In this survey, we asked dentists how concerned they are about various potential public health threats linked to dentistry. Dentists’ concerns, in order, are:

1. Lead in dental lab work
2. Mercury in amalgam
3. Bisphenol-A in composite, and
4. Fluoride in water supplies.

General dentists had higher levels of concern on all issues than specialists. However, specialists and generalists agreed on the relative dangers of the chemicals covered in this survey.

Dentists’ thoughts

• “I’d like to be doing all gold restorations.” (New Jersey dentist)
• “All four of these need to be totally nailed down as to their safety, or lack thereof.” (Arkansas dentist)
• “Two things that will bite dentistry in the butt are fluoride and amalgam if we don’t stop forcing them on the public.” (Idaho dentist)

Mercury

• “150 years have not proved Amalgam to be dangerous.” (Arkansas dentist)
• “Amalgams have saved billions of teeth!” (Washington dentist)
• “A known toxin, no safe levels, should be banned.” (Louisiana dentist)

Lead

• “Lead in dental casting alloy? Outrageous!” (Colorado dentist)
• “Recent articles have debunked the worry over the amount of lead in ‘farmed-out’ crowns. Still, we need to monitor that work.” (California dentist)

Bisphenol-A (BPA)

• “This stuff is everywhere. Composites without BPA just don’t hold up well.” (Wisconsin dentist)
• “It’s probably not too dangerous, but don’t cast stones, Mr. Composite: you live in a glass house!” (New Jersey dentist)
• “It’s ironic that many patients are removing long tested amalgam and replacing them with bisphenol composites of unproven safety.” (California dentist)

Fluoride

• “It’s been shown to be effective, but we shouldn’t be medicating the whole population.” (Colorado dentist)
• “The best public health measure ever instituted in this country for caries prevention.” (Texas dentist)
• “Known to be toxic.” (California dentist)

Post your thoughts or read the complete dental public health threats survey results

Given the recent negative publicity surrounding bisphenol-A (BPA), our survey covered dental sealants and composite. One in four dentists is very worried about the safety of these products.

“It doesn’t matter if composites and sealants are safe,” wrote one respondent. “If public perception is that they are not, it is very harmful to dentistry.”

Here are some additional dentist comments on the subject:

• “The enormous and unexplained increase in the incidence of breast cancer corresponds with the advent of the bisphenol-A introduction into dentistry.” (Michigan dentist)
• “The cumulative release of BPA from composites appears to be minimal from the available research.” (New Hampshire dentist)
• “I had fellow church members ask me if they needed to get all their composites removed.” (New York dentist)
• “I am concerned that we are using a material whose biocompatibility is really unknown.” (New York dentist)
• “I am particularly concerned about using composites and sealants in children.” (Texas dentist)
• “Slow news day?” (Georgia dentist)
• “Forget about bisphenol-A. Resins are far more toxic on a cellular level than amalgam. Are you familiar to amalgam studies showing how cells in a petri dish respond to amalgam? They continue to happily divide. When unset resin is placed the cells die!” (General dentist)
• “A vegan grilled me the other day. I told him that he was at greater risk from salmonella from not washing his veggies properly!” (Colorado dentist)
• “I’m more worried about BPA in soda and water bottles. Patients have never expressed any concern.” (Arizona dentist)
• “Most patients assume that if we are doing something it is okay.” (New York dentist)
• “It’s the amalgam issue all over again. What are all the ‘Bondadontists’ going to tell their patients now?” (Virginia dentist)

Post your own comments or read the complete bisphenol-A and dental composite survey results…

Perhaps you’ve heard the recent news reports of possible health problems with water bottles and other plastic products.

The chemical causing so much concern is bisphenol A, found in some (but not all) plastics. Research suggests that BPA may act like the female hormone estrogen. While hormonal effects have been seen in animal tests, no one has shown the same response in humans.

However, many health experts urge caution, especially with substances that mimic the effect of hormones. Estrogen is a reproductive hormone with feminizing effects, one that has a dramatic impact on sexual development. Some wonder if BPA may be the reason why girls are hitting puberty so early these days. Others fear that a pregnant woman’s exposure to BPA can damage not just the child growing inside her, but that its effect on the fetus’s gonads could harm her grandchildren as well.

BPA exposure is hard to avoid. The chemical may leach into food from plastic containers (especially when heated). In fact, manufacturers of baby bottles now offer BPA-free bottles.

Though plastic bottles have received the most mainstream attention, dentists need to know about another possible avenue for BPA exposure: dental composites and sealants. The dental sealant bisphenol A dimethylacylate is of particular concern.

Dental composites are created from monomers. Composite resin is often based on bisphenol A glycidyl methacrylate (bis-GMA, also known as Bowen’s monomer). Though bis-GMA and some other monomers are chemical derivatives of BPA, BPA itself is not used in dental composites or sealants.

A 1996 study by Nicolas Olea of Spain’s University of Granada was the first to report detectable levels of BPA in the saliva of patients who had just been given dental sealants. The study is still a source of controversy. Further research suggests that some (but not all) dental sealants do raise a patient’s salivary level of BPA. However, blood levels of BPA do not detectably change, and saliva levels quickly return to normal.

This is the dilemma: Yes, there can be detectable levels of BPA. But are they significant?

• Some people will tell you that the EPA says it’s okay and the levels of BPA found in humans are far below the levels found to cause problems in animals.
• Others will say that the levels of BPA found in humans are well above the levels found to cause detectable hormonal changes in animals.
• Some will tell you that dental products cause negligible BPA exposure when compared to food products, water bottles, environmental pollution, and other sources.
• Others will say it’s downright irresponsible for dentists to give young children dental sealants that could damage their reproductive development.
• I will straightforwardly tell you that I have no idea if any of this is a big deal or not.

Here are some other resources…

• Definitely pro-BPA: Bisphenol-A.org
• Somewhat pro-BPA: ADA Statement on BPA
• Somewhat anti-BPA: Wikipedia – Bisphenol-A
• Definitely anti-BPA: Environmental Health News

I’d like to know what you dentists think! Do you have any concerns about BPA in dental composites and sealants? Have your patients expressed any concerns? (If they haven’t yet, expect them to soon, as the BPA issue gets more press.)

Post your thoughts on bisphenol-A

Health Canada had announced that bisphenol-A (BPA) is potentially harmful. A chemical component of many plastics, BPA has received harsh media scrutiny recently because cells react to the synthetic chemical much like the female hormone estrogen.

The top concern is plastic baby bottles. When heated, BPA-containing bottles can leach significant amounts of the chemical, raising the level of BPA in the infant’s bloodstream. The chemical’s hormone-like effects could cause permanent health damage.

In response, baby bottle manufacturers have released BPA-free bottles. Water bottle giant Nalgene has already made a similar announcement.

BPA is found in other products as well, ranging from food containers to dental sealants. (Stay tuned for Jim Du Molin’s upcoming editorial on the subject.)

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