Should dental amalgams be used in dental training? The perspectives of dental academics at a university in South Africa
Keywords:Dental amalgam; composite resin; dental curriculum; dental education; restorative dentistry, dental materials
Dental amalgam has been used in dentistry for the last 150 years to restore posterior teeth. Concerns regarding the safety issues with amalgam due to its mercury content have lead to the introduction of composite dental material to restore posterior teeth. This has transformed the teaching and training trends of direct restorative materials for posterior teeth. This descriptive study aimed to gain insight into academic staff and clinical supervisors’ perceptions regarding the use of dental amalgams in the teaching of restorative dentistry. This study used a qualitative method of data collection. Two focus group discussions were conducted between March and May 2020. Seventeen participants were invited to participate. Fourteen responded and participated, yielding an 82% response rate.
The data identified two major themes, viz. the challenges experienced with the teaching of dental amalgam and curriculum development recommendations. Clinical quota requirements, disposal of waste products, and occupational and environmental risks regarding mercury exposure were sub-themes. Some of the curriculum recommendations included the skills gained during cavity preparations, the training and quota requirements of dental materials, and teaching trends locally, nationally and internationally.
This study revealed that dental amalgam is still an integral part of the restorative dentistry curriculum at the university. However, the teaching of resin composite now occupies more than fifty percent of the restorative dentistry curriculum. Academics and clinical supervisors show a greater affinity for the placement of composite restorations.
World Health Organization. Sugars and dental cariesTechnical information note. Available from https://www.who.int/oral_health/ publications / sugars-dental-caries-keyfacts/en/ (Accessed 02 March 2021)
Schulmann, J. The Stages of Tooth Decay: What They Look Like. Healthline, 30 July 2020. Available from https://www. healthline.com/health/dental-and-oral-health/tooth-decay-stages (Accessed 02 March 2021)
WebMD. Dental Health and Tooth Fillings.WebMD Medical Reference, reviewed by Michael Friedman, DDS on 10 October 2019. Available from https://www.webmd.com/oral-health/guide/ dental-health-fillings (Accessed 02 March 2021)
Soni R, Bhatnagar A, Vivek R, Singh R, Chaturvedi TP, Singh A. A systematic review on mercury toxicity from dental amalgam fillings and its management strategies. Journal of Scientific Research. 2012;56(2012):81-92. Available from https://www.bhu.ac.in/ journal/ vol56-2012/BHU-7.pdf (Accessed 02 March 2021)
Auster P. Evolution and Revolution: Groundbreaking changes in Composite Dentistry. Dentistry Today, 01 February 2019. Available
from https://www.dentistrytoday.com/articles/10522 (Accessed 02 March 2021)
Singh H, Kaur M, Dhillon JS, Mann JS, Kumar A. Evolution of restorative dentistry from past to present. Indian J Dent Sci.
;9: 38- 43. doi: 10.4103/0976-4003.201634
Kateeb ET, Warren JJ. The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics. Clin Exp Dent Res. 2019 Jun 12;5(4):413-419. doi: 10.1002/cre2.196.
Lynch CD, Wilson NH. Managing the phase-down of amalgam: Part I. Educational and training issues. Br Dent J. 2013 Aug;215(3):109-13. doi: 10.1038/sj.bdj.2013.737.
Ylinen K, Löfroth G. Nordic dentists’ knowledge and attitudes on dental amalgam from health and environmental perspectives. Acta Odontol Scand. 2002 Oct;60(5):315-20. doi: 10.1080/00016350260248319.
Pani SC, Al Abbassi MF, Al Saffan AD, Al Sumait MA, Shakir AN. Factors influencing Saudi dental students’ preference of amalgam
or composite for posterior dental restorations. Saudi J Oral Sci 2014;1:30-36. doi: 10.4103/WKMP-0056.124183
Alexander G, Hopcraft MS, Tyas MJ, Wong RHK. Dental educators attitudes towards the teaching of dental amalgam: A mixed method analysis. European Journal of Dental Education. 2020;24(2): 282-291. https://doi.org/10.1111/eje.12496 Competing interests
Zabrovsky A, Neeman Levy T, Bar-On H, Beyth N, Ben-Gal G. Next generation of dentists moving to amalgam-free dentistry:
Survey of posterior restorations teaching in North America. Eur J Dent Educ. 2019 Aug;23(3):355-363. doi: 10.1111/eje.12437.
