1. Dental Public Health Update
Dr shabeel pn

2. Overview Sealants Amalgam Controversy Fluoride Antibacterials
Caries Predictors
Floss
Soft Drinks

3. What does this have do with Dental Sealants?...
On June 16, 2006 Mayor Gavin Newsom signed into law the banning of Bisphenol-A (BPA) in articles or products intended for use in children under 3 years of age only in San Francisco
What does this have do with Dental Sealants?...

4. Sealants & BPA
BPA originally developed as synthetic estrogen, but is now used to make resins.
Composite resins formulated from a mixture, but no known use of BPA by itself in sealants.
Low levels of BPA may be released into saliva from sealants right after application.
Bisphenol-A was originally developed for use as synthetic estrogen, but is now used as a chemical building block that is used to make epoxy resins.
Composite resins are formulated from a mixture of monomers called bis-GMA, but there is no known use of BPA by itself in Dental Sealants
Based on data form 3 studies, it appears that low levels of BPA may be released into saliva from certain Sealants right after application. BPA has not been found in blood and systemic exposure does not occur.

5. Sealants & BPA In conclusion:
“Taken together, the weight of evidence does not support the hypothesis that low oral doses of BPA adversely affect human reproduction and developmental health.”
thus…
No scientific basis for the ordinance
SF government did not solicit any input
Therefore, in conclusion:
Taken together, the weight of evidence does not support the hypothesis that low oral doses of BPA adversely affect human reproduction and developmental health
There is no scientific basis for the ordinance and the SF government officials did not solicit any input, in particular scientific input, before taking action.

6. Sealants recommendations
Evidence-based Recommendations for the Use of Sealants A. Reeves, F. Chiappelli, & O.Cajulis
CDA Journal. Vol.34, July 2006, UCLA School of Dentistry
The preventive effect for 2nd generation sealants ranges from 33%-71%. The median preventive effect is higher when sealants are reapplied, compared to a single application, because sealant effectiveness decreases over time.

7. September 1, 2006, The Associated Press
Amalgam Controversy
“Federal review finds no scientific evidence of harm from mercury fillings.”
September 1, 2006, The Associated Press
Silver fillings aren't dangerous despite exposure to mercury.
The Food and Drug Administration reviewed 34 recent research studies.
WASHINGTON - Silver fillings used to patch cavities aren't dangerous even though they expose dental patients to the toxic metal mercury, federal health researchers said Friday.
The Food and Drug Administration reviewed 34 recent research studies and found "no significant new information" that would change its determination that mercury-based fillings don't harm patients, except in rare cases where they have allergic reactions.

8. Amalgam Controversy FDA Advisers: Fillings May Not Be Safe
September 7, 2006, The Associated Press
Government health advisers rejected the federal report
“...didn't objectively and clearly present the current state of knowledge about fillings.”
“…the report's conclusions about safety weren't reasonable.”
WASHINGTON, Sept. 7, 2006 (AP) Government health advisers rejected a federal report that concluded dental fillings used by millions of patients are safe, saying further study of the mercury-laden amalgam is needed. A joint panel of Food and Drug Administration advisers did not declare the so-called "silver fillings" unsafe. But in a 13-7 vote Thursday, the advisers said the federal report didn't objectively and clearly present the current state of knowledge about the fillings. In a second 13-7 vote, the panelists said the report's conclusions about safety weren't reasonable, given the quantity and quality of information currently available The Food and Drug Administration reviewed 34 recent research studies and found "no significant new information" that would change its determination that mercury-based fillings don't harm patients, except in rare cases where they have allergic reactions.

9. Amalgam Controversy
New York State Department of Health Practice Guidelines: Oral Health Care during Pregnancy and Early Childhood
Jay Kumar, DDS, MPH Bureau of Dental Health New York State Department of Health
Recently, the New York State Department of Health released practice guidelines titled: Oral Health Care during Pregnancy and Early Childhood ( This is how New York State addressed this issue: Jay Kumar, DDS, MPH Bureau of Dental Health New York State Department of Health

10. Amalgam Controversy
What advice should I give about the use of dental amalgam fillings during pregnancy?
All health professionals should educate women about the potential harm of untreated caries during pregnancy.
Women with symptomatic or severe caries should be treated promptly, including in the 1st trimester.
The oral health professional and the pregnant woman should determine the best treatment options based on the benefits, risks and alternatives of using dental amalgam fillings.
What advice should I give about the use of dental amalgam fillings during pregnancy?
All health professionals should educate women about the potential harm that can accrue from untreated caries during pregnancy.
Women with symptomatic caries or deep decay should be treated promptly, including in the first trimester.
The oral health professional and the pregnant woman should determine the best treatment options based on an evaluation of the benefits, risks and alternatives of using dental amalgam fillings.

