Interview with Hien Ngo: Towards the Post-Amalgam Era

An interview with Hien Ngo, moderator of the full day symposium 'Towards the Post Amalgam Era':


Q: Why is now the time to be organizing such a detailed symposium on dental restorative materials?

Hien Ngo (HN): The scope of the Minamata Convention (UNEP, 2013) is much wider than dentistry, its main objective is to “protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds”.   In 2014, the FDI issued a policy statement on Dental Amalgam supporting the recommendations of the Minamata Convention, which includes the “phasing-down” of amalgam. As this material has been one of the mainstays of dentistry for over 150 years, this move has huge impacts on the way dentistry is practiced everyday. We need to start preparing today!


Q: Surely with all the various tooth-colored restorative materials available today, we are already in the post-amalgam era?

HN: You are right, with the wide choice of tooth-colored restorative materials and their improved performance, we are well equipped to enter the post-amalgam era in dentistry. However, when the FDI and UNEP only called for the “phasing-down”, rather than the removal of amalgam from our profession, these authorities realized that amalgam is still an important tool in many parts of the world, this is mainly because of its perceived low cost, long track record and technique tolerant. There are still billions of amalgam restorations that are in still in service and the search for the ideal tooth replacement material is still on. In preparation for the eventual removal of amalgam, the FDI policy statement stresses that authorities should work with the dental profession on a comprehensive global dental materials research agenda together with effective preventive strategies.
In the post-amalgam era, the profession has to focus on both restorative and preventive approaches to the management of dental diseases.


Q: Briefly, how did the United Nations treaty on limiting the use of mercury come about? 

HN: It started with the realization of the negative impacts, of mercury, to the environment. In 2001, the United Nation Environmental Program (UNEP) looked into this issue. By 2003 it concluded that there was enough evidence to recommend reducing the use of mercury globally. However, by 2009 UNEP realized that there was insufficient voluntary action so it was decided to step up the pressure with the introduction of a “legally binding instrument”, this is the birth of the Minamata Convention in 2013. Today, over 128 nations have signed this convention, which also includes a call to phase-down the use of mercury in dentistry.


Q: As far as dentistry is concerned, what will be the main changes in the everyday practice of general dentistry?

HN: The main changes include focusing on managing dental diseases, early detection and empowering patients in effective preventive regimes. When repair is required, then the focus should be on maximum preservation of tooth structure. This can be achieved only with the use of adhesive dentistry and not amalgam. 

To gain public confidence, dental practitioners should demonstrate and communicate their commitments to safe handling practice, effective waste management and disposal of dental restorative materials. The public should be educated on the implication of the Minamata Convention and the choice of restorative materials should be based on a sound cost-benefit- analysis of each particular case.

in this new era, dentistry will be both challenging and fun and the symposium will prepare participants for this new phase.


Q: Dental Amalgam has been one of the mainstays of dentistry for over 150 years – how can dental professionals acquire the knowledge, learn the skills, and train their supporting staff to adopt the necessary procedures so patients may enjoy the benefits of these modern materials, in most cases, to replace amalgam? 

HN: The alternative restorative materials to dental amalgam are not that new, most dental professionals and their supporting staff will already be familiar with these materials, even if they may not be in widespread use day to day in their clinics. What is new is the features and benefits that the most recently developed materials offer. The symposium will place much emphasis, especially the clinical techniques, on this aspect. So the adoption of new techniques, understanding the strengths and the limitations of various materials and then the training of the wider dental team should not be too challenging. A benefit for every member of the dental team will be seen in patient satisfaction as the aesthetics and longevity are so much greater now. The symposium will address how to restore a tooth, a whole dentition and reestablishing a healthy oral environment.

Q: What are the major learning outcomes of the whole day symposium?

HN: This whole day symposium will enable participants to understand of the rationales behind the need to phase down the use of dental amalgam and to gain a detailed and complete update on the latest advances in dental materials and the optimal techniques for clinical success.
By the end of the symposium, participants will gain practical know-how to deliver effective, evidence-based and patient-centered preventive and restorative solutions in the everyday practice of dentistry.

We have assembled a panel of internationally renowned scientists and clinicians to share their knowledge and clinical experiences that will enable a greater understanding of the opportunities for oral health and dental practice in the shift towards the post-amalgam era of dentistry. 

Q: By attending the whole day symposium, will dentists be able to gain sufficient knowledge and skills, to initiate the changes required to their practices? 

HN: The secret for success in tackling this “call to action” is to focus on getting ready for the new era. This symposium is designed to arm participants with an understanding of the rationales behind the phasing-down of amalgam, gain detailed knowledge on tooth colored materials, learn new skills on the selection and application of these and most importantly be able to communicate to members of the dental team and patients on the importance of this change.
At the end of this day, participants will feel ready and empowered to embark on this new and exciting phase of dentistry.


Q: Clearly the environment is at the heart of the treaty and the consequent change in the practice of dentistry, but what do you see as other benefits – to both the dentist and of course the patient?

HN: The risk associated with free mercury has been well appreciated by the dental profession. Waste management and safe handling practice of amalgam have been observed by the dental profession and they are well regulated. One can argue that, for the majority of dental practitioners, the transition to tooth colored restorative materials happened a while back. These materials have much improved performance and they are now very popular. The main objective of this symposium is to bring together a group of excellent speakers to bring to the participants the latest information, as well as sharing of experience and skills. The list of speakers include eminent dental leaders, scientists and clinicians to ensure that each participant will benefit.


Q: What will be the main benefits of attending the symposium, and how would you respond to a dentist asking you why they should participate?

HN: The main benefits of attending the symposium will be to hear from leading researchers in dental materials and expert clinicians about the current science and state of the art techniques for both preventing dental caries and applying the most appropriate restorative materials to preserve as much tooth tissue as possible. For some, there is a lot of new knowledge to be gained, and for others there is a lot of reassurance that they are on the right path towards phasing down the use of dental amalgam and gaining the maximum benefit from today’s alternative materials.


Find out more about the full day symposium here.