Proceedings of the Standing Senate Committee on
Energy, the Environment and Natural Resources
Issue 7 - Evidence - October 26, 2006
OTTAWA, Thursday, October 26, 2006
The Standing Senate Committee on Energy, the Environment and Natural Resources met this day at 8 a.m. to review the Canadian Environmental Protection Act (1999, c.33) pursuant to section 343(1) of the said act.
Senator Tommy Banks (Chairman) in the chair.
[English]
The Chairman: Good morning. Over the last few months, the committee has held a number of scoping meetings on the Canadian Environmental Protection Act (1999) before deciding how best to proceed with our review of that act. We have decided to examine this sprawling act by analyzing three case studies to help determine how, in what ways and how effectively the act protects Canadian citizens from the detrimental health effects known to result from exposure to the substances. The first case study will focus on mercury.
Appearing before us today on behalf of the Canadian Dental Association is Wayne Halstrom, president, and Benoit Soucy, director of membership and professional services. We later hope to meet with Bob Watts from the Assembly of First Nations.
My name is Tommy Banks, I am from Alberta, and I am the chair of the committee. Senator Cochrane, the deputy chair of the committee, is from Newfoundland and Labrador. She holds a master's degree in education from St. Francis Xavier University. She also serves on the Standing Senate Committee on Social Affairs, Science and Technology, and the Standing Senate Committee on Fisheries and Oceans. She is very busy.
Senator Willy Adams, from Nunavut, was appointed to the Senate in 1977. He is an electrician and businessman by trade. His entrepreneurial ventures have included serving as owner of Kudlik Electric Limited, Kudlik Construction Limited, Polar Bear Cave Investments and Nanuq Inn at Rankin Inlet. He also serves as a member of the Standing Senate Committee on Fisheries and Oceans and on the Standing Senate Committee on Transport and Communications.
Senator Tardif, of Alberta, has long been recognized as one of Canada's foremost advocates and defenders of minority, linguistic and cultural rights, and for her considerable contribution in both secondary and post-secondary education. She was appointed to the Senate in 2005, and she is currently a member of the Standing Senate Committee on Official Languages and the Standing Committee on Rules, Procedures and the Rights of Parliament.
Gentlemen, please proceed with your opening presentation.
Wayne Halstrom, President, Canadian Dental Association: Good morning, ladies and gentlemen. Thank you very much for inviting the Canadian Dental Association to speak to you today on the Canadian Environmental Protection Act. The CDA represents nearly 19,000 dentists across Canada. It has as its mission to act as the national voice for dentistry, dedicated to the advancement and leadership of a unified profession and to the promotion of optimal oral health as an essential component of general health.
Since there was relatively little time since our invitation to this meeting, we have not had the opportunity to prepare an extensive written report. However, let me assure you that we will be more than happy to follow up with any information that you may require beyond what I will explain in my remarks today or that we are able to provide in our question period.
I have been asked to explain dentistry's use and management of mercury, as well as the relationship of this management to the Canadian Environmental Protection Act. I will begin with how mercury is used by dentistry.
Dental amalgam represents the main use of mercury by dentists. We have other uses in common with other health occupations, particularly in medical devices to measure blood pressure, temperature and as a preservative agent. Since we usually adopt recommendations produced for physicians for those devices, I will limit my discussions to dental amalgam.
Dental amalgam is a stable alloy of mercury, silver and tin, as well as other materials. It has been used as a filling material for more than 150 years. It is a flexible, durable, inexpensive material that functions very well. The safety record for dental amalgam goes back as long as the material itself. In spite of the relatively casual handling of mercury in the early years, its safety remains something we are proud of.
More recently, research has determined that, in fact, very small amounts of vapour do emit from fillings over time. However, even in individuals with numerous fillings, the cumulative amount is still well below any threshold that would cause secondary health effects. Nevertheless, as a result of the concerns about mercury, dental amalgam has been researched extensively and exhaustively by numerous dental and medical organizations in many countries around the world. The results of that research overwhelmingly point to the safety of the material. Even when dentists are used as a study group, due to their much more extensive exposure to amalgam, secondary health effects are exceedingly rare. Major creditable scientific organizations, including Health Canada, the Canadian Dental Association, the American Dental Association, the World Health Organization and many others, have investigated dental amalgam and continue to support its availability as a filling material.
This is not to say that there is no controversy in relation to the use of mercury by dentistry. There is definite political pressure being applied by special interest groups and some practitioners to ban dental amalgam. This pressure is based on opinion and assumption, and is unsupported by scientific evidence.