11. Amalgam Controversy
What advice should I give about the use of dental amalgam fillings during pregnancy?
The elemental mercury found in dental amalgams is different from methyl mercury, a form of organic mercury.
The consumption of fish and seafood is the major source of organic mercury.
The ingestion of methyl mercury during pregnancy is more of a concern than mercury vapor released from dental amalgams.
What advice should I give about the use of dental amalgam fillings during pregnancy?
The elemental mercury found in dental amalgams is different from methyl mercury, a form of organic mercury.
The consumption of fish and seafood is the major source of organic mercury.
The ingestion of methyl mercury during pregnancy is more of a concern than mercury vapor released from dental amalgams.

12. Fluoride – Clinical Trial
Sealant & Fluoride Varnish in Caries: A Randomized Trial
M. Bravo, J. Montero, J.J.Bravo, P. Baca, and J.C. Llodra
J Dent Res 84(12): , Granada, Spain
Purpose: to compare sealants with fluoride varnish in the prevention of occlusal caries in permanent 1st molars – 4 yrs. of the program + 5 yrs. of discontinuation.
Purpose was to compare sealants with Fl. Varnish in the prevention of occlusal caries in permanent 1st molars: 4 yrs. of the program + 5 yrs. of discontinuation.

13. Fluoride – Clinical Trial
Results: Sealants effective in reducing caries both during the program and 5 years after discontinuation. Fluoride Varnish effective during the program, but not in the discontinuation period. No rebound effect. The molars did not show the high risk found in the control molars. Overall effect of the 4 yr. program remained significant.
Results:
Sealants Sealants were effective in reducing caries during the program and the effect continued 5 yrs. after discontinuation.
Fl. Varnish Fl. Varnish was effective during the program, but the preventive effect appeared to cease during the discontinuation period. There was no rebound effect. The molars did not show the high risk found for the control molars. Overall the effect of the 4 yr. program remained significant.

14. Fluoride – Recommendations
Professionally applied topical fluoride: Evidence-based clinical recommendations
JADA, Vol. 137, August 2006 (See handout Table 3)

15. Fluoride – Clinical Trial
Fluoride Varnish Efficacy in Preventing Early Childhood Caries
Weintraub, Ramos-Gomez, Jue, Shain, Hoover, Featherstone, & Gansky J Dent Res 85(2):
No related adverse events were reported. Fluoride varnish added to caregiver counseling is efficacious in reducing early childhood caries incidence. Fluoride varnish applications resulted in a dose-response effect.

16. Antibacterial Treatment
Antibacterial Tx. Needed for Severe Early Childhood Caries Zhan, Featherstone, Gansky, Hoover, Fujino, Berkowitz, Den Bestin
J Public Health Dent. Vol. 66. Summer UCSF
Objective: Assess the effect of povidone iodine as an adjunct to treat ECC.
Conclusions: Prophy, fluoride gel, and caries treatment did not prevent new caries in > 60% of high risk infants. Single application of povidone iodine reduced SM and LB for 3 months, but failed to reduce future caries formation over 1 year.
Objective: To assess the effect of a single 10% povidone iodine application as an adjunct to extensive dental tx. in ECC. Conclusions: Prophylaxis, Fl. Gel tx. and complete treatment of caries were insufficient to prevent new caries in over 60% of these high risk infants. One time tx. with povidone iodine reduced SM and Lact. for 3 months, but failed to reduce future caries formation over 1 year.

17. J Public Health Dent. Vol.66. Summer 2006. Brazil
Caries Predictors
Assessment of Dental Caries Predictors in a 7 yr. Longitudinal Study Tagliaferro, Pereira, Meneghim, Ambrosano.
J Public Health Dent. Vol.66. Summer Brazil
Objective: Identify risk factors for dental caries increment in permanent dentition in 6-8 year old children.
Results: Past dental caries in primary teeth and mother’s educational level were significant predictors of caries.
Objective: Identify, in a group of 6-8 yr. old , risk factors for dental caries increment in permanent dentition. Results: Past dental decay in primary teeth and mother’s educational level were predictors of caries in permanent dentition.

18. Floss Dental Flossing and Interproximal Caries: A Systematic Review
Hujoel, Cunha-Cruz, Banting, Loesche J Dent Res 85(4):
Objective: Assess the effect of flossing on interproximal caries.
Results: Professional flossing for 1.7 yrs. on primary teeth was associated with a 40% caries risk reduction. Self flossing showed no effect.
Objective: To assess, the effect of flossing on interproximal caries.
Results: Professional flossing on school days for 1.7 yrs. on primary teeth was associated with a 40% caries risk reduction. Self flossing has failed to show an effect.

19. Soft Drinks
Carbonated Soft Drinks and Dental Caries in the Primary Dentition
Sohn, Burt, Sowers J Dent Res 85(3):
Objective: Analyze fluid intake data among 2-10 yr. old children in NHANES III ( ).
Results: 13% of children had high carbonated soft drink consumption, higher caries experience in primary dentition than other patterns. A fluid intake pattern, milk, water, or juice was less likely to be associated with dental caries.
Objective: Analyze fluid intake data among 2-10 yr. old children in NHANES III ( ).
Results: 13% of the children had high carbonated soft drink consumption, they had higher dental caries experience in primary dentition than other patterns. A fluid intake pattern, milk, water, or juice was less likely to be associated with dental caries.