Talk:Dental amalgam controversy

From Wikipedia, the free encyclopedia

This is the talk page for discussing improvements to the Dental amalgam controversy article. This is not a forum for general discussion about the article's subject.
Please sign and date your posts by typing four tildes (~~~~). Put new text under old text. Click here to start a new topic. New to Wikipedia? Welcome! Ask questions, get answers.	Be polite Assume good faith No personal attacks Be welcoming	Article policies No original research Neutral point of view Verifiability

This is a controversial topic, which may be under dispute. Please read this talk page and discuss substantial changes here before making them. Make sure you supply full citations when adding information to highly controversial articles.

Archives /archive 1

Contents 1 Transcluded workspaces 1.1 The "anti" side of the Dental amalgam controversy 1.2 The "pro" side 2 Awful Introduction 3 Acknowledge the kinds of arguments being made 4 Suggestions 5 Equally An Issue of Safety As It Is of Harm: Neither Has Been Proven, As FDA Hearings Found 6 Proposed infobox 7 Wikipedia is not a soapbox 8 The Scientific Case Against Amalgam 9 Why has this page been locked for 1 month 10 Typo

[edit] Transcluded workspaces

Let's place all arguments asserting that dental amalgams are unsafe (or safe) here:

There are no arguments that dental amalgam is safe or unsafe. There are only opposing beliefs. All science is then used by each side to try and justify their belief. The belief amalgam is safe was formed in 1859 with dental entrepreneurs starting up the ADA; the only requirement for membership was believing amalgam was safe to use. The belief it is unsafe is formed when people see recoveries with their own eyes from removing all amalgams. —The preceding unsigned comment was added by 70.49.247.230 (talk) 01:18, 15 February 2007 (UTC).

I can't really participate intelligently in this discussion because of my lack of knowledge. However, I believe this would work most effectively in bullet point form, not in large, unbroken paragraphs. I seriously doubt anyone that would otherwise possibly be interested in discussing the arguments point by point will take the time to read such a long discussion. Consider revising these, please. · j e r s y k o talk · 04:03, 15 February 2007 (UTC)

While the list below may be a good idea, and so far covers various initial points that are representative of the controversy, I strongly dispute the various statements concerning a "safe level." One of the most basic facts I have been suggesting which is most essential to this controversy is the issue of fundamental uncertainty, on both sides, from my wide reading on both sides of the subject, and similarly it is mistaken to presume to state a "safe number" of amalgams. That is a monumental presumption. Furthermore, this statement is not representative of the "anti" side, since most writers on the "anti" side do not believe there is a "safe number" of amalgams. Certainly if they are bad at all, then more is worse. But to state that there is a "safe level" is another matter. Therefore I'd suggest that all comments about a "safe level" of amalgams be relegated at most to a subsection, not placed in a prominent position as representative of the "anti" side of the controversy collectively - this is not a widely held "anti" belief, it is a theory advocated only by a few people based on one manner of interpretation of one survey.

It is interesting to read about the correlations shown up by the NHANES survey, but the fact that the rate of health problems occuring in people with more than 4 amalgams is significantly higher is not proof that 4 amalgams or less are safe. To draw such a conclusion is a very strong move, particularly since many on the "anti" have proposed the "barrel" theory of amalgam poisoning, i.e. a commonly suggested analogy is that amalgam leakage is a very slow dripfeed, gradually "filling the barrel" in vulnerable tissues over a period of time, and that then symptoms only appear when this "barrel" is full and begins to "spill." One popular anti-amalgam dental author, for example, Sam Ziff, has named this the "Toxic Time Bomb" effect in his book of that title. Furthermore, it is proposed that the rate at which a given tissue in a given person would reach the point of "spilling" is completely individual: in one person it could be quickly with only one amalgam, and in another person slowly with ten amalgams, depending on the individual set of genetic-biological strengths and weaknesses in different tissues. This variation is particularly apparent, for example, in weak populations, such as children or elderly people, hence the British government has since 1999 recommended that dentists should not give amalgam fillings to pregnant women - they didn't say 4 were okay, they suggested none.

Therefore I believe the following would be more representative of commonly held feelings on the "anti" side of the controversy: That one amalgam contains about three quarters of a gram inside someone's head of what the toxicity centre at the University of Tennessee, USA, has categorised (rated at 1600) as the second most toxic substance in the world after plutonium (which is rated at 1900), and that common sense dictates that it would be preferable not to have any amount of a toxin of this type inside the mouth. Most of all, the "anti" side, as has been pointed out below, has formed this belief<link rel="stylesheet" type="text/css" href="http://en.wikipedia.org/w/index.php?title=User:Lupin/navpop.css&action=raw&ctype=text/css&dontcountme=s"> based on clinical observation rather than a conclusion based purely on studies or surveys, and in my reading I have noted that many anti-amalgam authors have observed in clinical practice significant health problems in people with less than 4 amalgam fillings which they feel improved when the amalgams were removed using IAOMT safety precautions and additional detoxification procedures. For the purposes of this Wiki article, I am not suggesting these views as the correct ones, but if a list of "anti" beliefs is formed, it ought at least to be representative. Just to underline the point, here are a couple of typical quotations from famous "anti" authors/researchers:

"According to Chang at the University of Arkansas, one microgram damages nerve tissue. It takes 70 days to eliminate half of it...Glioma cells of the brain are destroyed at 0.2 ppm ionic mercury, and only 0.04ppm of methylmercury. Even the most resistant parts of the central nervous system are destroyed at 2.5 ppm. Ten ppm ionic mercury will induce cancer-causing DNA-DNA cross-links. This amount can also cause genetic defects.... The blood-brain barrier loses its protective selectivity at 1ppm within hours of administration of either ionic form or methylmercury.... One atom of mercury kills [cells]." (Hal Huggins, DDS). "There is no safe level of mercury and no one has actually shown there is a safe level and I would say mercury is a very toxic substance." (Dr Friberg, M.D., Ph.D.)

For those who believe that 4 amalgams is a "safe level," that is their personal decision, and that's not under discussion here - but for this Wiki article, it would be incorrect to state that this belief is commonly held on the "anti" side. Simon K 13:26, 15 February 2007 (UTC)

Hey, it's a start. For those in areas where mercury levels are higher in air/water, the safe level drops to less than four fillings. At one filling, NHANES shows health is actually better than average. Mercury was used as an antibiotic for centuries. The dose makes the poison, and NHANES verifies this. At this point, we will stop using the term "safe" and start using the term acceptable daily intake (ADI) as I agree that the term safe and the element mercury are opposites. —The preceding unsigned comment was added by 65.92.42.163 (talk) 13:54, 15 February 2007 (UTC).

A start it may be, but not a representative one, whether you use the word 'safe' or 'ADI'. This may be Mark Richardson's view based on one survey (NHANES), but then the vast majority of other dental authors/researchers that I have come across in my research into the "anti" side don't regard up to 4 amalgams as okay for most people, and would most likely regard this proposition as ludicrous, e.g. to my knowledge Sam Ziff, Dr Michael Ziff, Dr Hal Huggins, Dr Patrick Stortebecker PhD, Angela Kilmartin, Dr Christer Malmstrom, Dr Boyd Haley, Dr Timothy Ray, Dr Dietrich Klinghardt, Dr Gareth Rhidian, Dr David Harvie Austin, Dr Murray Vimy, Dr Shabir Pandor, Dr John Ahearne, Dr John Roberts, Dr David Hefferon, Dr Graeme Munro-Hall, Dr Savely Yurkovsky, Dr Jack Levenson, etc., to name a few. I can't personally vouch for the views of all these people, but from reading their books and papers it is generally clear to me that this is a representative list of some of the principal authors and researchers on the "anti" side and that most of the people on a list like this would be staunch opponents of the idea of an 'ADI' as you suggest. I approach the subject with a great interest in following the research on both sides, and I don't want either side to be misrepresented in this way for this Wiki piece. Simon K 19:30, 16 February 2007 (UTC)

Way to go, Simon. Great bibliography. Has nothing to do with an idea like ADI, but you clearly do a lot of reading. Keep it up.