Although there have been many advancements in dentistry over the years and many new materials have been introduced, there is currently no other filling material that can be considered a true replacement for dental amalgam. Currently available alternatives are either less durable, have more negative side effects, are significantly more expensive or generally lack some of the desirable properties of an ideal filling material. Although we have made great advancements in public education, we are not yet at the point where dental disease and cavities have been eliminated. Unfortunately, it remains a problem, especially in lower socioeconomic groups that have a special need for a long- lasting and relatively inexpensive restorative material.
Now I would like to move to the management of mercury in the dental office. In the past, dentists used bulk mercury that needed to be measured in the dental office before it was mixed with the shavings of tin and silver. In those days, the risk of mercury spillage and manipulation errors could lead to excess mercury in the mixed amalgam, and that was a real possibility. Fortunately, modern dental amalgam has little in common with the material produced in those early days. It comes pre-measured in factory-sealed capsules, a form that virtually eliminates the risk of significant mercury spillage and guarantees an ideally proportioned mix. In addition, as a result of the patients' demand for tooth-coloured, restorative materials, the daily use of amalgam is consistently declining, meaning that the amount of mercury used in dental offices is also declining. Also, not all dentists use or remove dental amalgam, for instance orthodontists, oral surgeons and so on.
This brings me to the part of the presentation that is most relevant to your discussions, since it touches on the Canadian Environment Protection Act. Under CEPA, since 1999, the Canadian government maintains an inventory of mercury emissions to the environment through the National Pollutant Release Inventory, NPRI. After that amendment to CEPA, reporting requirements for mercury were amended to include any person or enterprise that manufactures, produces or otherwise uses five kilograms or more annually of mercury. Dentists are exempted from this reporting requirement to minimize the paperwork burden of establishing that most dental clinics generate less than the minimum reporting quantity. This fact was confirmed with the dental community during the consultative discussions leading to the NPRI amendment in December of 1999.
In all applications, including waste management, mercury and dental amalgam are far from identical. As you may know, one of the basic techniques for the management of any hazardous waste is immobilization — the process of combining waste with other substances to create a stable compound in order to make it safe for disposal. As I mentioned earlier, mixing mercury with silver, copper and tin creates a stable alloy. If it were economically feasible on the scale needed, this might constitute a reasonable way to immobilize mercury to make it safe for disposal. This point is critical, because it clearly illustrates that mercury in dental amalgam is contained. It is not free to roam around the environment and become bio-available and contaminate water and fish.
Nevertheless, dentistry is a profession with a mantra of prevention. Dentistry has applied the principle to reduce even the smallest risk. In fact, any time science has determined some element of risk from dental practice or materials, dentists have been keen to find alternatives and to act as responsible environmental citizens.
A good example was the Canadian Dental Association's willingness to engage on a voluntary basis with Environment Canada and sign in 2002 a memorandum of understanding respecting the implementation of the Canada- wide Standard on mercury for dental amalgam waste. Adopted in 2001, the Canada-wide Standard for mercury in dental amalgam proposed to adopt a national reduction target based on best management practices. The goal was to achieve a 95 per cent national reduction in mercury releases from amalgam waste by 2005 from a base year of 2000.
In this case, best management practices essentially boil down to the installation, use and maintenance of an amalgam separator certified to meet the relevant ISO standard, a device that dentists install in their water systems to trap small particles of amalgam that would otherwise be washed away during placement or removal. Amalgam separators are so effective that they can easily meet and exceed the 95 per cent reduction target. Since the signing of the memorandum of understanding, there has been considerable movement towards adopting this technology. Although the MOU is voluntary, dental regulatory authorities in some provinces have introduced regulations to mandate the use of these separators. We are still in the reporting stage of the follow-up period for this agreement, so I am unable to give you numbers on its uptake. However, I can assure you that this technology is more than sufficient to give this committee and CEPA peace of mind with respect to management of amalgam waste in dentistry.
I and my colleague are happy to answer any questions you may have.
The Chairman: Mr. Soucy, would you like to add anything?
Benoit Soucy, Director, Membership and Professional Services, Canadian Dental Association: No, I think that was a good tour of the issue. If you have any questions, we would be happy to try to answer them.
The Chairman: What you have said sounds reassuring. As you have said, there have been questions asked about this subject. It is one of the few ways in which Canadians knowingly come into contact with mercury, and the subject has caught the attention of many Canadians. Your reassurances are welcome.
