Dental Products: Changes Linked to BPA

BPA in dental productsOne dentist in eight has changed dental products or materials because of worries about BPA content, this survey found..

When we previously surveyed dentists on the topic of bisphenol-A, we found about half of dentists were worried about BPA in dental composite and sealants.

"Patients should be told restorative treatment and material options, risks, benefits, average longevity, etc. (of composite, amalgam, castings, etc.). Then, as a well-respected lecturer sarcastically says, they can 'pick their poison,'" said a Maryland dentist. "I wonder if, a few decades from now, we will still see the short longevity composites to be as safe as amalgam is and was for 160 years."

Read more: Dentists Change Dental Materials over BPA

Dental Materials Safety Concerns (video)

Dental materials safety: who's responsible?The safety of dental materials has been in the news due to concerns about BPA in sealants and composite and reports of dental crowns manufactured in foreign dental labs that may be contaminated with lead.

So we asked dentists who should be responsible for the safety of dental products. One third said the FDA, one quarter said dental labs should police themselves, and 41% said dentists should take responsibility.

“My local lab is placing 'made in America' on all of the return cases for the patients to see,” mentioned one dentist.

“Too many dentists are accommodating low dental insurance payment schedules by buying their dental materials and laboratory fabrications that are too cheap," complained another. "It doesn't seem to matter that it compromises the health of the patient."

Read more: Lead found in dental crown from China: Dentist Survey Results

Dentists Split Over BPA

Dentists split over dental BPA (bisphenol A)One of every two dentists is so worried about bisphenol A (BPA) that they think the American Dental Association (ADA) should issue a warning about the chemical’s dangers.

On the other hand, half think we still need more research. "The ADA must respond only to true science," one dentist declared.

BPA, an ingredient in some dental sealants and dental composites, has been getting a lot of bad press… this could be a serious dental management issue for cosmetic dentistry in the not-too-distant future.

When asked if the ADA should take a stand against dental bisphenol A, here’s what dentists had to say:

  • "The ADA should conduct a thorough Scientific Study so we do not have another 'amalgam controversy.'" (Kentucky dentist)
  • "Whatever the studies show, the ADA needs to get that PR out to the public… If we say nothing, then the only voice the public hears will be other voices." (General dentist)
  • "Look into this more fairly before alarming everyone, perhaps unnecessarily." (New York dentist)
  • "I think that we need all appropriate in vivo experimental and clinical studies in order for the proper authorities to rule one way or the other."
  • "BPA is linked to female issues. We need to be preemptive, even if there is a doubt. What are they waiting for, a return to amalgams?" (Michigan dentist)
  • "I have a one year old and we make sure never to have him use bottles or other items made of BPA. Most companies that produce products placed in babies mouths are removing BPA from them (bottles, pacifiers, etc). Therefore, why should dentists continue to use dental sealants with BPA? It doesn't make a whole lot of sense." (Ohio prosthodontist)
  • "It is my understanding that BPA itself is not an ingredient in composite materials, but bis-GMA, which is made from BPA. The amount of unconverted BPA in dental materials is almost undetectable and has not been shown to be a health threat. There is also no better alternative material for long-term restoration of the dentition."

Read more: Dental BPA: ADA Stance on Bisphenol-A Divides Dentists

BPA Safety in Dental Sealants Worries Some Dentists (video)

BPA safety concerns about dental sealants and compositeOne dentist in four reports being very concerned about the issue of bisphenol-A (the problem chemical in water bottles and baby bottles) in dental composite and dental sealants in this survey.

Because children may be particularly sensitive to the hormone-like effects of BPA, this issue is of particular concern for the pediatric dentist.

Read more: Bisphenol-A in Dental Composite Worries Dentists

BPA in Dental Restorations: Does It Matter?

BPA in dental workLast week we started talking about whether the chemical BPA (bisphenol-A) will prove to be the next dental amalgam.

There's more than just a passing similarity between the issues. Both mercury and BPA are known to be harmful in certain quantities. Both can be found in some dental restorations. And in both cases, the scientific evidence is inconclusive about how much BPA or mercury these restorations release into the human body.

Let's also note that there are significant differences. Mercury is a metallic element that is poisonous in its raw form. Bisphenol-A is a plastic additive that appears to have an estrogen-like effect on cells.

When it comes to possible toxic effects of BPA, here's what the ADA says:

The ADA believes any concern about potential BPA exposure from dental sealants or composites is unwarranted at this time. When compared with other sources of BPA, these dental materials pose significantly lower exposure concerns.

Published in the ADA Journal in 2006, the research study Exposure to bisphenol A from bis-glycidyl dimethacrylate–based dental sealants found measurable amounts of BPA in patients' saliva after the application of dental sealants. Though the study concluded, "Sealants should remain a useful part of routine preventive dental practice, especially those that leach negligible amounts of BPA," it also recommended further research:

Clinical Implications. Dental sealants may be a point source for low-level BPA exposure at levels that show health effects in rodents. Further research is required to determine whether human exposure to BPA at these levels causes adverse effects.

In a November 2008 statement, the ADA acknowledged that BPA can be found in some dental products:

BPA may become part of dental sealants or composite resin filling materials in three ways: as a direct ingredient, as a by-product of some ingredients in dental composites or sealants that may have degraded, or as a trace material left-over from the manufacture of some ingredients used in making dental composites or sealants.

But an ADA newsletter from April 2007 seems to contradict that:

BPA is a chemical found in many hard plastics and used in resins that line food and beverage cans. Although some believe BPA is an ingredient in dental sealants and composites, it isn't, although there's some evidence that some dental sealants and to a lesser extent composites may contribute to low-level BPA exposure, probably through the action of salivary enzymes on a minor ingredient. We see no cause for concern at this time but do look forward to the results of a review of a draft report on BPA safety by an independent NIH panel of endocrinologists, statisticians and biologists.

While the possible estrogen-like effects of BPA are news to most consumers, the ADA and concerned dentists have been aware of this issue for many years. In a 1996 letter to the Journal of the American Dental Association, two dental professors from Tufts wrote:

"An article appeared in the March 1996 issue of Environmental Health Prospectives entitled 'Estrogenicity of resin based composites and sealants in dentistry' that raises some familiar concerns that critics of the profession have espoused. The thesis elaborated in this article states that the bisphenol-A and bisphenol-A dimethacrylaic components of sealant and resins are estrogenic and probably contribute to xenoestrogen exposure in humans.

"As dental professionals who have seen dentistry criticized for the use of mercury in restoratives and the lack of appropriate disinfection procedures for our instruments and equipment, we feel that this issue should be resolved through competent scientific investigation. Hopefully, this issue will be addressed in a more intellectual and scientific manner than the emotion and hysteria that have been the center of some issues in dentistry in the recent past."

Some 13 years later, we still don't have conclusive scientific results about BPA's safety. Consumers and dental professionals alike need a clearer scientific picture. But at the same time, no one needs mass hysteria that keeps patients from getting the dental restorations they need. While the health risks of BPA exposure might not be clear, the risks of tooth decay and abscessed teeth certainly are.

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