BILL ANALYSIS
AB 2270
Page 1
Date of Hearing: April 23, 2002
ASSEMBLY COMMITTEE ON HEALTH
Helen Thomson, Chair
AB 2270 (Dickerson) - As Amended: April 9, 2002
POLICY QUESTIONS :
1)Should a dentist be prohibited from providing a patient with a
dental filling containing mercury, commencing January 1, 2007?
2)Should a dentist providing a patient with a dental filling
containing mercury until January 1, 2007, be required to
provide a patient with a written disclosure warning patients
of the risk to children and pregnant or lactating women?
SUBJECT : Dental fillings: mercury.
SUMMARY : Prohibits a dentist, commencing January 1, 2007, from
providing a patient with a dental filling containing mercury,
and requires a dentist providing a patient with a dental filling
containing mercury until then to provide the patient with a
written disclosure warning patients of the risk to children and
pregnant or lactating women. Specifically, this bill :
1)Prohibits a dentist, effective January 1, 2007,
notwithstanding any other provision of law, from providing a
patient with a dental filling that contains mercury.
2)Requires a dentist that provides a patient with a dental
filling that contains mercury prior to January 1, 2007, to
provide the patient with the following written disclosure:
"This dental amalgam contains approximately 50 percent
mercury, a highly toxic element, and therefore poses health
risks. This product should not be administered to children
less than 18 years of age, pregnant women, or lactating
women."
3)Specifies that a violation of the provisions of this bill
constitutes unprofessional conduct and is grounds for the
revocation or suspension of the dentist's permit, certificate,
license, or all three, or permits the dentist to be
reprimanded or placed on probation.
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4)Makes various legislative findings and declarations, including
the following:
a) Mercury is a highly toxic element;
b) A dental amalgam, commonly referred to as a "silver
filling," consists of 43% to 54% mercury.
c) The mercury in a dental amalgam continually emits
mercury vapors;
d) Mercury toxicity is a retention toxicity that builds up
over years of exposure;
e) According to the Agency for Toxic Substances and Disease
Registry Agency, the mercury from amalgam goes through the
placenta of pregnant women and through the breast milk of
lactating women, giving rise to health risks to an unborn
child or a baby;
f) The federal Environmental Protection Agency considers
removed amalgam filling and extracted teeth containing
amalgam material to be hazardous waste;
g) The use of mercury in any product being put into the
body is opposed by many health groups, including the
American Public Health Association, the California Medical
Association, and Health Care Without Harm; and
h) Alternatives to mercury-based dental fillings exist, but
many publicly and privately financed health plans do not
allow consumers to choose alternatives to mercury amalgams.
EXISTING LAW :
1)Licenses and regulates dentists through the Dental Board of
California (DBC).
2)Requires DBC to develop and distribute a fact sheet describing
and comparing the risks and efficacy of the various types of
dental restorative materials that may be used to repair a
dental patient's oral condition or defect. Requires the fact
sheet to be made available by DBC to all licensed dentists,
and to include all of the following:
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a) A description of the groups of materials that are
available to the profession for restoration of an oral
condition or defect;
b) A comparison of the relative benefits and detriments of
each group of materials;
c) A comparison of the cost considerations associated with
each group of materials; and
d) A reference to encourage discussion between patient and
dentist regarding materials and to inform the patient of
his or her options.
3)Requires the fact sheet in #2) above to be provided by a
dentist to every new patient and to patients of record prior
to the performance of dental restoration work. Specifies that
the dentist needs to provide the fact sheet to each patient
only once. Requires an acknowledgment of the receipt of the
fact sheet by the patient to be signed by the patient and a
copy of it to be placed in the patient's dental record.
FISCAL EFFECT : Unknown.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
sponsored by Consumers for Dental Choice to stop mercury
dental fillings going into children and pregnant or nursing
women, give warning to all, and to phase out mercury dental
fillings in five years. The author states that this bill
gives dentistry plenty of time to convert out of using
mercury, pointing out that one survey reports that the number
of dentists choosing to be mercury free tripled from 9% to 28%
in the past five years. The author states that according to a
1999 report from the U.S. Agency for Toxic Substances and
Disease Registry, those most at risk are children, because
their brains are still developing and the mercury may
adversely affect this development. The author also asserts
that the mercury from dental offices now constitutes the
largest source of mercury into the wastewater - 83% according
to a 2001 study by the City of Palo Alto. The author points
out that although dentists argue that amalgam is safe because
it has been used for more than 100 years, many other 19th
century medical vestiges have been discarded.
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2)DENTAL MATERIALS FACT SHEET . Legislation passed in 1992
required DBC to develop and distribute a fact sheet describing
and comparing the risks and efficacy of the various types of
dental restorative materials. This fact sheet was updated in
2001, and in regards to the toxicity of amalgam fillings,
contains the following statement: "Generally safe; occasional
allergic reactions to metal components. However, amalgams
contain mercury. Mercury in its elemental form is toxic and
as such is listed on Proposition 65."
3)SUPPORT . The Children's Advocacy Institute (CAI) supports
this bill, stating that no other health profession supports
using mercury in the human body. CAI states that each filling
contains about three-quarters of a gram of mercury. A person
with eight "silver" fillings has the equivalent of six grams
of mercury, a concentration that CAI states would shut down a
school chemistry lab or bring a toxic clean-up crew to a lake.
CAI states that banning mercury will ensure that children do
not have highly toxic elements placed in their mouths. The
American Academy of Biological Dentistry also supports this
bill, stating that it is true that the dental profession is
split on the issue of using mercury, but when there are safer
alternatives, it just makes no sense to continue to implant a
known toxin into the mouths of our citizens. The Coalition to
Abolish Mercury Fillings states that this bill parallels the
bipartisan Diane Watson-Dan Burton bill in the U.S. House of
Representatives, and focuses first on protecting children from
exposure to mercury. Dams, Inc. supports this bill, stating
that every amalgam releases about 10 micrograms of mercury
into the body every day, that the lungs inhale the vapor that
comes from the fillings, and from the mercury is absorbed into
the blood stream.
4)OPPOSITION . The California Dental Association (CDA) is
opposed to this bill, stating that amalgam has been used for
more than 100 years and is the most durable, affordable, and
long-lasting dental restorative material in use today. CDA
argues that thousands of valid, peer-reviewed scientific
studies have been done on the safety of dental amalgam. CDA
points out that current law requires dentists in California to
provide their patients receiving fillings with a dental
material Fact Sheet that was developed by a third-party expert
who reviews existing scientific research on all restorative
materials, commenting on the risks and benefits of each. CDA
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states that in spite of repeated attempts by amalgam opponents
to have the fact sheet outcome modified to reflect their
position, the contractor was unwilling to change the fact
sheet to reflect purported risks that were unsubstantiated by
science.
REGISTERED SUPPORT / OPPOSITION :
Support
Consumers for Dental Choice (sponsor)
American Academy of Biological Dentistry
Children's Advocacy Institute
Coalition to Abolish Mercury Dental Fillings
Dams, Inc.
Holistic Dental Association
International Academy of Oral Medicine and Toxicology
Prostate90 Education & Research Foundation
Several individuals
Opposition
California Dental Association
Analysis Prepared by : Vincent D. Marchand / HEALTH /
(916)319-2097