The Slovak Republic has signed as a Member State of the European Union Minamata Convention on Mercury committed to phasing out use of dental amalgam in dental practice (ambulance dental medical and dental emergency services). According to Paragraph 81 (1) (a) (i) (ii) of the basic Regulation, the Commission must assess whether the aid is compatible with the internal market. 6 Health Care Providers Act No 578/2004, workers, health professional organisations and amendments certain laws as amended by the Ministry of Health issues National plan for phasing-out measures dental amalgam (hereinafter referred to as "the national plan of measures') with effect from 1.7.2019 in in accordance with Article 10 (1), (4) and (6) of Regulation (EU) No 182/2011 of the European Parliament and of the Council Regulation (EU) No 182/2011 of the European Parliament and of the Council of 16 February 2011 laying down the rules and general principles concerning mechanisms for control by Member States of the Commission's exercise of implementing powers (OJ L 55, 28.2.2011, p. 13). OJ L 137, 24.5.2017).

Dental amalgam is a permanent filling material that has long been used to treat tooth decay. Dental caries are chronic infectious non-transferable a disease that affects a human individual from infancy throughout his or her life. Due to untreated tooth decay, the risk of bacteraemia from focal infections that impair the health of other organs or cause premature loss teeth. Prevalence of dental caries in Slovakia is high and Worldwide Health organisation will not succeed in reducing dental caries until 2020 meet. The most important thing is to focus on children, as there is a prevention dental caries may affect its occurrence. World Health Organization set a target for 5-year-old children, 90% of whom should be free of tooth decay. Na According to data prepared by NCZI in 2017 was only 42,82 %. A group of 12-year-old children should be KPE's cartilage index = 1.5 in us recorded by KPE=1.71. This value may seem to be a success, but in 40% of children have no dental records. With increasing age the number of patients undergoing preventive examinations decreases. Need for treatment after a precautionary checkup in 0-5-year-old children is 48.63 percent and 6-14 years old is 57.71% and the number increases with increasing age. Slovakia since 1 January 2018 the use of amalgam in children under 15 years of age, pregnant and lactating women is prohibited. According to questionnaire survey of Slovak Stomatological Society in 2017 Most dentists already indicated as filling material photocomposite, instead of amalgam. In many specialised dental clinics amalgam waste separators are fitted. Also in the teaching process at medical faculties are education students of dentistry about disadvantages, the risk of mercury to the environment and in practical teaching to patients photocomposite. This same focus at the appropriate level is also on teaching dental assistance students in six high school health schools.

Individual measures:

1. From 1 July 2018, dental amalgam must not be used in all forms for the treatment of milk teeth, permanent teeth in children under the age of 15 years and pregnant or breast-feeding women, other than those cases where the dentist considers it necessary due to special therapeutic needs of the person, which must be recorded in the medical documentation persons.

As a spare material for filler therapy has been designed and indicated manually mixed ceramic cement fully covered by all health insurance companies for the entire population.
Performance category A: V12 (300 points) " Dentist treatment
Treatment and definitive dental filling regardless of type and extent. Plastic permanent fill in the whole range of dentures made of hand-mixed fiberglass cement,
Frequency of reporting: 1x per year per tooth
Carried out pursuant to Regulation No 777/2014 of the Government of Slovakia Z. z to which it is issued List of diseases where health performances are partially reimbursed or are do not pay on the basis of public health insurance, as amended Regulations.
Responsible: dental care provider

2. From 1 January 2019 onwards, dental amalgam should only be used as capsules (posed) with a pre-defined dose (note: only from EU certified manufacturers and dealers). Use alone packaged mercury by dentists is prohibited within the meaning of Article 10 (1) of the Regulation European Parliament and Council (EU) 2017/852 of 17 May 2017 on mercury and repealing Regulation (EC) No 1102/2008 (OJ L 137, 24.5.2017).
Responsible: dental care provider