Umesi DC, Oremosu OA, Makanjuola JO. Amalgam phase down: baseline data preceding implementation in Nigeria. Int Dent J. 2020 Jun;70(3):161-166. doi: 10.1111/idj.12536.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101. doi:10.1191/147808870 6qp063oa
Moodley I, Singh S, Creating opportunities for interprofessional, community-based education for the undergraduate dental therapy degree in the School of Health Sciences, University of KwaZulu-Natal, South Africa: Academics’ perspectives AJHPE. 2018;10(2):96-100. doi:10.7196/AJHPE.2018.v10i2.1005.
Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010 Dec 4;376(9756):1923-58. doi: 10.1016/S0140-6736(10)61854-5.
Bhayat A, Madiba TK. The self-perceived sources of stress among dental students at a South African Dental School and their methods of coping. S. Afr. dent. j. 2017;72(1):6-10. Available from http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0011-85162017000100005 (Accessed 02 March 2021)
European Commission and Deloitte. Assessment of the feasibility of phasing-out dental amalgam – Final report (under Framework Contract No. ENV.C.4/FRA/2015/0042 – Service request 15), 17 June 2020. Available from https://circabc.europa.eu/sd/a/4fd46a0f-54aa-48c6-8483-288ad3c1c281/Dental%20Amalgam%20feasbility%20study%20-%20 Final%20Report.pdf (Accessed 27 August 2021)
SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks). Possible effects of Electromagnetic Fields (EMF) on Human Health. 21 March 2007. Available from https://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_007.pdf (Accessed 02 March 2021)
Parvin R. Mercury in dentistry. Available from https://www.academia.edu/34790382/Mercury_in_Dentistry (Accessed 02 March 2021)
Sahani M, Sulaiman NS, Tan BS, Yahya NA, Annual ZF, Wan Mahiyuddin WR, Khan MF, Muttalib KA. Mercury in dental amalgam: Are our health care workers at risk? Journal of the Air & Waste Management Association. 2016;66(11):1077-1083. doi: 10.1080/10962247.2016.1188866
Warwick R, O’Connor A, Lamey B. Mercury vapour exposure during dental student training in amalgam removal. J Occup Med Toxicol. 2013 Oct 3;8(1):27. doi: 10.1186/1745-6673-8-27.
Anastasio M. EU countries urged to ban mercury in dental fillings on children and pregnant women. META from the European Environmental Bureau. 24 July 2018. Available from https://meta.eeb.org/2018/07/24/eu-countries-urged-to-banmercury-in-dental-fillings-of-children-and-pregnant-women/ (Accessed 02 March 2021)
Walford P. Design Principles For Class II Preparations. Oral Health, 01 December 2012. Available from https://www.oralhealthgroup.com/features/ design-principles-for-class-iipreparations/ (Accessed 02 March 2021)
Bharti R, Wadhwani KK, Tikku AP, Chandra A. Dental amalgam: An update. J Conserv Dent. 2010;13(4):204-208. doi:10.4103/09720707.73380
Aggarwal VR, Pavitt S, Wu J, Nattress B, Franklin P, Owen J, Wood D, Vinall-Collier K. Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation. BMC Health Serv Res. 2019;19:985. https://doi.org/10.1186/s12913-019-4835-1
Sadowsky SJ. An overview of treatment considerations for esthetic restorations: a review of the literature. J Prosthet Dent.
Dec;96(6):433-42. doi: 10.1016/j.prosdent.2006.09.018.
Schmidt CJ, Tatum SA. Cosmetic dentistry. Curr Opin Otolaryngol Head Neck Surg. 2006 Aug;14(4):254-9. doi: 10.1097/01.moo.0000233596.68928.39.
Walsh LJ, Brostek AM. Minimum intervention dentistry principles and objectives. Aust Dent J. 2013 Jun;58 Suppl 1:3-16. doi:
Watt RG. COVID-19 is an opportunity for reform in dentistry. Lancet. 2020 Aug 15;396(10249):462. doi: 10.1016/
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright for all articles is retained by the author/s of the individual articles.