[edit] The "anti" side of the Dental amalgam controversy

Dental amalgams are the largest contributor to the acceptable daily intake of mercury for adult Americans, with the ADI limit being reached with mercury vapor from 4 fillings in addition to air/water as calculated by Health Canada. The ADI can be exceeded in certain at-risk individuals with mercury vapor from less than 4 fillings:

• In toxicology, the dose makes the poison. Dr. Mark Richardson of Health Canada calculated that the acceptable daily intake (ADI) of mercury when including mercury vapor from amalgams with the amounts in air and water was 4 fillings for the average adult.
• This was verified using NHANES III datasets from the National Center for Health Statistics, which cost $120,000,000 to collect.
• Above mercury vapor from 6 fillings in NHANES III data, which represents the health of the American people and is owned by the Centers for Disease Control in Atlanta, disease rates jump by 50% across the board. In areas where mercury is higher in water and air, the ADI mercury level with fillings is in the range mercury vapor from 1-3 fillings.
• Mercury vapor does come off of fillings, this was shown with the Jerome portable mercury analyzer used for mercury spill response and the Tekran mercury background monitor.
• The vapor amount given off by fillings is enough to change the mercury levels inside rooms, at trade shows Tekran showed mercury levels doubling to 12 parts per million during coffee breaks, as the mercury vapor filled the conference hall; the source was found to be mercury fillings in teeth.
• To jump from 6pmm to 12ppm, it means people are the worst mercury polluters in a room. The safe level of mercury vapor in a room is 50,000 ppm, but this amount is reached in the small volume of the mouth during brushing and from hot liquids or chewing, and then exhaled into the room.
• Jerome meters inserted into the oral cavity verify this concentration. So we know where the mercury vapor is coming from (fillings), the concentration it reaches in the oral cavity (can exceed 50,000 ppm for a few minutes), where it goes (into the room air, doubles from 6 to 12ppm, and into the lungs and then bloodstream), and the health effects (4 fillings are the safe level, NHANES III verifies poor health escalates dramatically after this level of fillings).
• So the belief amalgam is "safe" is just that, a belief formed in 1859; the only criteria to become an American Dental Association (ADA) member in 1859 was to believe amalgam was safe.
• While the ADA has known since 1882 that mercury vapor comes off fillings, the detection at that time used the Daguerreotype process (silver halide detection).
• The science did not exist at the time to measure parts-per-million in Dr. Talbot's labs off-campus from Rush Medical College.
• The ADA still did not change its belief in 1882 that amalgam was safe, nor did it in 1983 when they admitted mercury vaporized off fillings, in 1990 on 60 Minutes, or in 2007 when the FDA outside panel voted 13:7 to disagree with the draft FDA report on the safety of amalgam.
• There is no "placebo" effect here, there is only the "wealth" effect and it is making dentists very nervous to even think about the liability they are at risk for.
• Panic was widespread in 1990 when 60 Minutes brought this issue to the attention of the whole world; something had to be done as dentists were literally under attack for months and months.
• Finally after calculating the liability, a bylaw was passed expelling dentists who believed amalgam is unsafe.
• The NHANES screenings, confirming mercury vapor 4 fillings as the acceptable daily intake level, have finally put a number on this issue: BOTH SIDES ARE RIGHT, amalgam has an ADI, the level is generally mercury vapor from 4 fillings including the mercury level in air and water. On the moon, it would be higher (6 fillings) as there is no mercury in NASA air or water.
• The ADA has never denied this, they just say "we believe amalgam is safe for the vast majority except for allergy".
• The issue is that 25% of Americans have more than 6 fillings, so in a sense the ADA is right because 75% (the vast majority) have mercury vapor from 6 or less fillings so are at less risk (and virtually no risk under mercury vapor from 4 fillings). So both sides are right.
• This is why it has come down to 2 beliefs, 2 sides, and science just used to justify the belief of either side. Ultimately, there is no "safe" level of mercury, so we deal with the idea of "acceptable". Is it acceptable that millions of people, when they take their fillings out, see their health improve? No, it is not acceptable and it is CONTROVERSIAL, if not downright outside the legal boundaries of acceptable behavior.

• Mercury is dangerous: Mercury poisoning has killed many people over centuries and epidemics have been mis-diagnosed for years; dental fillings contain 50% mercury which in 1859 was thought to be locked in. However in 1882 it emerged mercury vapor comes off in small amounts, which did not change the ADA's belief it was safe. Vaporizing of mercury from the fillings will be breathed in, absorbed and passed on into the body's tissues by the bloodstream in very small amounts, undetectable by blood tests, and will accumulate in key biological tissues. There is no way to counteract the spread of mercury in the body, the body will detoxify mercury once the contaminating environmental load is reduced/removed. The more fillings you have, the more likely you are to be sick.

• There is no conclusive evidence of safety: The burden of proof has always been on those who beleve that dental amalgam is safe, and it would be prudent to play it safe, and follow the Precautionary Principle and ban dental amalgams which contain mercury. The belief that amalgam is unsafe is formed from seeing recoveries after all amalgam is removed from patients; this was reported on 60 Minutes in 1990 in the broadcast "Is There Poison In Your Mouth", which eventually led the FDA panel vote 16 years later. As a result of the FDA panel vote, amalgam is considered neither safe/unsafe and patients are free to have them removed without interference or threats from the ADA.

[edit] The "pro" side

Amalgam fillings are fine:

• There is no conclusive evidence of ill effects at the level of one filling in the mouth.
• The acceptable daily intake for mercury, as calculated by Health Canada, is not exceeded unless four fillings are placed. 50% of Americans have less than 4 fillings, as shown by NHANES III from the National Center for Health Statistics
• It is only when six fillings or more are placed is there a large jump in disease rates across the board, and 75% of Americans have six or less fillings, as shown by NHANES III which is managed overall by the Centers for Disease Control. So for the vast majority of Americans (75%), dental fillings pose little risk.
• Those who beleve that dental amalgam is safe have cited many studies supporting this position. While it would be prudent to play it safe, it is now too late as the product has been in use for over 150 years.
• Those who claim amalgam is unsafe form this belief when they see recoveries from having fillings removed, this is unscientific and called anectodal.

[edit] Awful Introduction

Point by point, here we go...

• The Dental amalgam controversy is a debate over the use of amalgams,

It is not a debate, only "dentists" debate. It is a series of panics over the use of amalgams. The panics have erupted from time to time, the worst being in 1991 after 60 Minutes involving MILLIONS of people. In Sept 2006, it started up again when the FDA's outside panel voted against the FDA on the report "safety of amalgam".

• which contain mercury, as a dental filling.

Amalgam does not "contain" mercury. Mercury leaks out of amalgam, in the form of vapor. Amalgams are not a solid, they are a liquid with different phases. The leakage can be measured, which is why there is panic (not a "debate") in the first place

• A minority of dentists has always been opposed to the use of amalgam in dental fillings,

This is the worst statement of all, and represents ADA strategy. In the beginning, slightly after God created earth but just before he allowed scientists to learn about bacteria in 1863, the ADA was formed by dental entreprenuers in 1859 who all believed amalgam was safe. They were independents, because they had been kicked out of medical societies for using amalgam as it contained mercury. So the term dentist itself means "dental entreprenuer", they are not medical doctors.

So the majority of medical doctors believed amalgam was unsafe in the 1850's, which led to the formation of the ADA in 1859. Since then, a minority of ADA dentists have STILL been opposed to the use of amalgams; this results in their being expelled from the ADA (which they get quite vocal about).

So "why the hell" does the article start with the American Dental Assocation's view about "a minority of dentists". Who CARES what dentists think about this issue? The issue is about PANIC that they are causing in the general population.

• since they first began to be used 150 years ago.

Again, a tremendous "miss" in terms of truth. Began to be used by "ADA members" would be more truthful. "Began to be used by ADA members, who belief it is safe" would be getting warmer. "Began to be used by ADA members, who were kicked out of medical societies and believed it to be safe" would be getting real warm. "Began to be used by ADA members just prior to the dawn of modern medicine and the discovery of bacteria; who were kicked out of medical societies and still believed it was safe and wanted everyone in the real world to believe it as scientists and doctors at the time didn't; who used seeing is believing as the first groups of patients only had one or two fillings 150 years ago, which even today we know one or two fillings is of little risk based on NHANES III

• The essence of the problem

There is no problem. There is a controversy.

• is that it is intrinsically difficult scientifically

Each side just uses science to justify its belief that amalgam is safe/unsafe

• to demonstrate either conclusive safety or conclusive harm

Seeing is believing, the ADA was formed in 1859 because they saw one or two fillings didn't do much harm. The anti-amalgam belief is formed when people remove 10 fillings and their health recovers. Each side calls the others "belief" unscientific.

• without very large-scale long-term epidemiological studies of the type that have not so far been performed,

The ADA is responsible for the epidemiology, which they never did because they believe amalgam is safe. The National Center for Health Statistics did do Dental Epidemiology in NHANES III, so we looked it up. Above 4 fillings, health gets worse and above 6 fillings there is a 50% jump in disease across the board. The ADA knows this, they still believe amalgams are safe "for the vast majority of Americans, except those who are allergic". The calculation of the allergic subgroup is a high percentage of the 25% who have more than 6 fillings, which equals millions of people. People die from allergy reactions and in this case the allergy is to mercury, so the real term would be poison reaction as the dose makes the poison. This is verified with people's own EYES when they remove moutfuls of amalgam and get better, which the ADA calls "anecdotal" and say "we are happy the people are better". The eyes see what the data reports, big surprise! Not doing NHANES is why the FDA panel voted that the FDA's own "report" on the safety of amalgam could not be accepted. It was our group who found NHANES by calling the National Institutes of Health and getting it on the scientific "agenda". We blew the ADA away, but it took a hell of a long time, seven years from when we first reviewed the epidemiology to when the FDA panel nailed the ADA's behind. If you don't do NHANES, you are not scientific, that is the ultimate truth. The NHANES datasets are now $1 Billion, which is exactly $1 Billion more than the ADA's budget for the "safety of amalgam" research. So it wasn't much of a fight at the ADA panel, 13:7 was the vote NO.

• and might in any case be impossible due to ethical considerations.

Don't get me started. Ethics in Dentistry? Reader's Digest did a whole article on it, check it out sometime. The entire amalgam controversy will be taught one day by historians as one of the biggest ethical lapses in history. Why did the FDA's panel vote 13:7 to disagree with the FDA's report on the safey of amalgam? Because such a report had never been done before, the last time scientists, doctors and dentists were in the same room was in 1850, when the scientists and doctors were busy expelling the dentists from their medical societies for ethical violations of using mercury in humans.

