California Dental Materials Fact Sheet

10/22/2011 by Leave a Comment

This California Dental Materials Fact Sheet is provided by the CDA and is required in California to be made available to all new patients and to existing patients once before treatment. Please cross reference the statements made in the CA fact sheet about the World Health Organizations possition on dental mercury with the World Health Organization’s current publication.

California State Dental Materials Fact Sheet pdf

Dental Materials Fact Sheet

What About the Safety of Filling Materials?

Patient health and the safety of dental treatments are the primary goals of California’s dental professionals and the Dental Board of California. The purpose of this fact sheet is to provide you with information concerning the risks and benefits of all the dental materials used in the restoration (filling) of teeth.
The Dental Board of California is required by law* to make this dental materials fact sheet available to every licensed dentist in the state of California. Your dentist, in turn, must provide this fact sheet to every new patient and all patients of record only once before beginning any dental filling procedure. As the patient or parent/guardian, you are strongly encouraged to discuss with your dentist the facts presented concerning the filling materials being considered for your particular treatment.
* Business and Professions Code 1648.10-1648.20

Allergic Reactions to Dental Materials

Components in dental fillings may have side effects or cause allergic reactions, just like other materials we may come in contact with in our daily lives. The risks of such reactions are very low for all types of filling materials. Such reactions can be caused by specific components of the filling materials such as mercury, nickel, chromium, and/or beryllium alloys. Usually, an allergy will reveal itself as a skin rash and is easily reversed when the individual is not in contact with the material. There are no documented cases of allergic reactions to compos­ite resin, glass ionomer, resin ionomer, or porcelain. However, there have been rare allergic responses reported with dental amalgam, porcelain fused to metal, gold alloys, and nickel or cobalt-chrome alloys. If you suffer from allergies, discuss these potential problems with your dentist before a filling material is chosen.

Toxicity of Dental Materials

Dental Amalgam

Mercury in its elemental form is on the State of California’s Proposition 65 list of chemicals known to the state to cause reproductive toxicity. Mercury may harm the developing brain of a child or fetus. Dental amalgam is created by mixing elemental mercury (43­-54%) and an alloy powder (46-57%) composed mainly of silver, tin, and copper. This has caused discussion about the risks of mercury in dental amalgam. Such mercury is emitted in minute amounts as vapor. Some concerns have been raised regarding possible toxicity. Scientific research continues on the safety of dental amalgam. According to the Centers for Disease Control and Prevention, there is scant evidence that the health of the vast majority of people with amalgam is compromised. The Food and Drug Administration (FDA) and other public health organizations have investigated the safety of amalgam used in dental fillings. The conclusion: no valid scientific evi­dence has shown that amalgams cause harm to patients with dental restorations, except in rare cases of allergy. The World Health Organization reached a similar conclusion stating, “Amal­gam restorations are safe and cost effective.” A diversity of opinions exists regarding the safety of dental amalgams. Questions have been raised about its safety in preg­nant women, children, and diabetics. However, scientific evi­dence and research literature in peer-reviewed scientific journals suggest that otherwise healthy women, children, and diabetics are not at an increased risk from dental amalgams in their mouths. The FDA places no restrictions on the use of dental amalgam.

Composite Resin

Some Composite Resins include Crystalline Silica, which is on the State of California’s Proposition 65 list of chemicals known to the state to cause cancer.

It is always a good idea to discuss any dental treatment
thoroughly with your dentist.

Dental Materials – Advantages & Disadvantages

DENTAL AMALGAM FILLINGS

Dental amalgam is a self-hardening mixture of silver-tin-copper alloy
powder and liquid mercury and is sometimes referred to as silver
fillings because of its color. It is often used as a filling material and replacement for broken teeth.

