Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2014-06-27, 17:02:56 | version 1.30.01
news 7IDEM Singapore 2014 Show Preview The adoption of the Minamata ConventioninJapanrecentlymade way for a ban on mercury-contain- ing products on a worldwide scale. Provision was also made for phas- ing down the use of and trade in dental amalgam. Dental Tribune International had the opportunity to speak with the Executive Di- rectoroftheInternationalAssocia- tion for Dental Research (IADR), Christopher H. Fox, who attended four of the intergovernmental ne- gotiating committee sessions on behalf of the dental profession, abouttheimpactthiscouldhaveon dentistry and the future of dental amalgam as a restorative dental material. DTI: The recently adopted Mina- mata Convention on Mercury includes provisions on phasing down dental amalgam on a globalscale.Whatimpactdoyou think this will have on the den- tal community and particularly 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.Inaddition,itisintended to address the need for the reduc- tion of atmospheric emissions of mercury, as well as mercury releases on land and in water. Dental amalgam is included in thetreatyasamercury-addedprod- uct contributing to the global de- mand for mercury. In this regard, it is important to note that the treaty calls for phasing down the use of dental amalgam, as opposed to phasingoutorbanningtheuseofit. This will give the industry and pro- fession time to make a transition and preserve dental restorative choices for our profession and pa- tients. One of the provisions for phas- ing down dental amalgam is for countries to set national objectives aimed at dental caries prevention andhealthpromotion,therebymin- imising the need for any dental restoration. A greater emphasis on preventionandhealthpromotionis indeed welcome and will provide the greatest benefit to populations. Another provision promotes re- searchanddevelopmentofalterna- tive dental restorative materials. So, in the long run, dentistry and restorative dentistry, in particular, will have improved dental restora- tivematerialsfromwhichtochoose for their patients. You were involved in some of theintergovernmentalnegotiat- ing committee sessions in the run-up to the Convention. What were the most discussed issues in formulating the treaty, and didtheoutcomemeettheexpec- tations of those involved in den- tistry? Themostdiscusseddentalamal- gam issue was a ban versus a phase-down. Led by the Responsi- bleOfficerfortheWHOGlobalOral Health Programme, Dr Poul Erik Petersen, a coalition of concerned dental organisations was able to show country negotiators that a ban would be detrimental to popu- lation oral health. Dental amalgam is a safe and effective dental restoration and remains the best restorative choice in many clinical situations or health system situa- tions. As with any complex negoti- ation, the outcome has met many people’s expectations, but there are those who would have pre- ferred a phase-out of dental amal- gam and those who would have preferrednolimitationssetonden- tal amalgam. Another area of discussion was the need for best environmental practices in dental facilities to re- duce releases of mercury and mer- curycompoundstowaterandland. Dentistrymustbeagoodstewardof the environment and implement best environmental practices for dental amalgam, as well as for all other dental materials, medical waste and consumables. You mention that in the dental communityamalgamisstillcon- sidered to be effective and safe. Sowhyphasedownitsuseatall? Dental amalgam is a safe and ef- fectiverestoration.TheUSNational InstituteofDentalandCraniofacial Research funded two large-scale randomised clinical trials on the safety of dental amalgam in chil- dren and failed to find any adverse health effects. The reason for the agreed-upon phase-down is solely the environmental and health ef- fects of mercury in the environ- ment, not the direct health effects of the use of dental amalgam. Mercury poisoning from amal- gamismostlyfoundincountries where recycling of the material is insufficient. Is this not a more pressingissuethatshouldbead- dressed globally? The proper handling of dental amalgam and its waste must be ad- hered to by the dental profession and the health facilities in which they work. In addition to the provi- sion in the Minamata Convention calling for best environmental practices, there is a provision call- ing for dental amalgam to be used only in its encapsulated state. Only some countries require the use of dental amalgam separators and many more dental professional or- ganisationsarecallingfortheiruni- versal use. Even if we were successful with our oral health promotion pro- grammes however and could stop usingdentalamalgamtomorrowby theintroductionofnext-generation dentalrestorativematerials,dental facilities would need dental amal- gam separators in place for at least a generation as currently placed dentalamalgamscometotheendof their life cycle and need to be re- placed. Alternatives to mercury-con- taining dental filling material were discussed last year at an IADR–FDI workshop on dental materials. Is there any viable al- ternative, and what needs to be done to implement and sustain its use in the future? The symposium at the recent FDI Annual World Dental Congress 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, innovativedentalrestorativemate- rials, but it is going to take a signifi- cant 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, clinical safety and effective- ness trials and regulatory ap- provalswilltakesignificantlymore time. Practising dentists have an importantroleheretoo,astheycan participate in research networks evaluatingnewmaterialsandiden- tifying research questions, not to mention advocating for research fundingwithpolicymakersintheir country. Withtheadventofpreventative dentistry, stem cell research 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- tagedpost-fluoridegeneration.Our greatest challenge is addressing theoralhealthneedsofsociallydis- advantaged and vulnerable popu- lations. The IADR has a research agenda to reduce these oral health inequalities across populations andhopefullywewillreachapoint at which dental restorative materi- als are rare for everybody. Thank you very much for the in- terview. AD “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