By CYNTHIA R. JENNINGS, MARK A. MITCHELL, MARK A. BREINER
Connecticut’s Department of Social Services has taken a giant leap backward in providing dental care for Connecticut’s children. Without explanation, the state now mandates that Medicaid recipients must accept dental fillings with 50 percent mercury in their molars.
Once the mainstay of dentistry, amalgam’s popularity is in sharp decline. In several nations, its use has been eliminated altogether. Because it is 50 percent mercury, the 120 nations which signed the Minamata Convention on Mercury (including the U.S.) call for scaling down its use. So does, ironically, Connecticut. The Department of Energy and Environmental Protection is “concerned about [amalgam’s] possible effects on human health and the environment,” and mandates a wall posting in every dental office to inform consumers that amalgam is mainly mercury and guaranteeing toxic-free alternatives are available.
There is a state-mandated fact sheet in every dental office, titled “The choices you have.” DSS audaciously, if not illegally, rules that “you” does not mean “you” if “you” don’t make enough money.
To relegate the youngest and most vulnerable people in our state to the potential health effects caused by mercury is unconscionable. In mandating mercury fillings for poor children, we are placing their health at risk, if not directly, then through its contribution to the buildup of mercury in tuna and freshwater fish. Half of the mercury released into rivers and lakes is from dental offices. Nationally, 5 percent to 10 percent of newborns have mercury levels high enough to affect brain development.
Amalgam is a primitive, pre-Civil War material that cracks teeth, an inferior product compared to today’s minimally invasive choices such as composite and glass ionomers. Contrary to conventional wisdom, amalgam is not the lowest-priced filling; glass ionomers cost less. Once we factor dental mercury’s horrid impact on Connecticut’s land, water and air, composite fillings cost less too. So whether the costs are dental, medical or environmental, Connecticut taxpayers are on the hook for future health and environmental costs relative to mercury exposure. Mercury-free alternatives represent cost-effective 21st-century dentistry and are now considered superior to amalgam at leading dental schools.
Cynthia Jennings, co-author of this piece, recently wrote Gov. Dannel P. Malloy a letter of objection, noting that the DSS policy is grossly inequitable because it takes away the right to choose mercury-free dentistry, which was granted to all consumers; promotes mercury pollution, which in turn highly endangers developing babies through maternal exposure to methylmercury; and reduces access to dental care because it arbitrarily excludes from participation so many of the state’s dentists.
American dentistry is in the midst of the scholastic equivalent of a barroom brawl over whether to keep amalgam or to confine it to the dustbins of history. Half continue to use amalgam, while the other half – especially younger dentists – categorically reject putting mercury in the mouth. Instead of inviting all dentists to serve low-income children, DSS inexplicably chooses sides. It is hard enough for Medicaid families to find a dentist; it is shameful that DSS orders that half of the state’s dentists be off limits to them.
In a statistic that should embarrass our state government, a Kaiser Family Foundation report ranks Connecticut dead last in availability of dental care professionals in medically underserved areas. The decision by DSS to cut off all mercury-free dentists from participation makes the situation even crueler in low-income communities crying out for oral health care.
By segregating Medicaid patients from access to mercury-free dentists, DSS creates a separate-but-equal system of dentistry. As thinking Americans know, separate-but-equal was never equal in the Jim Crow days, and it is not equal today.
This anti-science, anti-patient, anti-dentist, anti-poor, anti-taxpayer, anti-environment policy from the Capitol must be repealed at once. Failing that, Gov. Malloy should order the agency to act in the best interest of Connecticut taxpayers, and more important, the children of this state. All Connecticut children, regardless of income, deserve good, regular dental care that reduces exposure to dangerous toxins, such as mercury.
Cynthia Jennings is a civil rights attorney and a member of the Hartford city council. Mark A. Mitchell, M.D., M.P.H., is former health director of Hartford and founder of the Connecticut Coalition for Environmental Justice. Mark A. Breiner, D.D.S., is a mercury-free dentist practicing in Fairfield and the author of “Whole-Body Dentistry.”