***, you need to start your essay with an introduction.

Some of the information you have in your first paragraph would be useful to use to provide the reader with a bit of background. You then need to outline how you are going to do what the assignment title says you are going to do discuss the effects of the use of amalgam in fillings. For example, you could say: Firstly, this essay will consider how the inclusion of mercury in amalgam fillings has caused controversy in dental practice. Secondly, the effect mercury is said to have on children is discussed leading into a discussion on the effects mercury has on the brain, particularly in relation to Alzheimers disease. Finally, this essay will conclude that Clearly one of the main issues in this essay is with citations (in-text referencing). You need to refer to the links in the VLE site relating to Harvard referencing and make several changes.

Discuss the effects of the use of amalgam in fillings By *** Amalgam fillings are dental restorative materials, used due to their durability, stability and safety. Dental amalgams are a mixture of 50% Mercury which is able to form solid amalgams with silver and small amounts of copper, tin or zinc. Dental amalgams are used: In stress-bearing areas and in small to moderate sized cavities in posterior teeth; in teeth with severe destruction; as a foundation for cast-metal, metal-ceramic and ceramic restorations; and when a patients commitment to oral hygiene is poor; and/or when moisture control is problematic (Dental Fillings, n.d.), this is shown in the source: (http://yourdoctor.com/patient_info/dental_info/dental_disorders/fillings.html). Amalgam fillings have been in use since 1844, as in (Westcott A. Report to the Onondongia Medical Society on metal paste (amalgam). Am J Dent Sci IV, 1st Ser, 1844:175201), it reports that % of all restorations placed in upstate New York consisted of amalgam. In the 1850s, American dentists who used amalgam were threatened with malpractice actions by dentists who did not. This became known as the amalgam wars. The controversy of the use of amalgam has always been present, as the American Dental Association which was founded instead in 1859, strongly defended dental amalgam since from allegation of being too risky from the health standpoint (Bremner MDF (1939).

This figure shows the composition of the metals in Amalgam fillings, it also shows that mercury comprises the most in the filling. (http://en.wikipedia.org/wiki/File:Composition.jpg) So why is there a controversy over the use of Amalgam fillings? Concern over the use of Amalgam fillings has been raised as they contain the element mercury. The concern revolves around the effects of toxicity which may be associated with constant mercury exposure, many research projects have been carried out to identify if the exposure to mercury effects chronic illnesses, neurodegenerative diseases, birth defects, and mental disorders, such as Alzheimers, Parkinsons Disease, and Multiple Sclerosis. The concern of the health effects which have been alleged to be caused by mercury, was initiated by the fact that dental amalgams emit mercury vapour that is inhaled and absorbed into the bloodstream, if the exposure to mercury vapour is increased this can lead to poisoning. (Thomas W. Clarkson, Ph.D., Laszlo Magos, M.D., and Gary J. Myers, M.D.N Engl J Med 2003; 349:17311737October 30, 2003). However, Dental amalgam releases low levels of mercury vapour, with higher amounts released with mastication and gum chewing. The first signs of mercury vapour toxicity at high doses are subtle effects on the nervous system, such as changes in nerve conduction, slight tremor, abnormalities in electroencephalography patterns, and changes in motor functions, cognitive functions, and behaviour. In (http://www.reuters.com/article/2008/01/03/idUS108558+03-Jan2008+PRN20080103 Retrieved 29 July 2009), it shows that currently dental amalgam is approved for use in most countries, although Norway, Denmark and Sweden are notable exceptions. Many countries have disapproved of the use of dental amalgam fillings; this may be due to the environmental and health effects caused by the use of mercury. The Minamata disease is a neurological syndrome which was caused by severe mercury poisoning, this occurred in Japan in 1956. Symptoms included numbness in the hands and feet, muscle weakness, narrowing of the field of vision and damage to hearing and speech. In extreme cases, insanity, paralysis, coma and death followed the symptoms.