So here is my suggestion for a fair introduction:

The Dental Amalgam Controversy is a series of panics over the use of amalgams, which vaporize mercury in small amounts, as a dental filling. Amalgam use spread with the formation of the American Dental Assocation in 1859, who believe it is safe. The ADA's position on amalgam was changed in 1983 to publicly admit mercury does vaporize from fillings. The dental profession grew out of the medical profession, those who wanted to use amalgam formed the ADA and took the term "dentist". At one time doctors performed dental surgery as well, but medical societies were opposed to the use of amalgam so expelled anyone who used it back in the mid-1800's. Even a minority of dentists has from time-to-time opposed the belief about the safe use of amalgam in dental fillings, since they first began to be widely used by ADA members 150 years ago.

The essence of the controversy is that each side's belief about safety (safe/unsafe) was not formed scientifically, so any science is simply used by each side to demonstrate either conclusive safety or conclusive harm. The ADA has operated without very large-scale long-term epidemiological studies, which were finally performed by the National Center for Health Statistics with the United States National Health and Nutritional Exam Surveys (NHANES), which cost $1 Billion and included Dental. The NHANES data shows that mercury vapor from four fillings is the acceptable daily intake including mercury from air/water as calculated by Health Canada, and that above six fillings disease rates jump 50% across the board. The FDA draft report on the "Safety of Amalgam Fillings" did not include NHANES epidemiology, and so was rejected by the FDA panel by a vote of 13:7. Serious questions have been raised about the ethical considerations of using dental amalgam, given that mercury has been phased out or eliminated in all other products/services.

Correct me if I'm wrong, but NHANES used DMFT/dmft as its index of caries experience, therefore no distinction was made between the presence of amalgam or other filling materials in the subjects' mouths. It is impossible to extrapolate the effect that the presence of amalgams had on the subjects. Furthermore, NHANES is an observational survey, assessing many markers and indicators. In order to reduce the effect of other diseases on your calculations, regression analysis must be used.

The only concept that I'm aware of that could be concluded from NHANES regarding fillings is the higher the number, the increased likelihood of other health problems (not entirely accurate - the higher the DMFT/dmft, the increased likelihood of other problems). In regards to this conclusion, let me just go ahead and say DUH! Hundreds of studies and common sense say that people who don't look after their teeth don't look after their general health either. No direct link can be established between DMFT/dmft surveys and the effect that amalgam has on systemic health, especially from NHANES data. Dr-G - Illigetimi nil carborundum est. 21:05, 15 February 2007 (UTC)

The NHANES III study was done at a time when composites were not in widespread use, unlike NHANES IV. As a result, while the effects of IDC disease codes showing 50% increases in diseases rates above 6 fillings is correlated only with fillings, the vast majority only had amalgam fillings because of the years the survey was done (late 1980's, early 1990s). To say otherwise, that people had OTHER filling material in their mouth and not amalgams in the late 1980's, my only response is DUH?

At any rate, we are not going to change your belief here in Wikipedia. Like I have said time and again, all science is simply used to confirm either the belief amalgam is safe or unsafe. The fact that disease rates jump dramatically as the number of fillings rise only confirms the belief that amalgam is unsafe from watching recoveries of removing all amalgam fillings. The fact that the type of filling material was not "catalogued" (because it was almost all amalgam) serves to confirm the belief that there must be something wrong with the $120,000,000 study, so it cannot be used to confirm the belief amalgam is unsafe, so therefore the belief amalgam is safe is still a safe belief. Congratulations, Dr. G. I follow where you are going, and know nothing will change your belief. Why not get 15 amalgams put in then in your teeth, and then we can watch you for a few years and see if you change....As a matter of fact, why not have 15 amalgams put in the teeth of ALL the top ADA leadership, who can keep them for the next 10 years, and then we'll see how they are all doing. You know the answer, G. You must know. Dentists don't have amalgam put in them, it's only for sale, not for personal use. That's called a Dealer. —The preceding unsigned comment was added by 69.157.96.154 (talk) 00:14, 16 February 2007 (UTC).

No reputable peer reviewed journal in the world would accept a study based on calculations supported by the statement that 'most fillings were amalgams in the 80's and 90's'. Not only is that what is called an assumption, it introduces infinite inaccuracy into any statistical analysis. In order to use NHANES data, data from another study on numbers of amalgam vs. composites from the same time period, geographic location and sample demographic must be used, which still introduces inaccuracy. Then, after all that is completed, you still have the idea that poor oral health (ie high DMFT/dmft and CPITN scores) correlates to poor general health due to common factors such as low-socioeconomic status, poor education, poor patient motivation, poor access to healthcare, etc. Therefore, NO conclusion can be made from those data regarding the effect of amalgams on oral health. By the way, composites have been used since the 60's, especially in the US, not to mention that NHANES III included gold inlays/onlays, crowns and bridges. That throws off your assumptions just a little bit. Just so you know, personal attacks are not allowed on Wikipedia. Also, please sign your contributions. Dr-G - Illigetimi nil carborundum est. 17:56, 17 February 2007 (UTC)

[edit] Acknowledge the kinds of arguments being made

There are a couple of very good reasons that this controversy has been going on for so long, and understanding those reasons can greatly help to intelligently organize how the various arguments on both sides are presented on the main article page. The points made here have been derived from a course entitled "Argumentation: The Study of Effective Reasoning, 2d Ed., by Prof. David Zarefsky of Northwestern University availabe from The Teaching Co. http://www.Teach12.com .

Prof. Zarefsky explains that "there are lots of times when we have to make a decision without knowing everything we need to know. And so we create a presumption that says, 'In the face of uncertainty, the decision ought to be weighted one way or another.' ... We are making an argument from ignorance. We are saying, 'Because we don't know X, we should do Y.'"

The main dental amalgam controversy page clearly shows that both sides are using precisely this type of argument from ignorance. On one hand, "the FDA maintains a web page on the use of amalgam ... on which it states, 'no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy.'" In other words, the FDA is arguing that because we don't know if amalgams cause harm, we should keep using them. On the other hand, in reporting that the outside panel voted 13-7 against the FDA report on amalgam safety, the main page says, "they stated the report's conclusions were 'unreasonable,' given the quantity and quality of information currently available. ... Michael Aschner, a professor of pediatrics and pharmacology at Vanderbilt University and a panel consultant said 'There are too many things we don't know, too many things that were excluded.'" In other words, Dr. Aschner (and presumably the rest of the panel majority) is arguing that because we don't know if amalgams are safe, we should not keep using them.

The key point here is that these two arguments are structurally identical; they are both arguments from ignorance, and thus the only way for a careful and critical reader to evaluate their relative strengths is for the main page to present them in conjunction with each side's reasons for presuming to weight the the conclusion the way they do. For example, take the argument that because we don't know if amalgams are safe, we should not keep using them. This argument is founded on a presumption that weighs against the use of anything that might cause harm. The reasons for this presumption appear to be, at least in part, that dentists are bound by the Hippocratic Oath to "first do no harm;" that (as stated on the main page) "it is proven that mercury exposure can cause health problems," and that (as also stated on the main page) "amalgams [are] known to release mercury into the mouth." See also World Health Organization, Concise International Chemical Assessment Document 50, Elemental Mercury and Inorganic Mercury Compounds: Human Health Aspects (Geneva 2003) at http://www.who.int/ipcs/publications/cicad/en/cicad50.pdf and World Health Organization, Policy Paper: Mercury in Health Care (WHO/SDE/WSH August 2005) http://www.who.int/water_sanitation_health/medicalwaste/mercurypolpaper.pdf ("World Health Organization confirmed that mercury contained in dental amalgam is the greatest source of mercury vapour in non-industrialized settings, exposing the concerned population to mercury levels significantly exceeding those set for food and for air.").

One advantage of acknowledging that both sides are employing an argument from ignorance is that it separates the arguments about why we don't know from the arguments about why we should weight our actions one way or the other in the face of that uncertainty. For example, if the proponents of continued amalgam use were to say, "The reason to lean toward continued use of amalgams is that they have not been proven to cause harm," readers would immediately see that the statement adds nothing new. It merely reverses the wording of the argument from uncertainty. Moreover, with respect to the true reasons for leaning toward continued use of amalgam, there must be better arguments than that amalgam is cheaper and more effective than other materials. Almost all of the world's current pollution problems are the result of toxic wastes leaking from disposal sites that were considered safe, cheap, and effective at the time. By eliminating any temptation to rely on "uncertainty" itself as a reason for deciding which way to lean, we can re-focus the debate on the heart of the matter: On the one side, why presume we should lean toward avoiding amalgam when it has not been proven to be harmful? And on the other side, why presume we should lean toward using amalgam when it has not been proven to be safe?

The main article implies that the ADA has tried to pre-empt such a discussion by simply declaring that "the overwhelming weight of scientific evidence supports the safety and efficacy of dental amalgam." However, if the main article explained the scientific context and scientific reasoning behind this statement, it would become clear that it does NOT say that amalgams have been proven to be safe. In fact, an understanding of the two basic kinds of scientific argument in which scientists engage would make the presentation of the competing arguments in the main article more cogent, more understandable, and more relevant to advancing the debate in the long run.

