The most important issue is that of initiation of the removal: should it be suggested by the dentist or by the patient? No scientific evidence exists to support dentists' suggesting to patients that these fillings need removal, regardless of the individual practitioner's beliefs. The American Dental Association has formulated clear guidelines on this matter. When a dentist suggests amalgam removal for a patient who is not allergic to the material, he or she violates the principle of beneficence, which includes the concept of ''doing good'' for the patient. Beneficent treatments are not idiosyncratic, but result from common beliefs among dental professionals. When patients request amalgam removal, dentists should consider nonmaleficence and autonomy. Nonmaleficence requires the practitioner to ''first do no harm''; if patients request removal because of incorrect information about amalgam's health consequences, they should be educated. The steps taken in such an educational approach are presented. Recognizing the patient's autonomy means the dentist realizes the patient has the right to self-determination, as well as the right to informed consent. The factors important for informed consent are enumerated. Dentists, too, have autonomy, and may refuse to remove amalgam even if patients, after education, desire it.
Contemporary best-practice dentistry is founded on the principles of evidence-based treatment modalities derived from research published in peer-reviewed scientific literature. The current evidence base confirms that there is no justification for a dentist to promote the removal of amalgam and replacement with other materials for health reasons. A dentist, who suggests that the removal of amalgam has the capacity to cure or alleviate diseases, infections or other conditions, is acting unethically. Such treatments are not based on accepted scientific knowledge or research.
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