Senator Adams: Thank you. You say mercury is mixed with other metals. Is that to make the mercury harder? How do those metals work together?
Mr. Halstrom: That is correct. The mixing binds the material, but I will turn that question to my expert here.
Mr. Soucy: Because mercury is liquid at room temperature, it is used to create a paste with the other metals that are used for the composition of amalgam. Once it has been mixed, it crystallizes together, and it sets to create that stable alloy. It is not a chemical reaction. It is a mixing of all the elements together, an alloying process.
Senator Adams: Are there any risks of toxicity in the mixture of metals? Have they tried other materials? We know that mercury alone is toxic. Is there a risk from brushing your teeth for many years and then finding out it has affected your health?
Mr. Soucy: Again, the mercury used for the amalgamation is mostly bound in the amalgam and is not available to be released. We have used the material for 150 years. Everybody thought that no mercury was being released. The only thing that changed is that the instrumentation for measuring mercury became better. Eventually, we made instrumentation that was sensitive enough to measure the very small quantities of mercury vapours that are released through, first, the corrosion of the amalgam. The mouth is a harsh environment, and anything metal you put there will tend to corrode, so a corrosive process takes place. There is also simply the wear from chewing on the amalgam. Both of these processes can release a very small amount of mercury vapour. That vapour is mostly exhaled, so it is not absorbed by the patient. It is too small to be an environmental concern.
The concern is the mercury that remains bound within the amalgam, and that is why we have put in place all those efforts to ensure that once the amalgam has served its useful purpose, it is not simply released out of control.
Senator Adams: Are people doing research on other materials? Technology has made huge advances through the use of computers. I have a ring here that comes from a walrus tooth. Is there any other similar material that we could use to chew and that would survive in the mouth?
Mr. Soucy: As far as areas of material being looked at, metals are a good class of materials to use in the mouth because they are solid enough to survive the environment, but they are not extremely hard so when you chew on them it feels comfortable.
The other area is ceramics, things like porcelain. These materials break easily, and when you chew, they are too hard. They are not very comfortable. Plastics have a lot of desirable properties, but they do not last long. The last hope is bioengineering. We hope that through bioengineering we can reconstitute materials that look like the tooth structure. We are not there yet. A lot of research is being conducted right now to engineer parts of teeth genetically, but that does not work at this point. That is the best area for an alternative to amalgam.
Senator Adams: We heard from the automotive and electrical associations a couple of days ago, and we talked about mercury coming from other things. The dental products that you use are not the same. Their mercury is up in the air. The mercury to fill your teeth is not out in the air dropping down on you. The mercury in your teeth will not give you cancer. As you say, you have been using it for 150 years, so there must be a difference between mercury in the air and mercury in your teeth and body.
Mr. Soucy: The difference is simply that if you talk about mercury vapour in the air, you talk about mercury that is available to be incorporated in your body and to create health effects. When you talk about dental amalgam, that mercury is bound into the amalgam and is not available to go anywhere.
Senator Cochrane: Dr. Halstrom, you mentioned that some provinces require the use of amalgam separators. Can you elaborate on this? Which provinces do so, and which other provinces are considering it?
Mr. Halstrom: It is something that is being considered across the country, and they change all the time.
Mr. Soucy: The two provinces that first required amalgam separators through dental regulators were Ontario and Manitoba. Other provinces did not see the need to go that way because they looked at the way we are progressing towards the goal of the Canada-wide Standards and did not see the need to add additional regulations.
Another layer of regulation that has been looked at is at the municipal level through sewage use bylaws. A number of municipalities have enacted requirements for a maximum concentration of mercury in effluents present in waste water. That issue affects dental offices. The way it has been managed in those cities is through the installation of those separators.
Senator Cochrane: When will data be available to indicate the level of the uptake of this technology?
Mr. Soucy: The MOU went to the end of 2005. Since the end of 2005, we have worked with Environment Canada to redo a survey that was initially completed in 2003.
The reason the survey was completed only in 2003 was that despite the fact the Canada-wide Standard was signed in 2001, it took a year of negotiation to complete the MOU and then another year to get the study underway and completed.
Therefore, we have the data from 2003 as a baseline. We will repeat that exact same study within the next few months, and we hope that sometime in 2007 — which is exactly in line with the requirement of the MOU on the reporting side — we will have the data to show what the uptake was on the amalgam separators.
Senator Cochrane: Will you have information on whether it was good or bad?
Mr. Soucy: We are confident it will be very good simply because we already know that virtually all dental offices that use amalgam in Ontario are equipped with separators. That accounts for the majority of dental offices in Canada.