Advantages 
❤ Durable; long lasting
❤ Wears well; holds up well to the forces of biting
❤ Relatively inexpensive
❤ Generally completed in one visit
❤ Self-sealing; minimal-to-no shrinkage and resists leakage
❤ Resistance to further decay is high, but can be difficult to find in early stages
❤ Frequency of repair and replacement is low

Disadvantages

• Refer to “What About the Safety of Filling Materials”
• Gray colored, not tooth colored
• May darken as it corrodes; may stain teeth over time
• Requires removal of some healthy tooth
• In larger amalgam fillings, the remaining tooth may weaken and fracture
• Because metal can conduct hot and cold temperatures, there may be a temporary sensitivity to hot and cold.
• Contact with other metals may cause occasional, minute electrical flow

COMPOSITE RESIN FILLINGS

Composite fillings are a mixture of powdered glass and plastic resin, sometimes referred to as white, plastic, or tooth-colored fillings. It is used for fillings, inlays, veneers, partial and complete crowns, or to replacement for broken teeth.

Advantages
❤ Strong and durable
❤ Tooth colored
❤ Single visit for fillings
❤ Resists breaking
❤ Maximum amount of tooth preserved
❤ Small risk of leakage if bonded only to enamel
❤ Does not corrode
❤ Generally holds up well to the forces of biting depending on product used
❤ Resistance to further decay is moderate and easy to find
❤ Frequency of repair or replacement is low to moderate

Disadvantages

• Refer to “What About the Safety of Filling Materials”
• Moderate occurrence of tooth sensitivity; sensitive to dentist’s method of applica­tion
• Costs more than dental amalgam
• Material shrinks when hardened and could lead to further decay and/or tempera­ture sensitivity
• Requires more than one visit for inlays, veneers, and crowns
• May wear faster than dental enamel
• May leak over time when bonded beneath the layer of enamel

GLASS IONOMER CEMENT

Glass ionomer cement is a selfhardening mixture of glass and organic acid. It is tooth-colored and varies in translucency. Glass ionomer is usually used for small fillings, cementing metal and porcelain/metal crowns, liners, and temporary restorations.

Advantages

❤ Reasonably good esthetics
❤ May provide some help against decay because it releases fluoride
❤ Minimal amount of tooth needs to be removed and it bonds well to both the enamel and the dentin beneath the enamel
❤ Material has low incidence of producing tooth sensitivity
❤ Usually completed in one dental visit

Disadvantages

• Cost is very similar to compos­ite resin (which costs more than amalgam)
• Limited use because it is not recommended for biting surfaces in permanent teeth
• As it ages, this material may become rough and could increase the accumulation of plaque and chance of periodon­tal disease
• Does not wear well; tends to crack over time and can be dislodged

RESIN-IONOMER CEMENT

Resin ionomer cement is a mixture of glass and resin polymer and organic acid that hardens with exposure to a blue light used in the dental office. It is tooth colored but more translucent than glass ionomer cement. It is most often used for small fillings, cementing metal and porcelain
metal crowns and liners.

Advantages

❤ Very good esthetics
❤ May provide some help against decay because it releases fluoride
❤ Minimal amount of tooth needs to be removed and it bonds well to both the enamel and the dentin beneath the enamel
❤ Good for non-biting surfaces
❤ May be used for short-term primary teeth restorations
❤ May hold up better than glass ionomer but not as well as composite
❤ Good resistance to leakage
❤ Material has low incidence of producing tooth sensitivity
❤ Usually completed in one dental visit
Disadvantages

• Cost is very similar to compos­ite resin (which costs more than amalgam)
• Limited use because it is not recommended to restore the biting surfaces of adults
• Wears faster than composite and amalgam

PORCELAIN (CERAMIC)

Porcelain is a glass-like material formed into fillings or crowns
using models of the prepared teeth. The material is toothcolored and is used in inlays, veneers, crowns and fixed bridges.

Advantages

❤ Very little tooth needs to be removed for use as a veneer; more tooth needs to be re­moved for a crown because its strength is related to its bulk  (size)
❤ Good resistance to further decay if the restoration fits well
❤ Is resistant to surface wear but can cause some wear on opposing teeth
❤ Resists leakage because it can be shaped for a very accurate fit
❤ The material does not cause tooth sensitivity
Disadvantages

• Material is brittle and can break under biting forces
• May not be recommended for molar teeth
• Higher cost because it requires at least two office visits and laboratory services

NICKEL OR COBALT­ CHROME ALLOYS

Nickel or cobalt-chrome alloys are mixtures of nickel and chromium. They are a dark silver metal color and are used for crowns and fixed bridges and most partial denture frameworks.