As explained by Prof. Zarefsky, in the usual method of reasoning employed by scientists, which he calls "Normal Science," they "use hypothesis testing. They state a hypothesis driven by existing theory. They predict what will happen if the hypothesis is true. They test it out and they see what actually does happen. They observe the results. If the results were consistent with their prediction, they count them as support for their hypothesis.... Now remember when we talked about fallacies, we said that could be the fallacy of confirming the consequent." The fallacy of confirming the consequent goes like this: If I were in Florida, the temperature outside would be above freezing right now (mid-February). The temperature outside is in fact above freezing right now. Therefore, I must be in Florida. (This is false; I am in Maryland). The point is that when scientists say the evidence "supports" their hypothesis, they do NOT mean the hypothesis was proven true. They only mean that it was consistent with their prediction and thus did not prove their hypothesis false. Given this context, it can be seen that the statement by the ADA that "scientific evidence supports the safety and efficacy of dental amalgam" is merely another way of saying exactly what was said above -- that the safety of amalgam has not been disproved. If the dental amalgam controversy were merely a Normal Science debate, Prof. Zarefky says that each side's claims would primarily be "factual statements about what we are observing." This model would fit, for example, the main article's factual report that the "ADA maintained until 1984 that mercury was bound in amalgam and did not release mercury vapor. In the 1970s studies demonstrated that a small amount of mercury vapor was constantly being released from amalgam, corroborating the first such study published in 1882 in the Ohio State Journal of Dental Science by Dr. Eugene S. Talbot." But the controversy is not merely a Normal Science discussion.

It matches more closely the kind of reasoning scientists engage in that Prof. Zarefsky calls "Revolutionary Science." Prime examples of Revolutionary Science were Copernicus and Galileo. But even in more recent instances, like the information revolution, this kind of reasoning arises "when a whole way of seeing the world and thinking about things is called into question because somehow it does not seem to fit anymore the facts it tries to describe.... There are anomalies that develop, things that an established theory cannot adequately explain, and the anomalies increase. They pile up. Then, eventually, there are enough anomalies there that people begin to say, 'Wait a minute. Maybe the theory is not right in the first place, and we ought to change the way we think about it....The argument is about the theories at least as much as about the underlying phenomenon."

In such a dispute, the claim is that theory X should replace theory Y, and the party advancing the new theory has the obligation to demonstrate that the proposed alternative theory can account for the phenomena better than the current one. By the same token, the advocates of the old theory have an obligation to demonstrate that it accounts for the observed phenomena better than the new one. In the dental amalgam controversy, for example, the FDA attempts to account for all anomalies -- all exceptions to the amalgam-is-safe theory -- by classifying them as allergic reactions. As stated on the main page, "the FDA maintains a web page on the use of amalgam, last updated in December 2002, on which it states, 'no valid scientific evidence has shown that amalgams cause harm to patients with dental restorations, except in the rare case of allergy.'" Does the allergy theory better explain all of the observed phenomena? Or the accumulating poison theory?

As these rhetorical questions demonstrate, this kind of dispute is not primarily about facts. Prof. Zarefsky says this kind of dispute "is primarily about paradigms. So, ultimately, it gets settled by means other than a strict appeal of facts.... One paradigm may be shown, over time, to subsume the other, to incorporate it. Or one paradigm may be shown to fulfill common values better than the other. It may be seen as simpler, or more elegant, and less dependent upon unobservable constructs. Or one paradigm may be defeated by exposing its self-contradictory nature; that is, if you accept the paradigm, it leads you to conclusions that you would be unprepared to accept." For example, is the ADA prepared to accept that all people who suffer from mercury poisoning got it from sources other than their amalgam fillings, even where no other sources of any kind can be identifed (i.e., they don't eat fish, have never worked near mercury, etc.)?

The main article should be re-structured to include not merely the currently accepted facts and the "fact" that there is an ongoing controversy, but to record the ongoing process of demonstrating (or refuting) the ability of the new theory to account for all of the observed phenomena better than the old theory does. To this end, each side should be allowed to present anomalies that cannot be explained by the theory posed by the other, together with evidence of how their theory better explains such anomolies. Indeed, by having a public forum where the competing theories can be explained and challenged and then defended, the public interest will truly be served. For example, can the amalgam-is-safe theory explain the findings of doctors engaged in research at the University of Calgary Medical School, Alberta, Canada, who are reported to "have shown definitively that mercury is continuously released from amalgam fillings, both as vapor and in microscopic particles, once the fillings are placed in the teeth." http://whale.to/d/biblio.html

The research findings are illustrated in a video prepared by the University of Calgary entitled "How Mercury Causes Brain Neuron Degeneration" (video 2001), which can be seen at http://movies.commons.ucalgary.ca/mercury

Drichw 11:16, 20 February 2007 (UTC)

I have one small problem with your observation - there have been no phenomena successfully linked to amalgam in the literature to date other than localised allergic reactions. Therefore, there is no build up of observable phenomena not satisfactorily explained by current theory. What people must learn is that science is not always intuitive, which is why we need evidence to support hypotheses. Currently, there is little evidence for or against the safety of amalgam as you correctly point out.Dr-G - Illigetimi non carborundum est. 20:01, 22 February 2007 (UTC)

Response by Drichw: The term "phenomena" was used to mean observable data, not the ultimate symptoms of mercury poisoning. More importantly, see the following two reviews of scientific studies linking dental amalgam to mercury exposure and accumulation in the body:

http://www.youtube.com/watch?v=9ylnQ-T7oiA (International Academy of Oral Medicine and Toxicology)

http://www.youtube.com/watch?v=MfVsUuhoFWY (Quoting manufacturers of dental amalgam and other sources)

—The preceding unsigned comment was added by Drichw (talk • contribs) 21:03, 27 February 2007 (UTC).

[edit] Suggestions

Let's describe the reasons each side has given for the danger and/or safety of dental amalgams. I'll start, by "writing for the enemy."

Mercury poisoning has killed many people, and dental fillings contain mercury. Leakage of mercury from the fillings will be swallowed, digested and passed on into the body's tissues by the bloodstream. There is no way to counteract the spread of mercury in the body.

The burden of proof is on those who assert that dental amalgams are safe, but they have not produced any longterm studies supporting this position. To play it safe, we should follow the Precautionary Principle and ban dental amalgams which contain mercury.

Is this pretty much what amalgam opponents are saying? If not, what have I downplayed, left out or outright mis-stated? --Uncle Ed 13:06, 14 February 2007 (UTC)

The ADA has known since 1882 that mercury vapor comes off of fillings. They admitted publicly in 1983 that this is the case (100 years later), but said the amounts are too small to cause a problem. That is their BELIEF, it is not a fact. When we looked up in NHANES III, we found the more fillings you have, the more likely you are to be sick. However, that again is not proof. When it comes to amalgam, there are 2 beliefs (safe/unsafe), and both sides use science to try and justify their belief. However, the belief it is unsafe is formed when amalgams are removed and people get better, which is a case of Seeing is Believing. That is what makes this so controversial, the belief it is unsafe is formed by seeing recoveries. —The preceding unsigned comment was added by 69.157.98.33 (talk) 13:10, 14 February 2007 (UTC).

Seeing is Believing is not good enough because recovery could be attributable to any number of other factors including PLACEBO effect. That is why evidence needs to be stronger. Dr-G - Illigetimi nil carborundum est. 19:16, 14 February 2007 (UTC)

The belief amalgam is safe is just that, a belief that was formed in 1859 when pro-amalgam believers were invited to join the ADA. No one on this talk page was alive then. However the belief is still alive, and changing it will cost the ADA $5 Trillion so they will not and cannot change it, so we are stuck with THAT. It is easy to trot out science to justify any belief, however the belief amalgam is unsafe is formed when people see recoveries with their own eyes. Since amalgams emit mercury vapor, finally admitted by the ADA after 150 years of denial, belief that amalgam is safe also requires believing that small amounts of mercury vapor are safe. This is why the safety threshold, as calculated by Dr. Mark Richardson and verified in NHANES III, is 4 fillings. Above this amount, amalgams are potentially unsafe and above 6 fillings are outright associated with a 50% jump in disease. To believe otherwise requires a form of belief called Denial. This is why the FDA panel could not endorse the FDA report on the safety of amalgam: It is dose-related, and the dose makes the poison with mercury. As fillings go above 6 in number, disease rates jump by 50% across the board. —The preceding unsigned comment was added by 70.49.247.230 (talk) 01:25, 15 February 2007 (UTC).

Here are some changes to your proposed writing:

Mercury poisoning has killed many people over centuries and epidemics have been mis-diagnosed for years; dental fillings contain 50% mercury which in 1859 was thought to be locked in. However in 1882 it emerged mercury vapor comes off in small amounts, which did not change the ADA's belief it was safe. Vaporizing of mercury from the fillings will be breathed in, absorbed and passed on into the body's tissues by the bloodstream in very small amounts, undetectable by blood tests, and will accumulate in key tissues. There is no way to counteract the spread of mercury in the body, the body will detoxify mercury once the contaminating environmental load is reduced/removed.

The burden of proof has always been on those who beleve that dental amalgam is safe, and they have cited many studies supporting this position. While it would be prudent to play it safe, and follow the Precautionary Principle and ban dental amalgams which contain mercury, it is now too late as the product has been in use for over 150 years. As a result, the FDA convened an extraordinary panel of scientific experts, who voted in September 2006 that by 13:7 they disagreed with the FDA Draft Report on the safety of amalgam fillings. This vote was reported worldwide, and confirmed that the ADA's belief in the safety of amalgam is simply that, a belief they have held since 1859 at their formation. The opposing belief that amalgam is unsafe is formed from seeing recoveries after all amalgam is removed from patients; this was reported on 60 Minutes in 1990 in the broadcast "Is There Poison In Your Mouth", which eventually led the FDA panel vote 16 years later. As a result of the FDA panel vote, amalgam is considered neither safe/unsafe and patients are free to have them removed without interference or threats from the ADA. —The preceding unsigned comment was added by 69.157.98.33 (talk) 13:23, 14 February 2007 (UTC).

