49 Pa. Code § 33.213 - Replacement of dental amalgams-statement of policy
(a)
Background. The safety
of dental amalgams, specifically, whether the mercury in amalgams causes or
contributes to a variety of health problems, has become a recurring issue in
dentistry. The Food and Drug Administration has determined that while elemental
mercury has been associated with adverse health effects at high exposures, the
levels released by amalgam fillings are not high enough to cause harm in
patients. The Board is not aware, however, of conclusive evidence that the use
of alternative restorative materials or removal of amalgams will prevent, cure
or ameliorate disorders other than those associated with confirmed allergic
reactions to mercury. Nonetheless, nonallergic patients may request the use of
alternative restorative materials or replacement of amalgam restorations in the
belief, or merely the hope, that a medical condition will thereby disappear or
improve. Dentists receiving these requests must make ethical and professional
decisions compatible with the best interests of their patients.
(b)
Purpose. Section
4.1(a)(8) and (9) of the act (63 P. S. §
123.1(a)(8) and
(9)) authorizes the Board to take
disciplinary action against licensees who engage in unprofessional conduct or
commit acts of negligence, incompetence or malpractice. The replacement of
amalgams may implicate both provisions by, for example, generating complaints
of unnecessary or even harmful treatment. The Board therefore provides the
following guidelines to assist its licensees in conforming their behavior to
the requirements of the act. In a disciplinary action brought against a dentist
for treatment associated with replacing amalgams, the Board will consider
whether these guidelines were followed.
(c)
Guidelines.
(1) The Board recommends that, before
replacing amalgams in a nonallergic patient, the dentist:
(i) Explain to the patient the current status
of research on the safety of dental amalgams.
(ii) Provide the patient with information on
contraindications and costs associated with removal/replacement of amalgam
restorations.
(iii) Advise a
patient relying on third-party payment to ascertain whether the insurer will
cover removal/replacement procedures.
(iv) Encourage a patient seeking amelioration
of a medical condition to consult with a physician and, as appropriate, secure
from the physician documentation of recommendations made to the
patient.
(v) Memorialize in writing
the disclosures made to the patient and the patient's informed
consent.
(2) The Board
recognizes the right and duty of dentists to refuse to replace amalgam
restorations when, in their professional judgment, this procedure would not be
in the best interests of the patient.
Notes
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