Advantages

❤ Good resistance to further decay if the restoration fits well
❤ Excellent durability; does not fracture under stress
❤ Does not corrode in the mouth
❤ Minimal amount of tooth needs to be removed
❤ Resists leakage because it can be shaped for a very accurate fit

Disadvantages

• Is not tooth colored; alloy is a dark silver metal color
• Conducts heat and cold; may irritate sensitive teeth
• Can be abrasive to opposing teeth
• High cost; requires at least two office visits and laboratory services
• Slightly higher wear to opposing teeth

PORCELAIN FUSED TO METAL

This type of porcelain is a glasslike material that is “enameled” on top of metal shells. It is toothcolored and is used for crowns and fixed bridges

Advantages

❤ Good resistance to further decay if the restoration fits well
❤ Very durable, due to metal substructure
❤ The material does not cause tooth sensitivity
❤ Resists leakage because it can be shaped for a very accurate fit

Disadvantages

• More tooth must be removed (than for porcelain) for the metal substructure
• Higher cost because it requires at least two office visits and laboratory services

GOLD ALLOY

Gold alloy is a gold-colored mixture of gold, copper, and other metals and is used mainly for crowns and fixed bridges and some partial denture frameworks
Advantages

❤ Good resistance to further decay if the restoration fits well
❤ Excellent durability; does not fracture under stress
❤ Does not corrode in the mouth
❤ Minimal amount of tooth needs to be removed
❤ Wears well; does not cause excessive wear to opposing teeth
❤ Resists leakage because it can be shaped for a very accurate fit

Disadvantages

• Is not tooth colored; alloy is yellow
• Conducts heat and cold; may irritate sensitive teeth
• High cost; requires at least two office visits and laboratory services

DENTAL BOARD OF CALIFORNIA
1432 Howe Avenue • Sacramento, California 95825
www.dbc.ca.gov
Published by
CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

Filed Under: Dental Materials, Materials Sensitivity Tagged With: , , , , ,

World Health Organization “Future Use of Materials For Dental Restorations” 2011 pdf

10/22/2011 by Leave a Comment

dental_material_2011

Filed Under: Dental Materials, World Health Organization Tagged With: , , , ,

The World Health Organization Dental Amalgam Review

10/22/2011 by Leave a Comment

The World Health Organization recommends a global phase out of dental mercury.   In the WHO’s  newly released  2009 report on “Future Use of Materials For Dental Restorations”.  This is a great article by Charlie Brown from Consumers for Dental Choice.  You can find a full view of the WHO Dental Materials report here.

10/2011

In a clear sign that dentistry’s amalgam era is fading, the World Health Organization (“WHO”) just released its long-awaited report on dental amalgam. In Future Use of Materials for Dental Restoration, WHO urges “a switch in use of dental materials” away from amalgam.

“[F]or many reasons,” WHO explains, “restorative materials alternative to dental amalgam are desirable.” The report describes three of these reasons in detail:

  • WHO determines that amalgam releases a “significant amount of mercury”: WHO concludes that amalgam poses a serious environmental health problem because amalgam releases a “significant amount of mercury” into the environment, including the atmosphere, surface water, groundwater, and soil. WHO says “When released from dental amalgam use into the environment through these pathways, mercury is transported globally and deposited. Mercury releases may then enter the human food chain especially via fish consumption.”
  • WHO determines that amalgam raises “general health concerns”: While the report acknowledges that a few dental trade groups still believe amalgam is safe for all, the WHO report reaches a very different conclusion: “Amalgam has been associated with general health concerns.” The report observes, “According to the Norwegian Dental Biomaterials Adverse Reaction Unit, the majority of cases of side-effects of dental filling materials are linked with dental amalgam.”
  • WHO determines that “materials alternative to dental amalgam are available”: WHO concludes that “Materials alternative to dental amalgam are available” – and cites many studies indicating that they are superior to amalgam. For example, WHO says “recent data suggest that RBCs [resin-based composites] perform equally well” as amalgam. And compomers have a higher survival rate, says WHO, citing a study finding that 95% of compomers and 92% of amalgams survive after 4 years. Perhaps more important than the survival of the filling, WHO asserts that “Adhesive resin materials allow for less tooth destruction and, as a result, a longer survival of the tooth itself.”

