Informed consent: does doctrine apply to HIV, amalgam, fluoride?

Article Abstract:

The concept of informed consent, first applied to dentistry in 1916, is discussed as it relates to infection with human immunodeficiency virus (HIV, associated with AIDS), dental amalgam (fillings containing mercury), and fluoride. Originally intended to protect a dental patient from unwanted extraction of teeth, the doctrine of informed consent is being invoked in situations that are extremely complex. In general, it implies that patients have a right to know in advance whether significant risk is associated with a contemplated procedure. However, defining significant risk is not always easy. Pressure by consumers and others, including the dental profession itself, is currently being exerted to force HIV-infected health care providers to stop performing invasive procedures or to inform their patients if they are infected. This makes sense legally because there is a very small probability of disease transmission. However, in the real world, disclosing HIV infection opens the dentist to litigation from patients. Another less devastating option for infected dentists is to stop performing invasive procedures. Informed consent has been traditionally applied prospectively, before treatment; in the current context, it is often applied retrospectively, after treatment. It is not clear what the legal implications of retrospective disclosure of HIV status will be. Credible evidence does not exist to support views that amalgams or fluoride pose health risks, Therefore, any application of the doctrine of informed consent is inappropriate. In summary, the doctrine cannot be appropriately applied to any of the three areas discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Beliefs, opinions and attitudes, Dentists, Informed consent (Medical law), Informed consent, Dental law

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When your patients ask about mercury in amalgam

Article Abstract:

'Antiamalgamists', people who oppose the use of dental amalgam (mixtures of mercury and other metals for fillings), have created public consternation over the safety of such materials. Similar concerns that might be encountered by a dentist are presented and answered. Mercury is used in amalgams because it helps the filling harden without shrinking, and it can withstand grinding and chewing pressures. Mercury in amalgams is not biologically active, and, therefore nontoxic. A small amount enters the mouth during vigorous chewing, but it is smaller than would be consumed in a regular fish meal. No reports of amalgam-related mercury toxicity exist. Alternate materials can be used in dental fillings, and new compounds are under investigation. Gold, porcelain, and resins are useful in certain situations, but none is as versatile as mercury. The ADA (American Dental Association) has approved some of these materials, and it has also approved amalgam. In fact, it so supports amalgam that the ADA's Principles of Ethics and Code of Professional Conduct considers removal of amalgam for the purpose of reducing toxicity an unethical procedure, if the impetus for such a step comes from the dentist. The only patients who need to have amalgams removed are those with a demonstrated allergy. Dental patients and people with additional questions can be referred to state or local dental societies, or to the ADA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Physiological aspects, Ethical aspects, Dental amalgams, Mercury (Metal), Mercury in the body, Dental materials

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Dental amalgam and cognitive function in older women: findings from the Nun Study

Article Abstract:

Silver fillings do not appear to be associated with cognitive function in older women. Media reports suggest that mercury vapor released from silver fillings during chewing may contribute to age-related neurologic disease. Researchers performed oral examinations on 129 nuns between the ages of 75 and 102 to determine the number and size of silver fillings on the chewing surfaces of their back teeth. Investigators administered eight neuropsychological tests to each nun. Sisters who had the largest surface area of silver fillings had cognitive function that was similar to those with smaller silver filling surface areas, sisters without silver fillings, and those without teeth. This finding is irrespective of age, education, and number of back teeth.

Health aspects, Testing, Cover Story, Cognition in old age, Old age cognition, Amalgams

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