Bailey Oliver
Clinical Fellow, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
Br Dent J. 2025 Apr;238(8):621-629. doi: 10.1038/s41415-024-7992-5. Epub 2025 Apr 25.
Understanding the long-term oral health implications of an amalgam phase-out is complex. However, amalgam is a simpler, cheaper, quicker, more predictable and effective material to place and replace than composite, which is the main alternative. It also has fewer postoperative complications in United Kingdom (UK) primary care and has been shown to be more cost-effective over a lifetime. Existing economic evaluations are limited, however, with rudimentary models which fail to consider clinicians and patients, and likely significantly underestimate the broader costs of placing composite compared to amalgam. Amalgam alternatives require improvement and their environmental impacts require characterisation. Composite restorations can be successful in extensive cavities, but they require much technical skill and expensive and time-consuming specialised equipment, which are not being commonly used in UK primary care, especially by National Health Service (NHS) dentists. Postgraduate composite education is not generally making UK clinicians confident when faced with difficult cavities and requires improvement. Expert consensus on the use of techniques to restore varying cavity presentations with composite would help to guide this, while also considering how its dissemination could be improved. NHS clinician fees are significantly lower than in Europe. The NHS system therefore essentially incentives the use of amalgam and disincentivises the use of expensive and time-consuming recommended equipment for composite restorations. This has likely contributed to a failure of clinicians to upskill and be confident in providing posterior composite restorations safely. These issues, alongside a loss of trust, have led to dentists leaving the NHS, which has created access issues for patients, disproportionately affecting the most at need in society. An amalgam phase-out would almost certainly exacerbate this issue, widening existing health inequalities while not providing restoration characteristics which the most affected patients most value. Failure to urgently address these issues risks an oral health crisis in the UK if amalgam is imminently phased out.
了解汞合金逐步淘汰对长期口腔健康的影响是复杂的。然而，与主要替代品复合树脂相比，汞合金是一种更简单、更便宜、更快、更可预测且更有效的填充和替换材料。在英国初级医疗保健中，它的术后并发症也更少，并且已被证明在一生中更具成本效益。然而，现有的经济评估有限，其模型简陋，未能考虑临床医生和患者，而且与汞合金相比，可能大大低估了使用复合树脂的更广泛成本。汞合金替代品需要改进，其对环境的影响需要进行描述。复合树脂修复在大面积龋洞中可以成功，但需要很高的技术技能以及昂贵且耗时的专业设备，而这些在英国初级医疗保健中并不常用，尤其是国民保健制度（NHS）的牙医。研究生阶段的复合树脂教育通常无法让英国临床医生在面对复杂龋洞时充满信心，需要改进。关于使用复合树脂修复不同龋洞表现的技术的专家共识将有助于指导这一点，同时也需要考虑如何改进其传播。NHS临床医生的费用明显低于欧洲。因此，NHS系统实际上鼓励使用汞合金，而不鼓励使用用于复合树脂修复的昂贵且耗时的推荐设备。这可能导致临床医生未能提升技能，也无法放心地安全提供后牙复合树脂修复。这些问题，再加上信任的丧失，导致牙医离开NHS，这给患者带来了就医问题，对社会中最需要的人群产生了不成比例的影响。汞合金的逐步淘汰几乎肯定会加剧这个问题，扩大现有的健康不平等，同时又无法提供受影响最大的患者最看重的修复特性。如果汞合金即将被逐步淘汰，而不紧急解决这些问题，英国可能面临口腔健康危机。