Can someone provide a link to this NHANES III study so I can read it and contribute to a proper debate on the matter. Threshold levels always make little sense, especially when you put it in terms of number of fillings, especially when there is no determination of average surface area of fillings etc. You keep speaking of belief and science, they are similar. You speak about belief in terms of faith, which is belief in the absence of definable proof. Science is the OPPOSITE of this. Science is belief supported by PROOF.Dr-G - Illigetimi nil carborundum est. 19:21, 15 February 2007 (UTC)

Sure. Go to the National Institutes of Health Website. Find the download files for NHANES, they are huge, the most massive statistical files in existence. Then go and hire a statistician to run the data for you, just reference IDC Code disease rates vs. # of fillings. It will take 20 minutes, and then you can come back and tell us all about it. I thought all you dentists were doing epidemiology, or are you just placing fillings because the society in 1859 believed they are safe? Why, Dr. G, are you telling us the American Dental Assocation has never done NHANES III correlations of dental fillings vs. disease rates? I thought it said in this article that "it is too difficult scientifically", and yet anyone can do it. The National Institutes of Health told us that correlations like these are not "proof", we said we understood but they are sure as hell controversial. Disease rates rise as filling rates rise, and it's all in the $1 Billion NHANES Dataset? And Dr. G and all the dentists don't know how to run the data? Why do you think the FDA panel blew you guys away and voted your "safety of amalgam paper" was a joke, and said 13:7 they don't agree with it? So you are serious, you don't know how to do NHANES? Then why are you writing on this site in the first place? —The preceding unsigned comment was added by 69.157.96.154 (talk) 00:28, 16 February 2007 (UTC).

Read my response above. I am not in the habit of reading large scale US epidemiological surveys because it does not have much bearing on practice here in IRELAND, as Irish epidemiological surveys would. So your assumptions that I am an American dentist, practicing in the US and that I am a member of the ADA are all false. I never said that the ADA has never done NHANES III oral health vs. general health correletions, in fact I am not aware whether they have or they haven't. I am aware of several other studies of oral health vs. general health that state a correlation based on factors that affect both such as low socioeconomic status, poor education, poor motivation, poor access to healthcare, etc. I do in fact know how to run the data.

It was not an FDA panel that blew an ADA report away, it was an independant panel that blew an FDA report away. And they didn't blow it away, they found that it was unreasonable to conclude that amalgam was safe based on the available data. I'm sure if the question had been asked whether it was reasonable to conclude that amalgam was unsafe the vote would have gone the same way, there is simply not enough good quality evidence to support either side.

I didn't say that I didn't know how to do NHANES as you so eloquently put it. In fact I do, it's just that I wasn't aware of NHANES before now, which is not unreasonable considering I didn't study dentistry in the United States, and most of the epidemiological studies that I have read pertain to Ireland or the UK as they are most relevant to the patient set that I am treating.

Just to make you aware, personal attacks are not allowed on Wikipedia. Please have the decency, manners and courage to sign your posts, or you are in danger of being accused of trolling. God forbid that eventuality.Dr-G - Illigetimi nil carborundum est. 18:14, 17 February 2007 (UTC)

Look, G. No dentist is in the habit of doing epidemiology, that is the point. I'm glad that all the dentists contributing on this post are from Ireland, or Greenland, or Finland, or Swasiland. It's comforting to know that absolutely no American Dental Association members are on here, they are too busy creating national standards for dental education (or so we've been told). I think we've pretty well run the course on this post, I've trotted out $1 Billion worth of epidemiology (NHANES I - IV) and in response on behalf of all the dentists of the world you've told me you are from Ireland. I think all the people who read this post (and thousands do) see now what the real controversy is about, two sides talking but neither listening to each other. Look G, I'm glad your dental forefathers (in Ireland, America, or wherever) learned to believe with all their heart amalgam is safe, because what's the problem with putting a little Fear into people in the form of mercury implants anyway; after all, dentists are as close to God as we are going to get, aren't they? That's why it's been great talking to you, even though you and all other dentists on this post take pains to point out you are not American or ADA members (or both). It's just helped our side to realize that after 150 years, after $1 Billion of Epidemiology, after 13:7 FDA vote against, in order to get amalgam out of the USA and the rest of dental practice worldwide dentists are simply going to have to leave the ADA and join societies that won't use amalgam. Hey, if that is what it takes, that is what will come to pass. Nothing succeeds like an idea whose time has come, and this is one is overdue. —The preceding unsigned comment was added by 69.156.45.70 (talk) 03:35, 1 March 2007 (UTC).

Thanks for those pearls of wisdom.Dr-G - Illigetimi non carborundum est. 00:31, 2 March 2007 (UTC)

[edit] Equally An Issue of Safety As It Is of Harm: Neither Has Been Proven, As FDA Hearings Found

Hi JzG. . . ? I am wondering why you have reverted my recent two changes. Is there a reason that we could discuss here? I made two separate changes, both of which you have reverted:

(1) I was trying to make the opening paragraph more neutral. The issue there has always been with this article, as I see it, is simple: those who feel that amalgam fillings are fine tend to decry that “there is no conclusive evidence of ill effects”, and those who feel that amalgam fillings are not fine tend to decry that “there is no conclusive evidence of safety,” and neither group steer a middle ground of encyclopaedic writing by stating BOTH of these indisputed facts in the same sentence/paragraph. Both statements are now stated in the second paragraph, which is a good thing. However, in the opening sentences, you seem to have an objection to me adding the words “or safety”, which merely brings this first paragraph into line with the second one, and without which this opening paragraph remains biased towards one side of the controversy, because it mentions “ill effects” but not “safety”. The only conceivable way of encyclopaedically presenting a balanced opening definition of this controversy is by bearing in mind that both of these issues (safety vs. harm) remain ultimately unverified, and stating such.

(2) I also sought to flesh out the reference to the recent FDA hearings because they are of great historic importance. By way of explaining this last statement, i.e. the “historic” importance of these hearings, please consider the following, an interesting aside that is worth mentioning here even though I didn’t feel it belonged in the article itself: that the FDA have never held such hearings before in over 150 years of the use of amalgam fillings, making this an unprecedented attempt to analyze the controversy at a national level in the US, and that during this long period of over 150 years of use the ADA and FDA have always held them to be safe, and yet an independent panel at these hearings now concludes otherwise and questions this assumption that their use is safe. The findings of these hearings are therefore of great historic importance, and the hearings were precisely on the same topic as this article. So, bearing all of this in mind, why do you object to me adding a couple of extra quotations and links to this part of the article? My additions changed neither the content nor the tone, but merely cleaned up the language, made it more readable, and added some further quotations and links, and without even lengthening it by more than a few sentences. Furthermore, in the version you have reverted it to, it now incorrectly states “As described above”, which I had corrected before you undid my correction.

Happy New Year, by the way! Simon K 00:00, 1 January 2007 (UTC)

