Dentists Say Lead Is Dentistry’s Biggest Health Threat

Other Dental Health Concerns Include Mercury and Bisphenol-A

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

General dentists versus specialists

  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

Is Bisphenol-A The Next Dental Amalgam?

BPA safety fearsThe chemical bisphenol-A (BPA) made headlines last year as a possible health risk – and now it’s back in the news. BPA is added to many plastics and can be found in lots of products, including food containers, baby bottles, and dental sealants and composite.

Will this call the safety of modern dental products into question?

Unfortunately, evidence indicates that BPA can leach from plastics and be absorbed by the human body. It mimics the effects of the female hormone estrogen, and animal studies have linked high levels of BPA with all sorts of unpleasant health problems.

Baby bottles seem to be the most worrisome product, releasing even higher levels of BPA when heated or filled with hot liquid. [Note: Not all baby bottles contain bisphenol-A.] And BPA’s hormone-like effects are likely to be even more harmful to a developing baby than a full-grown adult.

Last year, the FDA declared that the amount of BPA released by consumer products is too low to cause health problems. In a June 2008 statement to the US House of Representatives, the FDA’s Associate Commissioner for Science, Dr. Norris Alderson, said:

At this time, FDA is not recommending that consumers discontinue using food contact materials that contain BPA. Although our review of the NTP reports is continuing, a large body of available evidence indicates that food contact materials containing BPA currently on the market are safe, and that exposure levels to BPA from these materials, including exposure to infants and children, are below those that may cause health effects…

FDA’s reassessment of possible “low-dose” effects of BPA concluded that the current level of exposure to adults and infants is safe as defined in 21 CFR §170.3(i).

However, the FDA is now reviewing that decision. In fact, a recent Harvard University study found elevated levels of BPA in students’ urine after only one week of drinking from plastic containers.

Many cities and states are considering banning the additive in some products, particularly baby bottles.

  • Canada banned the import and sale of baby bottles containing BPA
  • New York’s Suffolk County passed a BPA ban
  • Minnesota has banned BPA-containing plastic beverage containers for children under 3 (effective for manufacturers January 2010; for retailers January 2011)
  • Chicago just passed a city-wide ban on selling baby bottles and children’s sippy cups that contain BPA (effective January 2011)
  • Connecticut‘s House will ban BPA from plastic containers used by babies and children (effective October 2011)
  • California‘s Senate narrowly approved a bill banning BPA that still needs to be approved by the state Assembly
  • There’s more and more talk of a nationwide ban

A number of companies are voluntarily removing or limiting BPA. Water-bottle manufacturer Nalgene has announced it will remove BPA from its products. Both Walmart and Kids-R-Us will stop selling baby bottles that contain BPA. The six largest baby bottle manufacturers will remove the ingredient. Even Sunoco has said that it will not supply manufacturers with BPA if the resulting products are intended for children under 3.

Next week we’ll take a look at how this may apply to dental composites and sealants.

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.

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

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

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