Senator Cochrane: You are talking about Ontario. Are other provinces ready to join this endeavour?
Mr. Soucy: The other provinces have not seen the need to introduce regulation.
Senator Cochrane: What about the results that will come out shortly?
Mr. Soucy: We have to wait for those results to come in. When they do, we will see if there is a need to push for more regulation or if the voluntary approach has worked the way we expected it would.
Senator Cochrane: Are you involved with CEPA on this endeavour?
Mr. Soucy: The Canada-wide Standard was written under CEPA. It is a result of CEPA. That is how the link was made.
Senator Cochrane: Is that why this was started?
Mr. Soucy: Yes.
Senator Cochrane: Would you say CEPA is doing well in this area?
Mr. Soucy: As far as we are concerned, the process that led to the Canada-wide Standard was a good process that allowed us to find a good solution to the problem. The solution manages both the uncertainty concerning any negative effect of amalgam in the environment and the need to take a precautionary approach and ensure no risks were taken if the risks could be prevented. The process from the point of view of the Canadian Dental Association has worked extremely well.
Senator Cochrane: Are you happy with CEPA?
Mr. Soucy: We are happy with the way we have lived with CEPA.
Senator Cochrane: I wanted to know that. That is what our study is all about, as you are well aware.
You stated that 150 years ago you started using amalgams. I and others I know have lost fillings. What happens to these fillings that have mercury in them?
Mr. Halstrom: It comes back down to the fact that the mercury is bound. Once it becomes filling material, the mercury is bound into an alloy, and it is no longer a loose piece of mercury floating around in the environment. It is advisable that we contain that as much as possible, but the potential amount of mercury vapour from an alloy is small.
It is not as if once the filling falls out the amalgam leaks out. There is no leaching out of the mercury, so that is not an issue.
Mr. Soucy: The goal is to ensure that whatever amalgam we place in the mouth we gain control of when we take it out. Obviously, it is impossible to control what happens to a filling that simply breaks down and falls out of the mouth of the patient. It is the responsibility of the patient to dispose of it appropriately. If they are willing to come to us and give it to us, we can gain control of it. However, if the patient simply discards the filling when it falls out, there is not much we can do, as dentists.
It is only a very small percentage of fillings whose life will end in that manner. Most end up being removed by dentists in their offices. They are cut into small pieces, and they go through the vacuum system to the amalgam separator, Tat is where they are taken out of circulation.
The amalgam separators are emptied on a regular basis, and the waste that has accumulated is sent to licensed waste haulers for appropriate disposal.
When we looked at the life cycle of amalgam with Environment Canada in our work towards the Canada-wide Sandard and the MOU, two methods of disposal were seen as appropriate. First, disposal was in appropriate landfills that have effluent control measures to ensure any mercury that might be released from the amalgam is not released into the environment. Second, there is the option of recycling. One can use amalgam and send it to a recycler. The biggest downfall with that option is there are no recyclers in Canada for mercury. It must be shipped internationally, and that makes thing much more complex.
Senator Cochrane: Where is it shipped?
Mr. Soucy: Mostly to Austria and the United States.
Senator Cochrane: Is that process followed in all dentists' offices?
Mr. Soucy: The goal is to have all dentists' offices who handle amalgam follow that process. We will realize success through information campaigns that promote voluntary implementation across Canada as soon as the results of the study are in.
Senator Milne: I apologize, gentlemen, for being late. I went to the other meeting room and no one was there. I missed the first part of your presentation, unfortunately. I think I have picked up on some it from Senator Cochrane's questions.
Are there any dentists' offices in Canada that do not use amalgam?
Mr. Halstrom: Yes, especially when you look at the broad spectrum of the word ``dentist,'' whether they are oral surgeons or those not involved in the actual restorative process. There are dentists in the country who do not use amalgam because they use alternate materials such as gold.
The issue really lies in the fact that there is no effective replacement for this particular highly durable and inexpensive filling material.
Senator Milne: Gold sounds pretty good.
Mr. Halstrom: It is excellent. The problem is, it costs $500 an ounce. Once they turn it into a usable material for dental offices, the $500 is expanded substantially higher.
Senator Milne: How much amalgam waste do you estimate there is in Canada per year, just a ballpark figure?
Mr. Soucy: I would have to go back to the study completed in 2003. Unfortunately, I do not have the numbers off the top my head, but that is something we can send to you following the meeting.