We have come a long way. Less than a year ago, dental trade groups were circulating an unedited and unreviewed draft of this report to government officials, implying that it was WHO’s final position. But the draft was riddled with factual errors and scientifically unsupported claims. Consumers for Dental Choice – working with non-governmental organizations, scientists, and environmentalists from around the globe – organized a letter-writing campaign to insist that the draft be immediately withdrawn, accurately rewritten, and properly reviewed.

And it worked! Now WHO has removed all claims of amalgam’s safety. Now WHO has committed itself to “work for reduction of mercury and the development of a healthy environment.” Now “WHO will facilitate the work for a switch in use of dental materials.”

Thank you to everybody who urged WHO to take this important step to protect future generations from dental mercury.

Filed Under: Dental Materials, Mercury In The News, World Health Organization Tagged With: , , , ,

Patient Guide — Safe Mercury Removal

10/19/2011 by Leave a Comment

Are Mercury Fillings Safe? Mercury fillings emit dangerous mercury vapor.

How we protect you from mercury vapor exposure.  When a dentist removes (drills) on an old amalgam filling, it releases a lot of mercury vapor. You can recognize an amalgam filling because it looks dark gray or silvery. When this mercury vapor is released, you can potentially breathe it in and then have it absorbed into your nervous system or other tissues.

Here’s what we do.

  1. Non-Latex Dental Dam
  2. Medical Air Nasal Hood
  3. High Volume Vacuum
  4. High Speed Suction
  5. Chunck Amalgam Removal
  6. Lots Of Water
  7. Protective Eyewear
  8. Ventilation
  9. Primary Health Provider Communication

Here’s what we do  to protect you from mercury vapor during amalgam filling removal.

First, we use a non-latex dental dam. This is sometimes called a rubber dam; it prevents you from not only breathing in vapor through your mouth but also prevents that vapor from contacting the more permeable mucosa inside your mouth. We use a non-latex dam instead of latex because it resists mercury vapor better than latex does, and because many people have latex sensitivites.

The second thing we do to protect you from mercury vapor is we use a nasal hood supplied with medical air at a high flow rate. We use the same kind of clean, filtered air they use in an operating room. With this air rushing past your nose, you’re much less likely to breathe in mercury vapor from outside the nasal hood.

Third, we place a large, high-volume vacuum right under your chin. This draws a high percentage of escaping vapor away from you and into the vacuum. The vacuum itself has special filters in it that filter not only the particulates but also bind the mercury to special carbon and sulfur layers.

Fourth, we use a high speed suction next to the dental drill, and that suction stays next to the tooth throughout the procedure.

Fifth, we use suction underneath the dam in case any vapor makes it past the nitrile dam.

Sixth, we remove the amalgam in as big of pieces as possible by using thin burrs and sectioning the filling. This way, less mercury vapor gets released.

Seventh, we use lots of water to keep the amalgam cool.

Eighth, we give you protective eyewear.

Ninth, we ventilate the room throughout and after the procedure.

Last, we communicate with your whole-body practitioner to coordinate your dental treatment with your overall plan for detoxification and to optimize your whole-body health plan.

Filed Under: Dental Materials, Natural Dental Health, Safe Mercury Removal Tagged With: , , , , , ,

The Dangers of Removing Old Mercury “Silver” Fillings.

10/09/2011 by Leave a Comment

When old mercury “silver” fillings are removed/replaced the dental drill causes the filling to emit high levels of hazardous mercury vapor.  Dr. Taylor has advanced training in “Safer Mercury Removal” and accreditation from the IAOMT (International Academy of Oral Medicine and Toxicology).  When Dr. Taylor removes old amalgam (mercury) fillings he uses the most current practices available for “Safer Mercury Removal” to reduce the amount of toxic mercury vapors and particles that you and our staff are exposed to.  Please watch this video from the IAOMT which demonstrates they need for protective barriers and what those protective barriers are.

