygrantdentistsafineofuptoEUR3,919.• anadjustmentofthesubsidyforalternativefillingsisplannedinthenextfewyears
IndependentNationalRegulationsbyEUMembersNewCaledonia(France)
• On16thSeptember2019theHaut-CommissariatdelaRépubliqueenNouvelle-Calédoniedecidedtoimmediatelystoptheuseofdentalamalgam.
Sweden(currentuseofdentalamalgam:proximately0%)• Swedenstoppedtosubsidizedentalamalgamin1999• In2009dentalAmalgamwasbannedforthegeneralpopulationwithfollowingexceptions:
1)inSpecificmedicalcondition2)whenotherdentalfillingmaterialscannotbeusedorcannotprovideadequaterestoration
• Swedenceasedtheexemptionson31December2011Denmark(Theuseofdentalamalgamhasdecreasedfrom22%to1,7%intheperiodfrom2007to2017)
• Denmarkdecree:mercury-freealternativesshouldbethefirstchoice• Since1995amalgamshouldonlybeusedasfillinginpermanentmolarsinthefollowinginstances:
1)lackofpossibilityofdrying,2)difficultaccessibilityofthecavity,3)especiallylargecavity4)largedistancetoneighbouringtooth
NonEU-MembersIceland-IntendstoadopttheMeasuresoftheEU-Mercury-Regulation(2017):
• Dentalamalgamshallnotbeusedfordentaltreatmentofdeciduousteeth,ofchildrenunder15yearsandofpregnantorbreastfeedingwomen,exceptwhendeemedstrictlynecessarybythedentalpractitionerbasedonthespecificmedicalneedsofthepatient.
• In2017only9FillingsweremadeofDentalAmalgam(0.04%)Norway
• In1991,Norwayissuedguidelinesthattheuseofamalgamshouldbelimitedduetoenvironmentalimpacts.Strongerguidelineswereissuedin2003,requiringmaterialsotherthanamalgamtobeconsideredasthefirstchoiceintoothfillings.
• Since2008Norwayhashadageneralbanonmercuryproducts.Thisincludedabanonamalgam,withanexemptionperiod–nowexpired–forspecialcases.
• Amalgamusehasbeeneliminatedsince2011.Montenegro
• Montenegroisnolongerpurchasingdentalamalgamforthepublicsector.Thestockwillbeusedoutin2020/2021• IntendstoadopttheMeasuresoftheEU-Mercury-Regulation(2017)
Switzerland• InSwitzerlandthe1989SwissOrdinanceonRiskReductionrelatedtochemicalproductsstatedthatamalgammay
notbeusedifamercury-freealternativecanbeappliedinitsplace.• TheuseofdentalamalgamisbannedinSwitzerlandsincetheratificationoftheMinamataConvention• Thetradeofmercuryandmercurycontainingcompoundswillbestoppedin2027
CountriesthatDiscourageorRestrictAmalgaminVulnerablePopulationsCanada
• DiscouragesorRestrictsAmalgaminVulnerablePopulations• “Avoidusingamalgamfillingsinchildren,pregnantwomen.”
Australia• DiscouragesorRestrictsAmalgaminVulnerablePopulations• Warnsparents,pregnantwomentoavoidamalgam
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Formoreinformationorassistance
WorldAllianceforMercury-FreeDentistry,CharlieBrown,[email protected],SiddikaSultana,[email protected]
CentreAfricainepourlaSantéEnvironnementale,DominiqueBally,[email protected],MaríaCárcamo,[email protected]
EuropeanCenterforEnvironmentalMedicine,FlorianSchulze,[email protected]