Senator Milne: Thank you. I do not know how many dentists in Canada do restorative work, but if you take the amount from your own offices per year and multiply it, what would the figure be?
Mr. Soucy: I do not have that number, but we will provide that.
Senator Milne: Thank you. You have told us how you dispose of the waste. I assume it is shipped to a hazardous waste disposal centre in your local municipalities?
Mr. Soucy: Yes, waste haulers' contracts with dentists include proper disposal. If the municipality does not have a hazardous waste disposal centre locally, it is shipped to such a site.
Senator Milne: I do not know if anyone has ever thought of this because it is probably a rather shocking thought, but has anyone ever thought of involving funeral homes in this process? I imagine that most fillings in Canada are buried with the patient's body when they die.
Mr. Soucy: That is definitely something that has been considered. The main concern is not really with burial but with cremation. If you burn an amalgam, it will release all of its mercury.
Senator Milne: Yes, and cremation is becoming increasingly popular.
Mr. Soucy: Yes, the issue becomes, what is the best approach to deal with that issue.
The first approach could be, we no longer use amalgam. We know there are lots of problems with that because there is no alternative that can work on a large scale. For an individual, you can go to gold and have something that will work. For other individuals, we could say we will go to the white plastic composites and they will accept the drawbacks of that; but on a large scale, you cannot stop using amalgam without creating a negative effect on oral health.
The second thing is, we could pull all the teeth and bury them in a safe location. That is not respectful of the beliefs of many people, so it is not something we can do. The best approach we have identified is to require crematoriums to be equipped with appropriate scrubbers to ensure that the mercury vapour that is released during cremation is recaptured and not released in the environment.
Senator Milne: Has that happened anywhere?
Mr. Soucy: It has been requested. I do not know what the state of the legislation at that level is and how it is implemented.
The Chairman: Along that line of questioning, we learned separately that cremation results in the release of mercury not only from amalgam fillings, but from other sources as well. It is natural when we burn: that is what happens.
[Translation]
Senator Tardif: Thank you, Mr. Chairman. You indicated that you signed a memorandum of understanding in 2001 and that this memorandum aimed at a reduction in mercury waste of 95 per cent for the year 2005. Have you met your objective?
Mr. Soucy: We do not know yet because the period for reporting on the results ends in 2007. We had to wait that the period covered by the memorandum of understanding ends, at the end of 2005, to set up a research project which satisfied the requirements of Environment Canada and the Canadian Dental Association to then do the research, complete it and have the results in 2007. We will have a confirmation of the efficiency of our approach in 2007.
Senator Tardif: What type of research is this?
Mr. Soucy: It is a survey. Environment Canada has already given the contract to the University of Toronto to carry out a survey with a predetermined protocol and questionnaire — a questionnaire which was already used in 2003 to enable us to compare the progress which has been made over the last two years of the memorandum of understanding.
Senator Tardif: What is the questionnaire's target population?
Mr. Soucy: Dentists.
Senator Tardif: All dentists?
Mr. Soucy: The memorandum calculates that a sample of 9,000 dentists will be included in the research.
Senator Tardif: What percentage of the dentist population does this represent?
Mr. Soucy: About half.
[English]
The Chairman: That is a pretty good sample. It is a better sample than we usually rely on for things of that kind.
When the amalgam has been removed from the dentists' office by the collector — whoever that is in whatever community — I gather that you trust that it is properly dealt with. In other words, municipal regulations ensure that either that amalgam has been put into an appropriate landfill, which contains the downstream effects of this; or if that is not the case, it is shipped to an appropriate recycling facility. Are you comfortable relying on that?
Mr. Soucy: We are; and actually it was the most difficult part of the MOU to implement. The work that needed to be done to supply the dentists with all the requirements that had to be met was to be done by Environment Canada. It turned out to be far more complex than we expected because of the overlap between municipal, provincial and federal responsibilities.
The Chairman: That is why I ask the question.
Mr. Soucy: After about a year and a half or two years, Environment Canada was able to post on their website the information for every province. As a result, a dentist setting up shop who wants to find out how to handle amalgam waste can go to the website and find the information directly, or find the phone number of the person to contact for more complete information. That is one of the positive results from the MOU.
The Chairman: That is good. I gather you are also confident that the 5 per cent — if it is that much — that escapes the collection is not sufficiently significant to cause anyone any kind of concern.
Mr. Soucy: That is exactly what we are confident about. We know that it is much less than 5 per cent because 60 per cent of the waste is recaptured in other filters before it gets to the amalgam separator. Therefore, we recapture 95 per cent of 40 per cent, so we are already way below; and 95 per cent is the minimum requirement to meet the ISO standard.