 

Filed Under: Natural Dental Health Tagged With: , , , , , ,

Dr. Scott Taylor Addresses FDA Director Dr. Shuren

09/27/2011 by Leave a Comment

On September 22, 2011 Dr. Scott Taylor addressed the FDA Director over Mercury use in Dentistry at a San Francisco FDA town hall meeting.  Dr. Taylor spoke directly on the need for FDA accountability to the established dangers associated with dental amalgam (mercury) fillings.

Here is a report issued from Charlie Brown of Consumers for Dental Choice covering the FDA town hall meeting.

FDA Director Shuren Confronted at Town Hall Meeting, Says Amalgam Announcement Coming Back

FDA agrees to amalgam announcement this year.

The U.S. Food and Drug Administration’s Director of the Center for Devices has agreed that FDA will issue an “announcement” on amalgam by the end of this year.
Dr. Jeff Shuren, who signed the appalling 2009 amalgam rule, agreed to this timeline as he presided at an FDA town hall meeting in San Francisco on September 22. It was the third FDA town hall meeting this year – and for the third time, our movement showed up in force to confront Dr. Shuren about the dangers of mercury fillings. The first town hall meeting was in Texas, the second in Florida, and now the third in California – these states represent a quarter of the U.S. population!

California grassroots director Anita Vazquez Tibau presented testimony on behalf of Consumers for Dental Choice. She highlighted amalgam’s devastating impact on the Latino community. “Many Spanish speakers told me that their dentists have never ever used the word ‘mercurio’ in a discussion,” Anita explained to Dr. Shuren. “Instead, it is deceptively called la amalgama plata – ‘silver fillings.’ I’d like to see you tell everyone that mercury is toxic, and please post it in Spanish as well.”

Then Anita reminded Dr. Shuren of his own famous boast: “We don’t use our people as guinea pigs in the U.S.” She held high a photograph of a Latino kindergartener whose mouth is filled – top and bottom – with mercury fillings. “FDA admits that amalgam can cause neurological harm in young children. Their developing neurological systems are ‘more sensitive to the neurotoxic effects of mercury vapor’ says FDA. And FDA admits there is no evidence that amalgam is safe in children under age six: ‘No clinical information is available’ says FDA.” So stop treating Latino children like guinea pigs, Anita concluded.

Dr. Shuren responded. “What I can tell you is we intend to come out with an announcement by the end of the year.”

The clock is running: FDA has 97 days left to act.

I congratulate all the Californian consumers and dentists who confronted Dr. Shuren at the San Francisco town hall meeting – and everyone who has spoken up for mercury-free dentistry in their community. It was the grassroots movement rising up all across America that put amalgam at the top of FDA’s “to do” list. Thank you.

So what will FDA do? Will FDA act as its own scientists recommended: (1) end amalgam use in children, pregnant women, and hypersensitive adults and (2) make sure that every parent knows amalgam is mercury, not silver? Or is FDA simply going to “announce” that it will do something at a later date?

As many of you have been doing since 2009, I urge that you write Director Shuren at jeff.shuren@fda.hhs.gov:

First, thank Dr. Shuren for agreeing to act on amalgam this year.

Second, ask Dr. Shuren to take real action this year – don’t just announce that FDA might act sometime in the future. As Anita explained, our children are being subjected to mercury fillings now – they cannot wait another year.

Third, tell Dr. Shuren to take the advice of the FDA scientists he convened in December 2010. Stop amalgam use in children, pregnant women, and hypersensitive adults immediately. And warn every consumer that amalgam is mercury – a neurotoxin.

Charlie
27 September 2011

Charles G. Brown
National Counsel, Consumers for Dental Choice
President, World Alliance for Mercury-Free Dentistry

Filed Under: Materials Sensitivity, Mercury In The News Tagged With: , , , , , , , ,

Join Former US Attorney General in a Dental Mercury Call to Action

09/06/2011 by Leave a Comment

Finally, we have two strong public figures advocating for patients dental rights.  It is time for the U.S. to move away from using mercury in dental fillings.    There are many people in  America, primarily low income individuals and families and members of the military, who do not have a choice in their dental filling materials.  This article address this injustice and how we can try to influence our leaders the make Dentistry less toxic.  Thank you Dr. Mercola and Charlie Brown.  We have called and sent a letter.