Simon, it is a breath of fresh air to have anyone else join this edit process. The last bunch of comments added throughout by ADA hacks have been to the effect that a) You don't need to be an ADA member to practice dentistry, b) The science is inconclusive on amalgam, and c) 60 Minutes was left out as an "oversight", etc, etc.... A pure bunch of garbage, the ADA knows exactly the dangers they are up against, they are the ones who have believed since 1859 that amalgam is safe with absolutely no scientific evidence; none, zero, nada, zip, zilch, their belief is on the same level as belief in UFO's, tooth fairies, and little green men on Mars. What they don't want us writing about is their belief and how/when it was formed, so they want us to write instead about science, that is why the send their hacks to fill these pages with it. It's called a smokescreen. They have fooled the entire world for 150 years, not a small accomplishment. Hell, they even knew in 1882 that mercury leaked out of fillings, but it didn't change their belief one bit that amalgam is safe. Just think how different the world would have been if the ADA hadn't been formed in 1859, if they had waited until 1869; by then Pasteur would have discovered bacteria, and likely the ADA would not have formed. The real controversy about dental amalgam is how beliefs rule this issue, and how both sides use science simply to justify their belief. The real issue then is "how can this be, aren't there ways to bring this issue into the modern world?". The answer is that the non-scientific belief that amalgam is unsafe is formed when people actually see with their own eyes that health improved by removing amalgam fillings, so has liablity written all over it. The opposite belief that amalgam is safe is so old, since 1859, that changing it will cost the ADA $5 Trillion in liability as they've installed Billions of amalgam since this time. With this much liability on the table, the one thing the ADA cannot do is change their belief amalgam is safe. Can the US Government change policy and rule that amalgam is unsafe? We analyzed the NHANES III database, and found that above 4 fillings health outcomes are much worse, so it is possible for the USA to rule this way, but then the cost would again be $5 Trillion. The budget of the United States in 2007 is $3.2 Trillion, so is this realistic? I don't think paying out almost twice the annual budget of the USA will improve things, it looks to any reasonable person like such a ruling could cause severe panic, economic catastrophe, not to mention near-riots from the anger that would result. Is there any wonder there are so many editors on this article? Don't you think we've been studying this issue and the ADA for a long time, and know the position they are in? They are toast, they have been hung out to dry, they are flapping in the wind, they are hanging by a thread, they are the poster child for bad behavior and all that is wrong with belief; when the only thing you believe is you have a god-given right to make as much money as you can sticking little chunks of mercury into human beings and calling it silver. They have harmed so many millions of people, it is catastrophic: The effects of mercury are to generate FEAR in human beings, it is called erethrism. As mercury ions attack the central nervous system, people register much higher levels of fear and that is simply not a good thing; this is why there is no safe level of mercury exposure. As the number of fillings rise above 4, the fear generated turns to panic and shakes (aka Mad Hatter), and this causes tremendous ill-health effects which are so obvious in NHANES III that they caused everyone involved in the initial reviews to go into shock. No one could believe the effect was so powerful, that it simply hit all the IDC disease codes and the jump was across the board. We called the National Institutes of Health to report back and they said "oh well, it is statistically an interesting result, you should publish this". We told them we aren't doctors, we are not going to publish and play the ADA's game, we've already seen recoveries with our own eyes and so NHANES III makes us sure we aren't hallucinating; so we know it is the ADA who are. Since our groundbreaking screenings, other scientists have been poking around in NHANES III doing Dental, but they haven't gone where we went because they know they will never work again if they do. We found next that above the level of more than 6 fillings, people are just nervous wrecks and their overall health is simply terrible across the board, a 50% jump in disease across the board. ADA hacks will say this is because they ate too much sugar! They will say anything to defend their belief, that's all. Will the US Government pay to run NHANES III and now IV, to generate a result which essentially bankrupts the government itself for 2 years? We are talking about a mass catastrophe, a mass panic, and a mass breakdown. So for these reasons, it was decided that the FDA Panel vote had to be 13:7 neither for nor against, in other words amalgam is neither safe/unsafe. This panel knew about NHANES III and IV, why do you think this vote came out the way it did? They knew because it was our side who did the research, and made it available to everyone. I have been accused in this article of not knowing enough about science, and yet the vote was 13:7 that the ADA's belief in the safety of amalgam is non-scientific; it happened because we reached into the most powerful corners of the US Science establishments at NIH, CDC, and elsewhere and finally forced this vote by sticking NHANES III and IV into the mix; we called every scientist we could find for two years about why they never studied amalgam until finally they told us to do NHANES III ourselves. The fact that NHANES holds this information has destroyed the ADA's credibility, we knew it would and it did! It just took seven years to work its way through the system. Scientists know what NHANES is, the gold standard of medicine; dentists know squat about it and we like it that way. That is why the vote was 13:7 that the FDA report doesn't represent "science". NHANES datasets are now worth $1 Billion, and they were never included in the FDA's report. Why? Because the FDA's dental division are not scientists, they are ADA hacks and couldn't find NHANES if their life depended on it. We set them up, and they walked right into it totally asleep. We took on the ADA and beat them, not a bad result after 150 years. We are talking about people who are so full of their own belief, that when the Environmental Protection Agency showed up at dental offices to ask why mercury amalgam was being flushed down the drain, they were told "our professors said amalgam is safe". This ended up creating the CBS News broadcast "Is There Poison In Your Mouth". In the end, we knew we would never get the $5 Trillion in compensation owed, but we were sick of them sticking their faces on TV and saying "amalgam is safe" so they could profit from screwing their fellow man. So now we are ready to stand down, this vote is final and the ADA lost. we know they will appeal it but it is OVER. This lets everyone off the hook, and patients are free to take matters into their own hands and get their fillings removed. Those who have 4 or more fillings need help the most, which is 50% of the US population. The other half are just fine, thank you very much, the USA can continue with only half the people running at full capacity, it creates a tremendous market for medical services for the other half who are in various stages of incapacitation. How do we know this? We did the epidemiology, because the ADA who is responsible for it won't. I heartily agree with putting the results of the FDA vote in the introduction of this article, along with anything that says the ADA's belief in the safety of dental amalgam is now officially on the level of the belief in Bigfoot. That is how they feel, like they just got a Bigfoot in the ---.

• • Whilst awaiting a response from you, or anyone else, I shall break up my very minor proposed changes into separate bits, make the small changes one at a time, and see if each one in turn seems suitable to everyone. Hope this is okay with everyone.

So the first one, which I have just made, is to restore the words "either. . . or of safety" to the opening paragraph. If anyone feels this is unsuitable in this article or for somehow against Wiki policy, please discuss it here rather than simply reverting. I could be mistaken, but to my mind this brings the opening paragraph closer to NPOV, and brings the whole article up to date with the latest research findings at the recent FDA hearings.

Since the FDA convened specifically to assess the topic of this article, in my mind this means that the conclusion of the independent panel of 20 scientists at these FDA hearings is one of the most up to date and reliable sources of information for this Wiki piece, and this conclusion was simple and specific: that the evidence of safety of amalgam fillings is lacking.

This represents the essence of the dental amalgam controversy, and why there is a controversy in the first place, in that it was the primary subject of the first American government scientific hearings in history (to my knowledge) to take up the controversy in this way, and consider the question: does scientific research demonstrate that they are safe? It is for these reasons that I feel the word "safety" needs mentioning in this opening paragraph either instead of, or alongside, the words "ill effects". To revert this change, or negate this proposition, would be to negate both the subject and the conclusions of these recent FDA hearings. In case you are an editor reading this and you feel that my change needs reverting, may I also ask in passing whether or not you feel you are more highly qualified scientifically than the entire panel of 20 scientists at these recent FDA hearings, hand-picked by the FDA to consider the question? Don't worry, it's not that I expect you to be, or myself to be, that's not necessary. All I mean to say is that this is the reason why, when composing Wiki articles, we seek to know what the most up-to-date and reliable sources have said about the topic, rather than making our own assumptions which are at variance with the conclusions of these reliable sources. Does my line of thinking seem reasonable? Please share your thoughts if it doesn't, and thanks for your assistance and input. Simon K 23:09, 1 January 2007 (UTC)

• • I have very politely invited everyone to share their views and responses to my above points before deleting my proposed minor amendments. In fact, I have done so in very polite and reasonable terms on no less than four occasions in the past three weeks, during which time one person in particular (JzG) has rudely ignored my polite requests, not once deigning to address my valid points above, but simply acting to repeatedly delete my minor proposed amendments for fallacious reasons.

You are (a) behaving rudely when I am seeking to maintain friendly communication and collaboration; & (b) apparently striking "from the hip", according to what I presume might be your gut instincts on the topic, without actually taking the time to address my points above and explain what qualifications or experience give you the authority to negate the recent conclusions of an independent panel of 20 scientists hand-picked by the FDA in the USA to comment on the subject of this article.

In reference to the latter, your repeated deletion of the word [referring to an absence of proof of] "safety" is not a deletion of my own contribution, it is a direct deletion of the presence in the opening paragraph of this article of merely a passing mention of the conclusions of those 20 scientists in the most up-to-date hearings that have taken place on the topic of the article - indeed the only national American governmental ones in history of this nature.

I am giving you the benefit of the doubt that you have not yet read my comments above, and have simply made an accidental error of judgment through not giving enough time to your investigation before deleting my amendments, because the only other conclusion I could make otherwise is that you must be a highly qualified research scientist with decades of references to your name in the field of the study of the safety of dental amalgams, so many that they outnumber the collective qualifications, experience and expertise of the entire panel of 20 scientists recently hand-picked by the FDA in the USA to make the decision regarding the absence of proof of safety, the exact sentiment you are continually acting to delete from the opening of this article. Simon K 07:42, 23 January 2007 (UTC)

• • I have also gone to review in my mind Wiki guidelines for resolving disputes.

There appears to be a dispute here, I would like to note, not between you and me, but between your opinion and the conclusions of an independent scientific panel recently chosen by the FDA because they were qualified to form conclusions on this topic.

Wiki policy suggests "First step: Talk to the other parties involved". I have tried this, both here on the Talk page, and by privately emailing you. On both occasions you have not responded to my questions as to why you are acting to delete a minor amendment and thus set yourself up against the FDA panel.

Wiki policy goes on to suggest "Second step: Disengage for a while". I have done this, by allowing more than three weeks to pass. I also hoped you might find time to respond, if you were busy before, but instead you continue to issue no polite response, merely another deletion.

Wiki policy continues by saying "Do not simply revert changes in a dispute". My comments above made it clear since over three weeks ago that there is a dispute here, but still you are simply reverting changes, not discussing them. Four times you have reverted my mention of "safety" in the opening paragraph.

Wiki policy also states "repeated reverting is forbidden". I acknowledge that you have not technically reverted my changes repeatedly in exactly the same way, because after each of your revertions I have decided to try rewording my new attempts, since apparently the previous attempts had not appealed to you. However, I expressed exactly the same sentiment in exactly the same place in FOUR different attempts, using the same key word "safety" on all occasions, and your response was simply to revert this again FOUR TIMES without responding to my polite requests for dialogue either here or by email. Hence I regard this as more or less the same as "repeated reverting," particularly because of the above-mentioned rude refusal to engage in dialogue before performing the reverting for the second time, third time and then fourth time.