Most amalgam separators, when tested in accordance with the ISO standard, perform closer to 98 per cent, so whatever gets out is really small. Whatever gets out, in addition, is still bound in the form of amalgam, which means that it cannot be released easily.
Once that is out in the environment, the concern is not for today or tomorrow, it is for geological scales of time, where you say what will happen in a few hundred years to that amalgam. No one has the answer to that, but we feel we have done the best we can to minimize the risk in that area.
The Chairman: We have a built-in suspicion of statistics because you can prove anything with statistics. I want you to refer again, and confirm for the record, something that Senator Cochrane asked you about.
You said you know this is working with most dentists in Canada because virtually all dentists in Ontario are doing it. However, if someone is concerned about the water stream and effluent in New Brunswick or in Alberta, the fact that Ontario is taking care of it is not much help because Ontario water does not come to the other provinces.
Would you address that question, and can you give us some comfort in that respect?
Mr. Soucy: We believe that, as professionals who are preoccupied with prevention, dentists are sensitive to the arguments we presented for the installation of amalgam separators. Until we have the survey that tells us how many dentists have actually complied, we do not know if we are right or not. We hope that our assumption concerning the behaviour of dentists is right, and that when the survey comes in, we will find out that the majority did. If our assumption proves to be wrong, then we need to look for other measures to ensure that this is actually happening.
The experience in Ontario and Manitoba tends to show that implementation of a requirement through professional legislation, through the dental regulator in the province, seems to be extremely efficient. Instead of going to federal legislation through CEPA, or through a municipal bylaw — which usually involves an inspections requirement, which in turn involves reporting requirements that are burdensome to dentists — we would rather go through the dental regulator in the province, have them implement a requirement for the amalgam separator and verify the behaviour through the regular professional inspection mechanisms in place in all provinces.
The Chairman: By that professional regime, you mean the college of dentistry of whichever respective province.
Mr. Soucy: Yes.
The Chairman: When you say a majority, do you mean the majority of dentists in Canada, not just in the places in which the regulations apply?
Mr. Soucy: We mean the majority in Canada. Also, on a regional basis, different actions may be required. For example, if we find out that in one specific province, the uptake of the amalgam separator is below our expectations, then we can focus our actions on that province.
The Chairman: Is there a reason you are aware of for which the effectiveness of the separator would be different in one province or another? Is it effective by nature of the water? Is there anything of which you are aware that would make a difference in that respect?
Mr. Soucy: Once the amalgam is released into the environment, because of the time of exposure, the nature of the water has a significant effect. However, when you capture it in the separator, it comes out of circulation fairly rapidly and those concerns become negated with respect to whatever else in the water could affect the release of mercury.
[Translation]
Senator Tardif: I have an additional question on this point. In the training schools, is this requirement or this new information presented to students of dental medicine, that is, the importance of the equipment and mercury waste?
Mr. Soucy: Absolutely. For dentists to be able to obtain a license to work in Canada, they must be graduates of an accredited program. The Commission on Dental Accreditation of Canada has standards on the content of training programs. One of the first things done when the memorandum of understanding was signed was to ensure that the commission's standards included training on mercury hygiene and on the equipment necessary to control the amalgam waste.
[English]
The Chairman: You referred earlier in your presentation about the fact that mercury in the amalgam is contained and an improvement in the measurement systems have allowed you to determine that there is off-gassing of a sort. Most of it is exhaled and there is no demonstrable or measurable ill effect on human health.
I would like you to comment. Mercury in whatever form, from the standpoint of Canadians concerned about their health, is listed in Schedule 1 of CEPA as a toxic substance. I know we are not talking about mercury in that form when we put it in our mouths to fill teeth, but I quote to you from an article that appeared in the Edmonton Journal, the lead paragraph of which states, ``A disease that you are suffering today could be a result of your great grandmother having been exposed to an environmental toxin during pregnancy, and you may already have passed it along to your children.''
The article goes on to explain there are, as you have said, increased efficiencies of measurement of these kinds of things and new knowledge about the cumulative effect of toxins of one kind or another that we did not know about before.
Have you heard any view or concern expressed elsewhere that there may be — and if not, are you confident there are not — debilitating effects on human health as a result of the off-gassing of mercury contained in the amalgam of people's tooth fillings?
Mr. Soucy: We are absolutely confident with the scientific evidence we have at hand that no negative effects have been shown on human health. Can I forecast the future? I absolutely cannot. I wish I could, but I cannot.