By Dr. Mercola With Consumers for Dental Choice

 

That American dentistry became mired in mercury is a story of profits first, people last. Amalgam is a primitive, pre-Civil War, pollution product that is half mercury. The 50 percent of North American dentists still using amalgam likely do so for the quick and easy profits – while handing us the bill for the health effects and environmental disaster.

Now is the time for those dentists still using amalgam to switch, and join their brother and sister dentists who practice mercury-free dentistry. Now is the time for you to decide that henceforth you will not allow mercury in your mouth or your child’s mouth – no matter what a pro-mercury dentist might say. Now is the time for you to tell your neighbor, cousin, or best friend: Don’t get a mercury filling.

And what is a mercury filling?

It is what the mainstream press calls “silver fillings.”

Mercury Amalgams More Commonly Used in Minorities and the Poor…

Just like the one-size-fits-all strategy of medicating community water supplies with fluoride, the use of mercury amalgams disproportionally affects minorities and the poor, as they frequently are left without options—even when they know better and want a safer alternative.

As explained by Charlie Brown in the featured interview:

“People on these very limited dental insurance plans or on Medicaid often have no bargaining power with their dentists. They are being told by the dentists, “This is what I’m going to do.” The dentist may not even tell them what they’re going to do. They just put in fillings. Some dentists treat their patients and those teeth like dollar signs.

 

There’s a disproportionate impact on working [class] American families—whether in Appalachia, where I’m from, or in inner-cities. Working [class] families: white, African-American, Latino, and Native Americans are much more likely to get a mercury filling.

 

… It’s unscrupulous dentistry and it’s terribly unfair to these families… One group that is particularly badly treated are children with disabilities… [T]here was just an all-out battle in Philadelphia, because we succeeded in getting a fact sheet law, so the parents were reading the fact sheets, saying, “I don’t want amalgam.” The dentists serving children with disabilities were telling the parents, “You will get the filling I decide on”… Parents were forced to leave the office or accept a mercury filling! These dentists were backed up by the Pennsylvania Dental Association. That was condemnable.

 

… The ADA in fact issued an apology recently for its history of racism. That appears to continue with their attitude that those who are disabled have no rights to mercury-free dentistry. That’s one of the battles that we’re [facing]… to protect those who are less able to fend for themselves in this economic society.”

Consumers for Dental Choice Paves the Way for Mercury-Free Dentistry Worldwide

Leading the charge against mercury fillings is Consumers for Dental Choice, a nonprofit group founded by Charlie Brown that merits your support. With its worldwide Campaign for Mercury-Free Dentistry, we get closer – year-by-year, and day-by-day – to ending this abominable 150-year historical mistake. But to win, we need action in communities across the United States and around the world.

Here’s what you can do right in your community or your workplace:

If your dentist has not switched to mercury-free dentistry, this is the time for him or her to do so. Call your dentist and ask. If they use mercury and insist on sticking with it, re-consider your choice of dentists.

If you work for a company that covers dental fillings, ask if they will cover composites, ART, or other alternatives to amalgam. Consider the stellar example of the Cleveland-based Parker Hannifin company, which fully covers composite but does not pay for amalgam! Parker-Hannifin employees and their families are getting non-toxic dental fillings.

If you have dental insurance, ask about ending primacy for amalgam. That’s what United Concordia has done with its policies.

If you know your Mayor or a member of your City or Town Council, consider asking if they will do what is happening in some California cities: pass a resolution calling for an end to amalgam and a request that dentists in your town stop using amalgam.

What You Can Do to Help Abolish Mercury Amalgams

Charlie Brown, who runs Consumers for Dental Choice, is headed to Nairobi in October to lead a worldwide delegation participating in the world mercury treaty negotiations. With him will be a team of dentists, consumers, attorneys, and scientists fighting to get amalgam into that treaty. With the world deciding whether we continue allowing mercury in children’s mouths, much is at stake.

During this Mercury-Free Dentistry Awareness Week, I urge you to take action.