3. From 1 January 2019 healthcare providers in a specialised dental practice medical and dental emergency services in which the use dental amalgam or remove amalgam fillings or teeth containing such fillings ensure that their equipment is equipped with amalgam separators with a minimum 95% efficiency for the capture and collection of amalgam particles, including the water used. Amalgam separators with at least 95% efficiency shall be maintained in accordance with the manufacturer's requirements to ensure the highest possible level of capture.
Dentists shall ensure that:

a) separators the amalgam put into service from 1 January 2018
a capture level of not less than 95% by amalgam particle efficiency;
(b) from 1 January 2021, all separators previously used amalgam (with lower capture capacity) provided capture levels referred to in point (a).
Responsible: dental health care provider

The inspection shall be carried out by: the authority competent to issue the authorisation under Law No. 578/2004 Coll. on Health Care Providers, Health workers, health professional organisations and amendments certain laws as amended.
c) Until 31 January 2020, the principal expert of the Ministry of Health SR for dental medicine in cooperation with Slovak Chamber of Dentists develop instructions for dental practitioners for the safe removal of amalgam filling of the teeth in the oral cavity as well as at the level of dental practice.
Responsible: main expert of MZ SR for dental medicine in cooperation with Slovak Chamber of Dentists

4. From 1 July 2019 dental care ensures that amalgam capsules; and amalgam separators comply with European and national standards they provide an equivalent level of quality and capture.
Responsible: dental health care provider

5. From 1 January 2018 for dental care provider (specialised dental clinic) medical and dental emergency services) where it is located more than one dental kit needs an amalgam separator of at least 95% the effectiveness of only one dental kit using dental amalgam; or Remove amalgam fillings. In the specialized jaw office orthopedics, where exclusively jaw care is provided An amalgam separator of at least 95% efficiency is not required.
Responsible: dental health care provider

6. From 1 July 2019 dental practitioners ensure that amalgam waste, including amalgam residues, particles, fillers; and teeth or parts thereof contaminated with dental amalgam have been processed; and collected in establishments or undertakings meeting the relevant consent to hazardous waste management. Dentists must under no circumstances release such amalgam waste directly or indirectly into the environment. After 2030 it is necessary to continue to have a specialised dental practice medical and dental emergency practice amalgam precipitator with at least 95% efficiency to remove amalgam fillings from teeth.
Responsible: dental health care provider

7. From 1.9.2019 medical faculties providing pre-graduate dental instruction must take into account these requirements in the curriculum. This also applies to secondary health schools, which carry out the training of dental assistants. As well as postgraduate education dental practitioners must be oriented in the field of use of mercury-free filling alternatives, in particular for vulnerable groups such as children and pregnant or breast-feeding women. This is also linked to the implementation of research and innovation in areas of dental practice in order to enhance knowledge of existing materials and their indications in the treatment of dental caries in order to develop new Materials and legislation on the system and requirements for the treatment of toxic waste specialized dental practice.
Responsible: Principal expert of MZ SR for dental medicine, Medical Faculties, secondary health schools, Slovak Chamber of Dentists.

8. Dental practitioners providing dental and dental practice Emergency services must phase out the use of capsule amalgam. All patients. The use of dental amalgam must be discontinued by 31 December 2030 in dentistry pursuant to Regulation (EU) 2017/852 of the European Parliament and of the Council of 17 May 2017 on mercury and repealing Regulation (EC) No 1102/2008 on 1.7.2019. From 1. 1. 2031 it is not possible under § 79 paragraph 1 letter ax) of Law No 578/2004 Z. z. on healthcare providers, healthcare professionals, health sector organisations and the amendment of some the laws, as amended, to be used in dental practice; and dental-medical emergency services for dental amalgam in all forms. In the event of a breach of that obligation under the Act, except the derogation provided for in measure 1 may be granted by the municipality concerned the provider providing dental practice with a fine of up to EUR 3319.
Responsible: dental care provider

The national plan of measures will enter into force on 1 July 2019.

Andrea Kalavská
Minister for Health