Is NYU dental school going 'amalgam-free'?

Students at the New York University (NYU) College of Dentistry were alarmed by a letter they received from faculty last month that appeared to indicate the school is implementing an "amalgam-free" policy.

In the letter, Mark Wolff, DDS, PhD, a professor and the chair of the department of cariology and comprehensive care and the associate dean for predoctoral clinical education at the dental school, wrote that, beginning immediately, "all treatment plans should consider alternative restorative materials other than amalgam."

However, "we have not discontinued the use of amalgam, just changed the default restoration from amalgam to composite," Dr. Wolff explained in an email to DrBicuspid.com. "Students are still being taught amalgam preparation design and placement. They may place amalgams in the clinical environment anytime it is the appropriate material."

Clinical and environmental concerns were among the reasons cited for the decision to make alternative materials the default.

"Preparations, designed to retain amalgam restorations, are less conservative and more destructive of tooth structure than preparations designed for bonded restorations utilized to treat the exact same carious lesion," Dr. Wolff wrote. "Lesion-specific dental care is better administered with the current generation of bonded restorations."

His letter also cited the United Nations Environmental Program's proposed legally binding global treaty recommending the phasing out of mercury amalgam as a factor in the decision.

"If this treaty becomes reality, all dentists may face a global mandate to stop the use of amalgam as a restorative material," Dr. Wolff wrote.

Student reaction

According to a July 20 blog post from the American Student Dental Association (ASDA), "students at NYU were shocked and frustrated with the new policy." However, ASDA President Colleen Greene said in an interview with DrBicuspid.com that those concerns have subsided.

"Students were confused initially," said Greene, a dental student at Harvard School of Dental Medicine, class of 2013. "To summarize what I think the sentiment is -- and Facebook is not the most journalistically accurate way to measure student opinions -- they were alarmed, but it seems like that as long as the rule is enforced with clarity and consistency, I don't think students are at any disadvantage."

As long as the school maintains open communications with the students, the policy could be positive, she added.

"As a spokesperson for ASDA, it does not violate any policies ASDA has on decision-making for materials usage," Greene said. "In fact, we agree that -- and I'm so grateful that this policy says -- 'no amalgam should be removed that has already been placed.' "

Other guidelines for amalgam usage at NYU outlined in the letter and confirmed as accurate by Dr. Wolff include the following:

• Amalgam will still be available at the supply area and will require justification by faculty for placement.
• Students will still receive preclinical training in the use of amalgam with special attention to the indications and contraindications.
• Strict mercury hygiene when using amalgam will be maintained in both the clinic and preclinical settings.