Philadelphia dentists cite consent form restraints

Feb 24, 2010

Philadelphia dentists testifying at a hearing this month about the impact of a legally required consent form regarding amalgam said they sometimes have to refuse treatment to disabled patients when they cannot get parents to sign it.

An ordinance requiring dentists to have their patients sign an information sheet about the effects of mercury, and their right to choose other options for fillings, took effect in 2009. Under the new law, dentists cannot treat patients without the signed form or, in the case of children, the signed consent of parents.

After years of debate, the FDA in July 2009 concluded that "the levels released by dental amalgam fillings are not high enough to cause harm in patients" -- including pregnant women, developing fetuses, and young children. But they did recommend that patients be informed about the potential effects of mercury.

Peter Carroll, D.D.S., president of the Philadelphia County Dental Society, was one of three dentists who testified at a recent hearing by the Philadelphia Board of Health on the impact of the new legally required form.

"I've never had anybody refuse to sign the form after I explained the research and the FDA's ruling," he told DrBicuspid.com. "But I have had patients who say they don't want amalgam, in which case I use composites or glass ionomer. Many parents want amalgam because they can't afford composites."

He said one dentist, who operates a mobile van that goes to schools, told the health board that she sometimes has problems treating disabled children because they have to be put under general anesthesia, and she had difficulty getting the required consent forms. He quoted another dentist as saying, "When providing full-mouth rehab to patients under general anesthesia, it is imperative that we have the option of amalgam in our armamentarium. Generally, we can clarify the situation and proceed but if a guardian flatly refuses amalgam and will not sign the information sheet, we will not see the patient."

Dr. Carroll explained that amalgam is often better to use on squirmy children or sedated patients because of moisture control issues and its faster application.

However, dental amalgam opponents say the consent form amounts to "strong-arming" parents of disabled children to "force their written consent to mercury fillings," according to a statement by Charles Brown, national counsel for Consumers for Dental Choice. He has asked the Pennsylvania Attorney General to conduct a civil rights investigation into the "despicable" policies of the Pennsylvania Dental Association and the Philadelphia County Dental Society.