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today ADX Sydney 2014

science & practice 13ADX14 Sydney The adoption of the Minamata Convention in Japan recently made way for a ban on mercury- containing products on a world- wide scale. Provision was also made for phasing down the use of and trade in dental amalgam. Den- tal Tribune International had the opportunity to speak with the Ex- ecutive Director of the Interna- tional Association for Dental Re- search(IADR),ChristopherH.Fox, who attended four of the intergov- ernmental negotiating committee sessions on behalf of the dental profession, about the impact this could have on dentistry and the future of dental amalgam as a restorative dental material. DTI: The recently adopted Mi- namata Convention on Mer- cury includes provisions on phasing down dental amalgam on a global scale. What impact do you think this will have on the dental community and par- ticularly restorative dentistry in the long run? Christopher Fox: I think it must be first pointed out that the Minamata Convention is a very broad treaty designed to reduce all use of and international trade in mercury, as well as the demand for mercury in products and processes. In addition, it is intend- ed to address the need for the re- duction of atmospheric emissions of mercury, as well as mercury releases on land and in water. Dental amalgam is included in the treaty as a mercury-added product contributing to the global demand for mercury. In this re- gard, it is important to note that the treaty calls for phasing down the use of dental amalgam, as op- posed to phasing out or banning the use of it. This will give the industry and profession time to make a transition and preserve dental restorative choices for our profession and patients. One of the provisions for phas- ing down dental amalgam is for countries to set national objectives aimed at dental caries prevention and health promotion, thereby minimising the need for any dental restoration. A greater emphasis on prevention and health promotion is indeed wel- come and will provide the great- est benefit to populations. Anotherprovisionpromotesre- search and development of alter- native dental restorative materi- als. So, in the long run, dentistry and restorative dentistry, in par- ticular, will have improved dental restorative materials from which to choose for their patients. You were involved in some of the intergovernmental negoti- atingcommitteesessionsinthe run-uptotheConvention.What were the most discussed issues in formulating the treaty, and did the outcome meet the ex- pectations of those involved in dentistry? The most discussed dental amalgam issue was a ban versus a phase-down. Led by the Responsi- ble Officer for the WHO Global Oral Health Programme, Dr Poul Erik Petersen, a coalition of con- cerned dental organisations was able to show country negotiators thatabanwouldbedetrimentalto population oral health. Dental amalgam is a safe and effective dental restoration and remains the best restorative choice in many clinical situations or health system situations. As with any complex negotiation, the outcome has met many people’s expecta- tions, but there are those who would have preferred a phase-out of dental amalgam and those who would have preferred no limita- tions set on dental amalgam. Another area of discussion was the need for best environmental practices in dental facilities to re- ducereleasesofmercuryandmer- cury compounds to water and land. Dentistry must be a good steward of the environment and implement best environmental practices for dental amalgam, as well as for all other dental materi- als, medical waste and consum- ables. You mention that in the dental community amalgam is still considered to be effective and safe. So why phase down its use at all? Dentalamalgamisasafeandef- fective restoration. The US Na- tional Institute of Dental and Craniofacial Research funded two large-scale randomised clinical trials on the safety of dental amal- gam in children and failed to find any adverse health effects. The reason for the agreed-upon phase- down is solely the environmental and health effects of mercury in the environment, not the direct health effects of the use of dental amalgam. Mercury poisoning from amal- gam is mostly found in coun- trieswhererecyclingofthema- terial is insufficient. Is this not a more pressing issue that should be addressed globally? The proper handling of dental amalgamanditswastemustbead- hered to by the dental profession and the health facilities in which they work. In addition to the pro- vision in the Minamata Conven- tion calling for best environmen- tal practices, there is a provision calling for dental amalgam to be used only in its encapsulated state. Only some countries re- quire the use of dental amalgam separators and many more dental professional organisations are calling for their universal use. Evenifweweresuccessfulwith our oral health promotion pro- grammes however and could stop using dental amalgam tomorrow by the introduction of next-gener- ationdentalrestorativematerials, dental facilities would need den- tal amalgam separators in place for at least a generation as cur- rently placed dental amalgams come to the end of their life cycle and need to be replaced. According to the Convention, a number of products containing mercury will be banned from 2020. Do you believe that amal- gam will still play a major role in restorative dentistry by that time? Seven years is a short time frame when we are relying on a re- search and development pipeline todeliverimproveddentalrestora- tive materials. Without being too pessimistic, a typical research and development time frame from dis- covery to clinical use in the phar- maceutical arena is 17 years. So, I believe dental amalgam will still be with us in 2020, but I am opti- mistic it will play a much-reduced role in restorative dentistry. Alternatives to mercury-con- taining dental filling material were discussed last year at an IADR–FDI workshop on dental materials. Is there any viable alternative, and what needs to be done to implement and sus- tain its use in the future? The symposium at the recent FDIAnnualWorldDentalCongress in Istanbul was actually a much- condensed summary of a two-day workshop held in December 2012 at King’s College London. In brief, yes, we can have much-improved, innovative dental restorative ma- terials, but it is going to take a sig- nificant commitment from govern- mentfunders,academiaandindus- try. Keep in mind that even if a new material could be developed within a one- or two-year time frame,clinicalsafetyandeffective- ness trials and regulatory ap- provals will take significantly moretime.Practisingdentistshave an important role here too, as they can participate in research net- works evaluating new materials and identifying research ques- tions,nottomentionadvocatingfor research funding with policymak- ers in their country. For a more complete answer to your question, I would refer your readers to the proceedings, which havejustbeenpublishedintheNo- vember issue of the Advances in Dental Research, an e-supplement to the Journal of Dental Research. With the advent of preventa- tive dentistry, stem cell re- search and the sophistication of tooth replacements, will restorative materials become obsolete someday? Dental restorative materials are already obsolete or nearly obsolete for the socially advan- taged post-fluoride generation. Our greatest challenge is address- ing the oral health needs of so- cially disadvantaged and vulnera- ble populations. The IADR has a research agenda to reduce these oral health inequalities across populationsandhopefullywewill reach a point at which dental restorative materials are rare for everybody. Thank you very much for the interview. “Reach a point where dental restorative materials are rare for everybody” An interview with Christopher H.Fox,Executive Director of the InternationalAssociation for Dental Research “The reason for the agreed-upon phase-down is solely the environmental and health effects of mercury in the environment,not the direct health effects of the use of dental amalgam.” Christopher H. Fox