If you look at the current available information, the overwhelming balance is that amalgam is a useful material if one has cavities that need to be repaired. If one has a choice in maintaining tooth health and that person does not require any fillings, that is a much better situation. That, by the way, is one of the things we are working hard to accomplish.
The Chairman: It must be said that dentists have worked hard at trying to put themselves out of business, for which we are all grateful.
Mr. Soucy: We continue to do that.
The Chairman: If you were the king, Dr. Soucy, and if money were no object and inconvenience to us as patients of dentists was not a factor, given everything you know, however inefficient, impermanent or otherwise expensive the alternatives are — either gold, plastic or porcelain — would you make a choice?
Mr. Soucy: I must confess to a serious conflict of interest here. By training, I am a specialist in prosthodontics, which is the replacement of teeth by whatever means possible. By training, I am much better prepared to use some of those alternative materials, in particular gold.
I have a strong preference, when possible, toward gold restorations that are fabricated outside of the mouth by laboratories that have better controlled conditions to produce a better restoration in the end. In the long run, those restorations will last as long as the patient.
Senator Milne: In addition, gold does not expand and contract as much with heat and cold, so it is better for what is left of the tooth.
Mr. Soucy: Expansion is always a problem because metals in teeth do not react in the same way. The ability to glue that restoration in the mouth is an issue. It is the weak link. The ability to stabilize the remaining part of the teeth and reinforce the tooth to give back its original strength is also an issue that remains.
Even if you take all those aspects together, today gold is the gold standard. However, it is simply not practical for most patients.
The Chairman: Is that because it is inert?
Mr. Soucy: It does not corrode in the mouth. It is soft so when one bites on it: it self-adjusts. If there is a change in the biting pattern or the position of teeth, it responds well to that. It does not wear in the way other materials do. It does not break because, again, it is fairly soft. Gold has all kinds of wonderful qualities.
The Chairman: Having declared your interest, if money were not a consideration or object, you would advise a patient, if they could afford it, to use gold as opposed to the other alternatives?
Mr. Soucy: Another part of training one obtains in dentistry is involving the patient in that kind of a decision.
One good example I heard recently is when one buys a vehicle, the decision on whether to buy a small inexpensive car or a top-of-the-line expensive car —
The Chairman: Everyone on this committee would urge the former, for purposes of the environment.
Mr. Soucy: I personally drive a Toyota. The decision belongs to the patient in the end.
If you look in my mouth, you will find I have amalgam. I do not have gold, but the reason for that is because I was lucky enough to have a good dentist when I was young who ensured I was sensitized to the need for prevention. As a result, my fillings are relatively small and do not justify changing to gold.
Many factors need to be taken into account. If you were to integrate all of them, the overwhelming decision factor becomes personal preference of the patient.
The Chairman: I think that would sometimes include cosmetic considerations.
Mr. Soucy: Absolutely.
Senator Adams: Many dentists travel up to Nunavut in the Territories. I have not checked about any regulations they must follow in repairing cavities. Is there any regulation about travelling, that a dentist is not allowed to repair a cavity unless it is done in a hospital? Is there a rule such as that for travelling dentists? When kids need a filling, a travelling dentist must carry the mercury and other stuff to make that filling.
When you talk about travelling to municipalities, you need to use equipment to complete your job. We have not heard anything in Nunavut where dentists must carry the material and travel to the schools. At every school they check the kids for cavities, and sometimes they need a filling. Are there regulations in place in order to accomplish that?
Mr. Soucy: The regulations that apply to mobile clinics are exactly the same as those that apply to regular dental clinics. There is absolutely no difference. They are treated in exactly the same way. That being said, the number of mobile clinics in Canada is extremely small.
It is something we are trying to promote, but not really because of remote communities in the North; there you have a problem with getting the clinic to the remote location. It is much more to address the needs of seniors who are not mobile and need to receive care in the facility where they live.
In the Territories, as a rule, the problem is that the next dental office is far away from where you may live, and that creates issues of its own. However, the requirements for those clinics are exactly the same, no matter where they are.
Senator Adams: Talking about false teeth, I have plastic ones now. I used to have stainless steel ones when I first got them. I had trouble in the winter, because when you go out on the land, you are travelling when the temperatures are between minus 40 and minus 50 and your mouth gets cold. Does the same thing happen if you have a filling in your teeth that has mercury in it? Have you had people complaining about that?