My next response has been to undo your last revertions, and once again request dialogue on my points above. Wiki seems to also suggest considering the possibility of third-party mediation, which is fine with me, or otherwise sensible dialogue on-topic would still be gratefully received rather than further silent revertions. Simon K 08:05, 23 January 2007 (UTC)

• • In spite of all my comments above, it appears that you (JzG) are not even reading this perhaps, and have now reverted my efforts for the FIFTH TIME while still RUDELY ignoring my polite requests for dialogue and collaboration.

Your only comment, attached to your last deletion, was the remark "Since the anti-amalgam camp can't bear for us to imply that 150 years of use without provable problems is evidence of safety, probably better not to say anything in para 1."

First of all, this is not dialogue, you are once again simply deleting without entering into discussion.

Secondly, the wording of your comment reveals that you apparently feel there are two "camps", a situation of "us and them." This is not encyclopaedic by its very nature, and I protest the basis of your logic for this reason.

I have my personal opinions, as I'm sure do you, and everyone else, but they are irrelevant to the composition of a Wiki article. My effort does not relate to my opinion or to a fabricated sense of "us and them," but rather the complete reverse: I am trying as best I can possibly do to adopt a neutral stance and encourage others, such as yourself, to engage with me in constructive, co-operative dialogue. My repeated invitations have been polite and scholarly in motivation, and all I want is to see articles improved in accuracy and neutrality.

In contrast to this, it appears you have rudely catalogued yourself as "us" perhaps fighting against a presumed "them", whom you describe as "the anti-amalgam camp", apparently an overly emotional bunch to judge from your use of the loaded words "can't bear". Does your phrasing and wording here indicate a desire to engage in constructive dialogue, which is what Wiki policy encourages?

It appears not, and therefore I would once again like to politely request to your higher sensibilities, and to your sense of all things honourable and good, that you try to put aside the use of opinionated language, and the expression of your personal views, in order to engage constructively with others to improve the education of humanity, which is what Wiki was meant for. In Wikipedia, there should be no "us and them", only "us". But only if you choose to be noble, and step out across the bridge into the territory of constructive dialogue. Instead you have made FIVE IDENTICAL DELETIONS in a row and behaved in a rude and abrasive manner, which I would be most grateful if you would be willing to stop doing, for the benefit of the betterment of humanity through the Wiki educational resource we are creating.

If this continues to be a monologue, rather than a dialogue, through your ongoing refusal to engage in discussion, then may I put out a request to any other viewers reading this that if JzG is not willing to live true to the spirit of Wikipedia by working constructively, is there any other reader who is, and would like to mediate for us, or take up the concept of dialogue which has so far eluded JzG? Simon K 22:47, 24 January 2007 (UTC)

To be honest, I cannot sift through all the above text. It is entirely too long. Looking at the edits between the two of you, however, the JzG version seems better to me because the question of "safety" is not as controversial as some would like to make it appear. I think clearly there are some strong sentiments about whether amalgams have a place as a dental filling nowadays, but most dental research has confirmed the safety of amalgam. It would be deceiving to imply that really a whole host of dental researchers and practitioners believe that amalgams may be causing diseases, such as Alzheimer's for example. Perhaps a better introduction may be created anyways. I tried to improve the lead in with a new sentence, which I hope would make things a bit better. And, when it comes to this particular issue, any further edits should probably be discussed here before simply reverting to a previous version. I am hoping we can at least get another perspective on this from someone else. - Dozenist talk 23:00, 24 January 2007 (UTC)

All Wikipedia articles must adhere to neutral point of view. Part of the neutral point of view policy tells us that undue weight must not be given to minority views in article text. Any changes to this article that make the safety of amalgam appear to be less (or more) accepted than it actually is (and the acceptance is fairly wide; the anti-amalgam position is a minority position, though it is not an insignificant minority) should be reverted per these policies. Thanks. · j e r s y k o talk · 23:12, 24 January 2007 (UTC)

Thank you, to both of you, for engaging in this discussion. I do apologise that my comments above became so long, but as you will appreciate, they were being ignored for nearly a month by a contributor who during this period silently reverted my changes no less than 5 times in a row without responding above. This then led to my repeated pleas above, which lengthened the text.

Dozenist, I like your new version of the first paragraph, thank you. I like it precisely because it is neutral, and also because the key word "safety" is included. Let's see how other people find it as well.

With regard to your comment "the question of safety is not as controversial as some would like to make it appear," the essence of my text above relates to the recent FDA hearings. These "some would like to make it appear" are not just any old "some" but actually 13 out of 20 independent scientists hand-selected by the FDA only a few months ago in national U.S. hearings to assess this question. Their conclusion was not the same as yours. Their conclusion was that there is cause for concern, and in particular, they voted that the sentiment you expressed - that "most dental research has confirmed the safety of amalgam" - is actually incorrect. Personally, I trust their expert conclusions more than those of you or me, and I also feel a Wiki article should reflect these official conclusions, not your or my opinions. Any thoughts? Simon K 23:37, 25 January 2007 (UTC)

Jersyko, thanks for chipping in too, and I agree with you. Neutrality is very important, and an article like this one certainly shouldn't give the false impression that amalgam fillings are generally considered unsafe. This is untrue, and I would be strongly against any edits to this article which introduced falsity and deception of this nature by declaring that most people consider amalgams unsafe (at least not until such time that it were true, if this minority view is vindicated by history in the future, which is not a concern of this Wiki article now). With regard to your other point, I also agree that undue weight shouldn't be given to minority positions, although as the topic of the article is "controversy" this in itself refers to at least two main views as the subject of the article, even if one is more widely accepted than the principal opposing one; it would be senseless in an article about a controversy to only present one view because it is the more popular one - then it would no longer be an article about a "controversy".

It is also notable that, while the minority view remains a minority view in most countries, 13 out of 20 independent scientists selected by the FDA to judge the question of amalgam safety recently concluded that this minority position has merit. The conclusions of these FDA hearings do not make the minority position a majority position. However, they have changed the controversy fundamentally and raised more questions than answers, because an official conservative group of independent scientists has paradoxically come out in support of the minority view, not the majority one. Since encyclopedic writing shows an interest in the conclusions of scientific boards and official experts, I'd suggest the FDA hearings, and their conclusions, require a prominent place in the opening of this article, even if just mentioned in passing. Furthermore, the conclusions of these hearings are much more up to date than the vast majority of other references in the article, another reason they are important. Any thoughts?Simon K 23:51, 25 January 2007 (UTC)

Perhaps we can say that:

• the safety of dental amalgams is generally accepted, although some challenges have been made

Is this a good compromise? --Uncle Ed 14:42, 26 January 2007 (UTC)

Thanks for the suggestion. Yes, it would be good to insert one more brief addition such as this to the opening paragraph, very briefly to summarise both sides of the controversy - the official view in many countries on the one hand, and opponents on the other hand with special reference to the recent FDA panel as the most notable example of the opposition concerns. So how about this slightly expanded version of the sentence you composed? It is your sentence but with some example references added to each side, and my hope is that this summarises in clear and concrete terms which view is the official majority one, and some examples of who supports this view (ADA, BDA, IDA, FDA, etc.), as well as then mentioning the FDA panel's conclusions in passing as the most relevant and up-to-date example of the minority opposition view, thus neatly and concisely summarizing both sides of the controversy in the opening of the article. Where I've put "citation" below are all places where I have concrete links to citations that I can add if this passage is deemed appropriate for adding to the actual article. If anyone likes or dislikes it, please respond below, and in the case that you dislike it please suggest what is wrong and how it could be improved -

"The majority view in the dental amalgam controversy is that dental amalgams are safe, a belief generally accepted by many dental associations such as the ADA [citation #1], BDA [citation #2] and IDA [citation #3], as well as other institutions such as the FDA [citation #4], and therefore by most national governments in most countries. In opposition, the minority view in the dental amalgam controversy is that dental amalgams are unsafe, a concern most notably raised in 2006 by the FDA in the USA at a review panel [citation #5] which sought to demonstrate their safety, but at which 13 out of 20 independent scientists voted that it was "unreasonable" to conclude that dental amalgams are safe [citations #6,#7,#8]."

For anyone wondering why this addition is needed: the readability of this article has been questioned by some contributors, and so this addition aims to readably, clearly, concisely and accurately summarise the most up-to-date concrete examples of both sides of the controversy named in the article's title, and thus would improve the quality of the article significantly by first briefly summarising what is to follow in the rest of the article below this. Please note that my proposed addition has no leaning more to one direction or to the other, and my aim is to create an entirely neutral and brief summary which states both views, as well as making it clear which is the majority view, and then in passing specifically mentioning the FDA panel's conclusions as the most credible and recent example of the opposition view. Simon K 14:55, 10 February 2007 (UTC)

I'm still waiting for responses on the above? I would also like to note that I can see there has been an "edit war" lately, and the article is now locked, but that my above proposed addition to the intro has nothing to do with this edit war, which I haven't been following very closely.