Figure 2 shows the symptoms of the Minamata disease (http://en.wikipedia.org/wiki/File:Tomokos_hand.gif). The National Institute for Minamata Disease states: Including fetal cases, all patients of Minamata disease who had been confirmed by 1968 at latest, were serious cases. Since the disease is a methylmercury poisoning that occurred through fishes and shellfishes via environmental pollution, it is a matter of course that there are patients with the diseases of many various patterns of the severity in addition to these severe cases. Thereafter, some patients were actually confirmed to have had the disease as a consequence of chronic exposure to the methylmercury compound, and a number of patients were confirmed to have had mild incomplete-type Minamata disease. As the mild type of fetal Minamata disease as well, some patients were confirmed to have had high mercury levels in the umbilical cord and shown intellectual disorder as the main symptom.(http://www.nimd.go.jp/syakai/webversion/pdfversion/e001009_intro. pdf). The Minamata disease shows that the dose of mercury used needs to carefully monitored, as due to any over-exposure of mercury, human health could be severely affected. This tragedy prompted various studies to be done in reference to the effects of the dental amalgam, this was seen as a significant event in regards to both chemistry and dentistry fields, as investigations needed to be done to safeguard public health and also to prevent further disastrous outcomes. Two recent studies on the health effects of dental amalgam in children concluded that dental amalgams should remain a possible restorative treatment option for children. In the source: (Bellinger DC et al. Neurophysical and renal effects of dental amalgam in children. Journal of the American Medical Association 2006; 295: 1775-83), it concludes that the first study showed that there were no statistically significant differences in neuropsychological or renal

effects observed over the 5-year period in children whose caries were restored using dental amalgam or composite materials. The second study (DeRouen TA et al. Neurobehavioural effects of dental amalgam in children. Journal of the American Medical Association 2006; 295: 1784-92) indicated that children who received dental restorative treatment with amalgam did not, on average, have statistically significant differences in neurobehavioural assessments or in nerve conduction velocity when compared with children who received resin composite materials without amalgam. The SCENIHR preliminary report also concludes that the most recent studies have failed to find any association between the use of amalgam and neuropsychological development in children. (http://www.fda.gov/downloads/medicaldevices/productsandmedicalprocedures/d entalproducts/dentalamalgam/ucm174024) demonstrates that regional brain levels of mercury were determined at autopsy in subjects with Alzheimers disease and controls. Brain mercury levels did not correlate with the number of amalgams and there were no differences between the Alzheimers disease and Control groups with respect to number of amalgams. In another study of aging and Alzheimers disease evaluating 129 Catholic nuns, aged 75102, no effect of dental amalgam number and surfaces was observed for eight tests of cognitive function. These findings do not support the hypothesis that mercury from dental amalgam plays a role in the pathogenesis of Alzheimers disease. However, no clinical studies have evaluated the effects of mercury vapour exposure from dental amalgam in children under six years of age. The FDA agency assumes that the daily dose of mercury from amalgams in children less than six years old would not be higher than the estimated daily dose for adults (15 g/day), (http://edocket.access.gpo.gov/2009/pdf/E9-18447.pdf). Therefore, I feel that minimal doses of amalgam should be used, however, as there have no investigations into the effect children have, I feel that alternative materials should be used for fillings instead. There are various alternatives that can be used instead of amalgam fillings. As a report in (http://jada.ada.org/content/134/4/463.full.pdf) shows that the relative number of amalgam restorations placed was exceeded by resin-based composite restorations in the late 1990s, and the use of amalgam continues to decline at a fairly constant rate. This decline can be endorsed to several factors, including the increase in the demand for aesthetic restorations, the reduction in dental caries and its severity and improvements in composite technology. What is Composite Resin? Composite restorative materials are complex blends of polymerised resins mixed with glass powder fillers. Colour and translucency of dental composites are modified to mimic the colour and translucency of teeth, making them the most aesthetic direct filling material available. Similarly, in (http://www.scribd.com/doc/51684277/Dental-Materials-Fillings-Performance ) it shows that resin-based composites are considered safe. Allergic reactions to

resin-based composites have been noted in a very small number of people. However, this is contradicted in the source (http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_016.p df ) which states that several cases of confirmed allergic reactions were caused by tooth coloured restorative materials. For example, an early case report described a female patient who developed a rash and hives on her chest, arms and legs after treatment with a composite (Nathanson and Lockhart 1979). In conclusion, from all the research I have conducted, I feel that as senior dental associations such as the American Dental Association proclaim that dental amalgams are safe and all the clinical trials taken place to date conclude that there is no effect of dental amalgams on any area of human health, they should be allowed, however their use should be minimised, and their dose should thereby be carefully controlled, this is to prevent any allergic reactions or any other severe reactions to take place. As the material used in fillings is continuously being developed, I believe that dental professionals will be able to use dental amalgam fillings safely.

Have a look at the powerpoint and PDF guides on referencing on the Yorkshare VLE site. To cite in text you just need the authors surname/organisation and date (see the example I have given you), and also include the page number for quotes.