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.

Dentists Not Concerned About Chemicals Used in Dentistry

Dentists Not Concerned About Chemicals Used in Dentistry“Not particularly worried” is the most popular response for concerns about the chemicals in dentistry among dentists, according to a new The Wealthy Dentist survey, but the results are pretty evenly split.

The online survey asked dentists from the U.S. and Canada if they are concerned about the safety of dental composite and sealants.

54% were not worried, while 46% had concerns about safety.

Here’s how the dentists responded —

  • 21% – Definitely yes! I am very concerned about this issue.
  • 25% – Somewhat. I have some worries about safety.
  • 38% – Not really. I’m interested, but not particularly worried.
  • 16% – Definitely not! I’m not worried at all.

Chemicals Used in Dentistry Survey Results Graph

“It’s about the same argument as the amalgam and mercury issue. I don’t see that the literature to date points in any direction toward concern about BPA!” a Mississippi dentist said.

BPA in tooth fillings has been in the news recently due to a study linking the chemical to behavioral problems in children.

According to Dr. John Reitz of Reading Eagle Press, “When dental manufacturers became aware of the health risk of BPA they made a conscious effort at eliminating or at least limiting the amount in dental products. According to research by the American Dental Association, BPA is rarely used today as an ingredient in dental products.”

Most of the dentists who responded to this survey agree that there are minimal risks from dental chemicals.

Here’s what many dentists had to say on the subject —

“We need more long-term studies.” (New Jersey dentist)

“To temper this, we have to remember that ANYTHING in the body outside of what is indigenous is considered foreign and has potential to elicit yet another of those unexpected side effects, sort of like most of Congress’ laws. Since I stopped doing sealants years and years ago, I am less concerned about the effect on most adults.” (General dentist)

“Amalgam is on its way out. Let the chemist reformulate BPA-free dental products!” (Alabama dentist)

“I didn’t know that I need to be concerned…” (California dentist)

“No patients have shown any worry. I do feel extensive research should be conducted.” (Mississippi dentist)

“Yes – patients ask about it! But I understand there are different kinds…some more damaging than others.” (Michigan dentist)

“I’ve never had a patient even mention it, unlike the ‘wackos’ who won’t let fluoride touch their kids lips…” (General dentist)

“None of our patients have mentioned it, yet. But, I won’t be surprised if or when they do in the future. I’m personally concerned about BPA in composites. I certainly didn’t want it in the plastic baby bottles my child used, so why would I want it in composite resin dental restorations? Dentistry certainly needs to have BPA free restorative materials.” (Ohio dentist)

“Parents are now asking me about our materials and if they contain BPAs.” (Pediatric dentist)

The ADA Council on Scientific Affairs has not identified evidence to suggest that the use of resin-based dental sealants or composite resin restorative materials is linked to adverse health effects from BPA exposure. (Source: ADA)

Dentists, what are your thoughts on chemicals used in dentistry?

Dentists: BPA is Back Making Front Page Dental News Again

BPA in Children is Making Front Page Dental NewsBisphenol A (also known as BPA), a chemical used in lightweight plastics, dental sealants and dental fillings is back making news headlines once again.

First, the federal government announced this month that baby bottles and sippy cups can no longer contain BPA.

This was followed by reports from a new study stating that children getting dental fillings made with BPA are more likely to have behavior and emotional problems later in life.

The study, as reported in Pediatrics Online, “makes a strong case that in the short-term, use of BPA-containing dental materials should be minimized,” asserts Philip Landrigan, director of the Children’s Environmental Health Center at Mount Sinai School of Medicine in New York City.

The researchers in the study tracked 534 children with cavities from when each child received their first dental fillings. Over the following 5 years, the researchers noted that those children who had cavities filled with a composite material containing traces of BPA consistently scored 2 – 6 points less on 100-point behavior assessments than those who didn’t have fillings.

As reported in Science News, the researchers never administered clinical diagnostic behavioral tests to the children.

Instead, they periodically administered some widely used checklists to the children or their parents, allowing each to self-assess features such as a child’s attitudes toward teachers or others, depression, self-esteem, attention problems, delinquent behaviors, acting-out or problems with attentiveness.

Since the children were 6-12 years old at the time, these type of behaviors are not uncommon for children living with a variety of circumstances like divorce, bullying, and problems at home.

However researchers argue that the behavior problems being reported seemed to happen more with the children who had BPA fillings, causing them to believe that some dental fillings may start to break down over time, thus exposing these children to the chemical.

The U.S. government is currently spending $30 million on its own BPA research to determine the chemical’s health effects on humans.

As a dentist, what are your thoughts on the use of BPA?

For more on this story see: Putting BPA-based Dental Fillings in Perspective 

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