Mr. Soucy: The coldest place I have practiced is Quebec City, so I have not experienced that.
Mr. Halstrom: I have not experienced that either.
The Chairman: I have not been in 50 below temperatures, but I have been in 40 below temperatures, and with the fillings I have — which I expect are amalgam, although I do not know for sure — I did not notice any discomfort. However, I have not gone long distances on a ski-doo at 40 below temperatures and I hope not to.
As a follow-up question to Senator Adams, when physicians are licensed or approved by the respective provincial college of physicians and surgeons to practice, they cannot practice elsewhere without authorization. Who governs, in the professional sense, the practice of dentistry in the territories? Is there such a thing as a Nunavut college of dentistry?
Mr. Soucy: The regulation of dentistry in the territories is different than it is in the 10 provinces.
The Chairman: Is that because of the federal involvement?
Mr. Soucy: It is because a government agency does the regulation directly. In the 10 provinces, the provincial governments have delegated that authority to the colleges, which are not government bodies. In the territories, it is done through a government body directly.
The Chairman: A federal government body?
Mr. Soucy: No, a territorial government.
The Chairman: Is there a control mechanism in the respective territories to ensure proper practice?
Mr. Soucy: Absolutely.
Senator Adams: I thought it was mostly Indian and Northern Affairs Canada that dealt with any dental things in the territory of Nunavut. I do not think the territories have a policy for things like that.
The Chairman: We will find that out.
Mr. Soucy: The licensing of dentists in the territories is done through the territorial government. The payment of the care is done through —
Senator Adams: Indian and Northern Affairs Canada.
Senator Cochrane: This is not pertaining to amalgam. Now that we have you here, I want to ask you about your school of dentistry. What is your enrolment in regards to women versus men? I do not see many women dentists. I am not from Ontario — you may see it there — but I do not see that. Can you tell me about your enrolment?
Mr. Soucy: You will see it, because right now the enrolment in dental school in Canada is more than 50 per cent female. You are right; historically, the ratio was strongly on the side of male dentists. That is why dentists with over 20 years of practice are mostly male. If you look at the younger dentists, the majority is actually female — so just wait.
Senator Cochrane: That is wonderful. I am glad I asked the question.
I will ask you another question about those mobile units. Are there any in place now in any of the provinces?
Mr. Soucy: There are a very small number — less than 10. Most of them are owned by some organization. The Ordre des dentistes du Québec has one of those mobile clinics that they use mostly for demonstration purposes. The Alberta Dental Association College recently purchased four to service seniors who cannot get out of their living environment. It is limited. The numbers in place are small.
Senator Cochrane: They are all regulated, are they not? CEPA is aware of them and they are doing their homework.
Mr. Soucy: The requirements are exactly the same as those for any other dental clinic in that jurisdiction. In Alberta, the five mobile clinics that they recently bought are actually huge buses that are equipped with the same equipment you would have in a fixed dental office.
Senator Cochrane: I have not gone through one of these bus units, but I have gone through a bus unit for other medical purposes — such as blood pressure and things of that nature — and I think they are fabulous. It is like a hospital on wheels.
Are you people promoting this? Is it your job? As great dentists, and as a great profession, you want to see people within our country taken care of. Seniors, especially, are at a disadvantage because some of them are not able to travel, some of them live a long distance away and so on.
Mr. Soucy: It is definitely something that the Canadian Dental Association takes to heart. Facilitating access to care is one of our main preoccupations.
The issue of using mobile clinics is one that has proven to be good for a limited number of circumstances. The reason it is limited is they come at a cost that is extremely significant. If a patient can get to a normal dental clinic, you can do things in a much more cost-effective fashion. The approach is really to reserve that kind of mobile clinic for situations where it is not practical for the patient to come to you.
The convenience factor for dealing with patients who are mobile is overruled by the cost factor.
Senator Milne: Are there any mobile clinics in northern Ontario?
Mr. Soucy: I do not know.
Senator Milne: Can you find out for me?
Mr. Soucy: We can try to find out, definitely. We are meeting with the Royal College of Dental Surgeons of Ontario in about an hour, and I will be happy to ask them.
Senator Cochrane: I am aware of one mobile clinic in Newfoundland.
Mr. Soucy: I did not know that.
The Chairman: Gentlemen, thank you very much. You have been most reassuring and useful to us in answering questions about this aspect of mercury in our environment. I am grateful for the time that you have spent.
I am glad we can get you off to your meeting with the Ontario college, to which I know you will look forward perhaps more than you did to this.
The committee adjourned.