Here’s what you can do:

Americans: Our number one problem is the Food and Drug Administration (FDA), which has partnered with the American Dental Association (ADA) to cover up the mercury; to make you think you are getting silver instead of toxic mercury in your mouth. The FDA intentionally conceals the warnings about amalgam deep in its regulation — so parents will never see them. On its website, the FDA gives dentists the green light to continue to deceive consumers with the term “silver fillings”

“Americans are ready for the end of amalgam.” This was the theme of the testimony to the U.S. Department of State on August 18 by former West Virginia state Senator Charlotte Pritt. Yes, Americans are ready. But FDA is not. So let’s send them a message.Nine months ago, FDA scientists advised the agency to disclose the mercury to all patients and parents, and to stop amalgam for children and pregnant women. Yet FDA sits – sits actually in the pocket of the American Dental Association – ignoring its own scientists.

Please write the Director of FDA’s Center for Devices, Jeff Shuren, jeff.shuren@fda.hhs.gov Ask Dr Shuren why the FDA continues to ignore scientists and covers up the mercury from American parents and consumers. Ask when the FDA is going to get in step with the world on mercury.

Dr. Jeff Shuren, Director
Center for Devices, U.S. Food & Drug Admin.
10903 New Hampshire Ave.
WO66-5431, Room 5442
Silver Spring, MD 20993-0002
Telephone:  301-796-5900
Fax:  301-847-8149
Fax:  301-847-8109

 

Filed Under: Materials Sensitivity, Mercury In The News Tagged With: , , , , , , , , , , ,

Mercury Fillings Are Alive and Strong Among Young Dentists

07/30/2011 by Leave a Comment

US Dentists’ Amalgam Use Surprises Researchers

June 17, 2011 — Despite improvements in resin-based composite technology, US dentists are placing more amalgam restorations than composites, and amalgam is still emphasized by US dental schools, according to the results of 2 studies published in the June issue of the Journal of the American Dental Association.

“I thought that most people were using composite,” researcher Sonia K. Makhija, DDS, MPH, an assistant professor of dentistry at the University of Alabama at Birmingham, told Medscape Medical News. “It was surprising that so many people are using amalgam.”

Dr. Makhija and colleagues in the Dental Practice-Based Research Network, a collaboration of practicing dentists who participate in research, analyzed reports from 182 US dentists on 5599 restorations of carious lesions in posterior teeth.

Overall, the dentists used amalgam for 3028 of these restorations, and composite in 2571 others. (The researchers collected no data on the 930 restorations these dentists made out of gold, glass ionomer, or anything else other than composite and amalgam.)

Although the dentists were not a statistical sample, previous studies have suggested that they are generally representative of what dentists are doing in the United States, Dr. Makhija said.

In the second study, researchers from universities in England, Wales, and Ireland and from the Georgia Health Sciences University in Augusta, surveyed 67 dental schools in the United States and Canada about how they teach students to restore posterior teeth.

At the 49 schools that responded, almost half the restorations placed in 2009 and 2010 were resin-based composites. Although this was a 30% increase from a similar survey done 5 years earlier, the study authors wrote that US and Canadian schools “lag” schools in Britain and Ireland, where composite gets more attention.

Not only is composite prettier, it is less invasive because it does not require as much cavity preparation, and in recent studies it has proved at least as durable, the authors write. “These tooth-friendly features of resin-based composites make them preferable to amalgam, which has provided an invaluable service but which, we believe, now should be considered outdated for use in operative dentistry.”

They called for new national guidelines that would emphasize the superiority of composite.

However, Dr. Makhija said such guidelines are premature. “I think we don’t have enough data yet,” she said. “You can find longevity studies on both that are good.” The Dental Practice-Based Network is following up on the 5599 restorations participants placed to see how they fare in coming years.

 

Glass Ionomer: Pros vs Cons

Offering another perspective, Douglas A. Young, DDS, EdD, MBA, associate professor of dental practice at the University of the Pacific, San Francisco, California, told Medscape Medical News that composite itself is becoming outmoded by glass ionomer. “The selection of the restorative material should be based on its ability to fight disease,” he said.

Glass ionomer binds better to teeth because of the ionic substitution that takes place between the fluoride in the glass ionomer and the calcium phosphate in the tooth, he said. In his experience, it is just as durable as composite resin, and the fluoride that it releases helps teeth remineralize, he said. “I like to use it on dentin and cementum, especially in sealants and small restorations.”