My proposed addition is not written either from one side or the other, and it is also brief, and with concrete citations for both sides. I believe it would greatly improve the introduction to this article by giving readers a clear summary from the outset of the "who" and "what" of this controversy. Simon K 15:25, 12 February 2007 (UTC)

Simon, I like the structure of your paragraph and if we can fill in the citations I think that this would be perfect, im sorry to see that you are getting frustrated with nobody responding to your frequent posts. It looks like you add something every couple of days. I think that your paragraph is very neutral, states the facts about who beleives what and in what proportion. thumbs up. ps is there a way that someone can lock that paragraph :D(Bouncingmolar 15:37, 13 February 2007 (UTC))

Bouncingmolar, many thanks for your input. Okay, so here are the 8 proposed citations I had in mind for now (I've added numbers above to correspond to this list) - see whether these seem appropriate/helpful. I don't know whether the exact quotations, in each case, should be left included or not if these references are copied to the reference list for the article itself, but I'll put them here for now for consideration, either way, plus a link for each:

Citation #1: “Dental amalgam (silver filling) is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans.” ADA Statement on Dental Amalgam. American Dental Association, USA. Revised January 8, 2002. http://www.ada.org/prof/resources/positions/statements/amalgam.asp

Citation #2: “To date no epidemiological links have been established anywhere in the world between amalgam use and general ill-health. It is never possible to say categorically that anything is safe in all circumstances. With amalgam, as with all bio-materials, there are risks and benefits to be balanced. Whether amalgam can be called ‘safe’ is a matter for manufacturers of amalgam and for the Department of Health, and for the toxicologists and other scientists who advise them.” Dental Amalgam Safety, British Dental Association Fact File. British Dental Association, UK. November, 1996. http://www.bda.org

Citation #3: “All available world-wide research indicates that amalgam is not harmful to health. No Government or reputable scientific, medical or dental body anywhere in the world accepts, on any published evidence, that dental amalgam is a hazard to health.” Frequently Asked Questions. Irish Dental Association, Ireland. February, 2007. http://dentist.ie/resources/faqs/prostho/index.jsp#amalgam

Citation #4: "Since the 1990s, FDA and other government agencies (CDC, NIH) have reviewed the scientific literature looking for links between dental amalgams and health problems. To date, the agencies have found no scientific studies that demonstrate dental amalgams harm children or adults. But we continue to review the literature and ask experts their opinions on the safety of dental amalgam.” CDRH Consumer Information. Food and Drug Administration, USA. Updated October 31, 2006. http://www.fda.gov/cdrh/consumer/amalgams.html

Citation #5: Joint Meeting of the Dental Products Panel (CDRH) and the Peripheral and Central Nervous System Drugs Advisory Committee (CDER) - September 6-7, 2006 (Meeting Documents). Food and Drug Administration, USA. Updated September 8, 2006. http://www.fda.gov/ohrms/dockets/ac/cdrh06.html#dentalproductspanel

Citation #6: “The draft FDA White Paper argued that mercury fillings are safe. By two votes of 13 to 7, this panel rejected the FDA staff position. It is highly unusual for a panel to disagree with staff. The questions presented: Q1. “Does the draft FDA White Paper objectively and clearly present the current state of knowledge about the exposure and health effects related to dental amalgam?” Yes 7, No 13. Q2. “Given the amount and quality of Information available for the draft FDA White Paper, are the conclusions reasonable?” Yes 7, No 13.” Joint Meeting of the Dental Products Panel (CDRH) and the Peripheral and Central Nervous System Drugs Advisory Committee (CDER) - September 6-7, 2006 (Summary). Food and Drug Administration, USA. Updated September 8, 2006. http://www.fda.gov/cdrh/meetings/090606-summary.html

Citation #7: Joint Meeting of the Dental Products Panel (CDRH) and the Peripheral and Central Nervous System Drugs Advisory Committee (CDER) - September 6-7, 2006 (Final Questions). Food and Drug Administration, USA. Updated September 8, 2006. http://www.fda.gov/ohrms/dockets/ac/06/questions/2006-4218q1-final.pdf

Citation #8: Joint Meeting of the Dental Products Panel (CDRH) and the Peripheral and Central Nervous System Drugs Advisory Committee (CDER) - September 6-7, 2006 (Comments). Food and Drug Administration, USA. Updated September 8, 2006. http://www.fda.gov/ohrms/dockets/dockets/06n0352/06n0352.htm

Simon K 23:30, 13 February 2007 (UTC)

There was an editorial published in the Journal of the Irish Dental Association in the Winter 06 edition about amalgam. I will try to get it.Dr-G - Illigetimi nil carborundum est. 19:21, 14 February 2007 (UTC)

Thanks Dr-G. The quote above is from a page maintained by the IDA on their website. Simon K 12:38, 15 February 2007 (UTC)

[edit] Proposed infobox

Without prejudice to the issue itself, would it be useful for Wikipedia contributors to have a list of articles related to mercury and health? How about an infobox?

• Mercury poisoning
• Mercury toxicity
• Mercury(II) chloride: toxicity
• Methylmercury: dietary sources, biological impact
• Mercury-in-glass thermometer: phase-out in America
• Mercury arc valve: environmental hazard
• Thiomersal controversy
• Dental amalgam controversy
• Mercury (II) nitrate: toxicity to hatters
• Syphilis: historical medicinal use
• [[]]
• [[]]

Add your links above. --Uncle Ed 22:24, 23 January 2007 (UTC)

Seems like a very good idea to me. Mercury is notoriously volatile, and has so many forms, that an infobox as you suggested above would help readers navigate between the various related pages that have something to do with health and mercury in one of its many forms. Simon K 16:07, 12 February 2007 (UTC)

At first I thought this was a good idea but i'm wondering now whether it is. The info box doesn't seem to have much to do with amalgams, and probably would be as relevant as an info box about scientific bodies that have reached conclusions but still have strong opponents, say global warming etc. However I do like the idea of having a link to mercury which i think should have that info box on the mercury page.(Bouncingmolar 15:42, 13 February 2007 (UTC))

[edit] Wikipedia is not a soapbox

Talk pages on Wikipedia are meant to be a place to discuss changes to an article and resolve editing disputes. Wikipedia is not a soapbox, including talk pages. Attempts to use a talk page as an outlet to advocate a point of view that has been rejected by consensus and attack other editors violate numerous policies. Common practice is to remove such talk page edits on sight and warn the offending editor of his or her policy violation, which can eventually lead to editing blocks. This talk page has been used recently as a space for what amounted to writing a POV article on the subject and as a vehicle to attack other editors. Please use this page only to suggest improvements to the article and resolve editing disputes, not as a space to write a new article in one's own image. · j e r s y k o talk · 03:27, 13 February 2007 (UTC)

I don't understand "point of view that has been rejected by consensus". Does this mean a viewpoint about a controversy which the overwhelming majority of contributors think is false? --Uncle Ed 14:43, 14 February 2007 (UTC)

Every editor that commented on the anon's proposed changes to the introduction (now housed in the archive of this talk page, mostly out of order at the top of the archive, though perhaps scattered throughout) disagreed with the proposed changes, some noting that they violated neutral point of view. The anon persisted in making the changes, even after it was clear that no one agreed with him/her. That's what my statement above is referencing, though perhaps my word choice isn't as precise as it could be. The article should obviously discuss both sides of the controversy; I am not saying that anti-amalgam points don't belong in this article (though we must adhere to WP:NPOV#Undue weight, of course). · j e r s y k o talk · 15:02, 14 February 2007 (UTC)

Okay, you were referring to POV changes which others here rejected because they would have violated NPOV. That makes sense.

BTW, how do you like my "restatement" of the anti and pro viewpoints at the top of the talk page? --Uncle Ed 15:46, 14 February 2007 (UTC)

I hope it leads to a constructive conversation. Thanks for hopefully starting it. I have no training in this area, so unfortunately I can't comment intelligently. · j e r s y k o talk · 15:48, 14 February 2007 (UTC)

I for one like the restatement. The strategy of the ADA to achieve "consensus" on a "controversy" has no place in this article.

I will comment on the "restatement" when I get a chance. If you look to see how much has been added in the past two days, there is a lot to respond to unless you check wikipedia every hour, which I have not had the chance to do recently. I think there is a lot in the revision that needs work, but, as I said, I want to give it a full response, which will take me some time. - Dozenist talk 14:34, 15 February 2007 (UTC)

[edit] The Scientific Case Against Amalgam

A summary of 97 scientific studies:

http://iaomt.org/articles/files/files210/The%20Case%20Against%20Amalgam.pdf

Drichw 22:35, 27 February 2007 (UTC)

[edit] Why has this page been locked for 1 month

Look, $5 Trillion in liability is not a small amount, but enough of locking this page so it can never be changed. That is called censorship. —The preceding unsigned comment was added by 70.49.211.171 (talk • contribs) 11:53, 8 March 2007.

• No, it's called preventing disruption of the project. Wikipedia policy allows for all sides of a debate to be covered with due regard to their significance, and provided that all facts are stated from a neutral point of view. Your edits fail on that score, give undue weight to one side of the argument, your failure to engage in debate on this Talk page is disruptive, your advocacy within the article is inappropriate. Feel free to propose changes, but be aware that the overall tone of the article must not leave the reader with the impression that this controversy is anything other than a sideshow as far as most dentists are concerned. Guy (Help!) 14:24, 27 March 2007 (UTC)

[edit] Typo

{{Editprotected}} Just a minor typo, but the following text:

• "all dental offices with more than nine employees must provide notices on the contents dental fillings to patients"

has an error. It should read: "on the contents of dental fillings".

I would also ask if the page still merits protection. --N Shar (talk • contribs) 18:59, 10 March 2007 (UTC)

Done John Reaves (talk) 22:26, 10 March 2007 (UTC)

There is also a small inaccuracy in the first line that should be corrected: where it states "since they first began to be used 150 years ago" it would be more accurate to write "over 150 years ago." Simon K 00:18, 14 March 2007 (UTC)