Nigeria targets 2022 to phase out dental amalgam

Picture Caption: L-R: Prof. Babajide Alo of the University of Lagos; Minister of State for Health, Dr. Ehanire Osagie; Dr. B.O. Alonge, Head, Dental Division, Federal Ministry of Health; and Mr Charlie Brown, President of the World Alliance for Mercury-Free Dentistry, during the summit in Abuja on Tuesday July 17, 2018.

Crucial decision on how Nigeria would phase out amalgam use in dentistry in line with the provisions of the Minamata Convention on mercury was achieved on Tuesday July 17, 2018 in Abuja as stakeholders set a target of year 2022.
The decision was taken by participants at a National Stakeholders Summit on “Development of a National Policy for the Phase-down of Dental Amalgam Use in Nigeria” theme “Towards Mercury-free Dentistry in Nigeria”.
Similarly, a national steering committee that comprises of all relevant bodies to the issue has been set up.
While emphasising that coordinated actions are needed to drive the phase down of Amalgam use, delegates resolved to end the use of dental amalgam as restorative material in children under 16 years, pregnant women and breastfeeding mothers (the vulnerable group) by December 2020.
Towards achieving this, they recommended that the Federal Government should initiate a coordinated multi-sectoral approach for an effective phase down of use of dental amalgam in the country.
Besides the introduction and promotion of alternatives/transition to alternatives through subsidies, participants clamoured the initiation of a phased down work plan, which they stressed must also include legislative review and development of guidelines, gathering baseline data and developing the National Policy.
While stopping the inflow of amalgam from other countries and donor agencies, and updating dental school curricula and training of academic staff of dental schools, it was also suggested that the media should be engaged in awareness creation on the health impacts of mercury in dental amalgam.
Besides halting the inflow of amalgam from other countries and donor agencies and devising a government budget sub-head for mercury management in products, participants demanded a government policy to reduce duties or provide waivers for the alternatives to amalgam and encourage lower tariff for alternative restorative materials.
Delegates also agreed to:
• Engage financial experts for advice on how to access available funds from global donor agencies to support the phase down implementation;
• Intensify the campaign for improved oral health at all levels in order to promoted prevention and reduce the need for Dental restorations; and,
• Modify National Health Insurance Scheme and government programmes
The objective of the summit, organised by the Federal Ministry of Health in collaboration with the USA-based World Alliance for Mercury-Free Dentistry, and Sustainable Research and Action for Environmental Development (SRADev Nigeria), was to provide a platform for national stakeholders to work collegially to begin the phase down of the use of dental amalgam, review the National Policy on phase down of dental amalgam use, and develop a draft phase down roadmap for Nigeria.
The forum brought together some 102 participants drawn from government, dental practitioners, dental surgery technicians, academia, civil society groups and the media to deliberate on policy issues for the phasing down of the use dental amalgam in the country.
Goodwill messages were delivered by the Nigerian Orientation Agency (NOA), Nigerian Medical Association (NMA), Nigerian Dental Association (NDA) and the World Alliance for Mercury Free Dentistry (WAMFD).
In a keynote address, the Minister of State for Health, Dr. Ehanire Osagie, provided an overview of mercury as a toxic substance posing a global threat, noting the damaging effects on health and environment.
According to him, the Minamata Convention calls for a phase down and consequently a phase out of the use of dental amalgam, adding that policy to be developed should give preference to a “phase out” for children, pregnant and breastfeeding women.
He said: “There is still a regrettably low level of awareness of the dangers of mercury, and the development of this policy on the phase-down of dental amalgam will give first priority to ending its use in pregnant and breastfeeding women and children in Nigeria. It is a task requiring multiple competences. I therefore urge all experts to engage each other exhaustively at this stakeholder meeting to develop a robust national policy document.”
While delivering a guest lecture, Prof. G. T Arotiba of the University of Lagos stressed that, contrary to the widely held impression that dental mercury mostly goes into the mouth of the patient, and stays there until a person dies, a close examination of the mercury life-cycle however shows that nearly 80% of the dental mercury used every year goes into the solid (municipal or hazardous) waste and wastewater streams.
He described mercury as a potent neurotoxin, with other systemic effects, adding that the fetus and young children especially vulnerable.
“There has been and two to three-fold increase of mercury in the environment since the Industrial revolution, and levels predicted to double by 2050,” Prof. Arotiba warned.
Executive Director of SRADev Nigeria, Dr Leslie Adogame, in a presentation, disclosed that a study revealed that most dental clinics/hospital and incinerators/medical waste treatment facilities in Nigeria are very high-risk environments for mercury vapour emissions and as such pose serious health risk to workers and the general population.
He suggested that the current curriculum at dental colleges and teaching institutions be reviewed and revised to include mercury toxicity and hazards, mercury specific occupational and health safety, mercury releases and emissions control, environmentally sound mercury waste management, non-mercury dental fillings and alternate material and capsulated mercury amalgam and mechanised mixing technologies.
Dominique Bally Kpokro of the African Centre for Environmental Health as well as World Alliance for Mercury-free Dentistry stated that Africa is leading the world to have amalgam phase down steps in the Minamata Convention in countries like Nigeria, Senegal, Togo, Benin, Côte d’Ivoire, Congo, Tunisia, Cameroon, Ethiopia, Kenya, Uganda, Tanzania, Burundi, Zambia, and Mauritius.
In Côte d’Ivoire for example, he listed activities to include:
• Opening of a mercury-free dental clinic in Abidjan
• Monitoring of mercury vapours in all dental clinics
• Change of dental curricula in dental faculty
• Validation of regulation banning amalgam use for children pregnant women and nursing mothers
The Minamata Convention is a global treaty intended to protect humans and the environment from the anthropogenic emissions and releases of mercury and mercury compounds, recognized as chemicals of global concern, due to long-range atmospheric transportability, persistence in the environment, ability to bio-accumulate in ecosystems and have negative effects on health and the environment.