Dr. Young also argued in favor of using glass ionomer in combination with composite in the “open sandwich” technique, which he said helps lesions remineralize underneath restorations. The authors of the study on dental schools specifically rejected this approach, arguing that dentin regenerates better with phosphoric acid rinse.

So what are dental schools teaching? In the survey, 44 of the 49 schools said they taught the total etch technique for cavities in the outer third of the dentin, whereas the other 5 taught the glass ionomer cement approach only.

For cavities in the middle third of the dentin, 24 schools taught the total etch approach, and 24 the glass ionomer approach, whereas 1 taught calcium hydroxide and glass ionomer. For those restorations in the inner third of the dentin, 6 schools taught total etch and 30 glass ionomer, with 24 schools teaching calcium hydroxide and glass ionomer.

However, dental schools teachings are only one factor in what dentists practice, Dr. Makhija found. Surprisingly, older dentists were more likely to place composite restorations, even though they were more likely to have attended dental school when this approach was less emphasized (P = .02)

Dentists who graduated in the past 5 years placed amalgam on 61% of the lesions they treated. One explanation may be that younger dentists are more likely to be in large group practices where they work on salary, rather than fee-for-service, said Dr. Makhija. The type of material might be dictated by managers of the group practice. In large group practices (4 dentists or more), 79% of the restorations were amalgam (P < .001). “It’s quicker, it’s easier and it’s cheaper to use amalgam,” Dr. Makhija said.

Dr. Makhija, Dr. Young, and the authors of the dental school survey have disclosed no relevant financial relationships.

J Am Dent Assoc. 2011;142;612-620. Abstract

J Am Dent Assoc. 2011;142;622-632. Full text

Medscape Medical News © 2011 WebMD, LLC

 

Filed Under: Mercury In The News Tagged With: , , , ,

The U.S. Calls for the Phase-Out of Amalgam Ultimately

06/06/2011 by Leave a Comment

The U.S. Calls for the Phase-Out  of  Amalgam Ultimately.

In an extraordinary developments that will change the global debate about amalgam, the United States government has announced that it supports a “phase down, with the goal for eventual phase out by all Parties, of mercury amalgam.” This statement- a radical reversal of its former position that “any change toward the use of dental amalga is likely to result in poitive public health outcomes” — is part of the U.S. government’s submission for the upcoming third round of negotiations for the world mercury treaty.*

While couched in diplomatic hedging — remember it is still early in the negotiations — this new U.S. position makes three significant breakthroughs for the mercury-free dentistry movement:

The U.S. calls for the phase-out of amalgam ultimately and recommends actions to “phase down” its use immediately.  Incredibly, the government adopted three actions that the World Alliance for Mercury-Free Dentistry and Consumers for Dental Choice proposed at the negotiating session in Chiba, Japan.  Our key ally, The Mercury Policy Project, laid the groundwork for this success at a World Health Organization meeting in 2009!

The U.S. speaks up for protecting children and fetuses from amalgam, recommending that the nations “educate patients and parents in order to protect children and fetuses.”

The U.S. stands up for the human fight of every patient and parent to make educated decisions about amalgam.

What does this mean?  Our position — advocating the phase-out of amalgam — is now the mainstream because the U.S. government supports it.  Who is the outlier now?  It’s the pro-mercury faction, represented by the World Dental Federation and the American Dental Association.  With the U.S. continuing its leadership role in this treaty, we will broadcast the U.S. position to other governments around the world, encouraging them to support amalgam “phase downs” leading to phase-outs not only globally, but within each of their countries.

 

We applaud the U.S. government.  But tough work lies ahead.  For example, we must demonstrate to the world that the available alternatives — such as composites and the adhesive materials used in  atraumatic restorative treatment (“ART”) — can cost less than amalgam and will increase access to dental care particularly in developing countries.

 

For now though, let’s mark this watershed in the mercury-free dentistry movement: the debate has shifted from “whether to end amalgam” to “how to end amalgam.”

 

5 April 2011

Charles G. Brown

National Counsel, Consumers for Dental Choice

President, World Alliance for Mercury-Free Dentistry

 

 

Filed Under: Materials Sensitivity, Mercury In The News Tagged With: , , , , , , , ,