Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2014-09-12, 17:13:35 | version 1.30.01
News Saturday & Sunday, 13–14 September 2014 4 www.fdiworldental.org A t the Public Health Section/ Chief Dental Officers’ Forum, whichwasheldyesterdayhere at the FDI Annual World Dental Con- gress in Greater Nioda, experts dis- cussed how India could prepare for the phase-down of amalgam follow- ing the adoption of the Minamata Convention in Japan last year which made way for a ban on mercury-con- taining products on a worldwide scale. Dental Tribune on behalf of Worldental Daily had the opportu- nity to speak with the Executive Di- rector of the International Associa- tion for Dental Research (IADR), Christopher H. Fox, who attended four of the intergovernmental nego- tiating committee sessions on be- half of the dental profession, about the impact the convention will have on dentistry and the future of dental amalgamasarestorativedentalma- terial. DTI: The recently adopted Minamata ConventiononMercuryincludesprovi- sions on phasing down dental amal- gamonaglobalscale.Whatimpactdo you think this will have on the dental community and particularly restora- tivedentistryinthelongrun? Christopher Fox: I think it must be first pointed out that the Minamata Convention is a very broad treaty de- signed to reduce all use of and interna- tional trade in mercury, as well as the demand for mercury in products and processes. In addition, it is intended to addresstheneedforthereductionofat- mospheric emissions of mercury, as wellasmercuryreleasesonlandandin water. Dental amalgam is included in the treatyasamercury-addedproductcon- tributing to the global demand for mer- cury.Inthisregard,itisimportanttonote thatthetreatycallsforphasingdownthe use of dental amalgam, as opposed to phasingoutorbanningtheuseofit.This will give the industry and profession time to make a transition and preserve dental restorative choices for our pro- fessionandpatients. One of the provisions for phasing downdentalamalgamisforcountriesto set national objectives aimed at dental caries prevention and health promo- tion, thereby minimising the need for any dental restoration. A greater em- phasisonpreventionandhealthpromo- tionisindeedwelcomeandwillprovide thegreatestbenefittopopulations. Another provision promotes re- search and development of alternative dental restorative materials. So, in the long run, dentistry and restorative den- tistry, in particular, will have improved dentalrestorativematerialsfromwhich tochoosefortheirpatients. Youwereinvolvedinsomeoftheinter- governmental negotiating committee sessions in the run-up to the Conven- tion.Whatwerethemostdiscussedis- sues in formulating the treaty, and did the outcome meet the expectations of thoseinvolvedindentistry? Themostdiscusseddentalamalgam issue was a ban versus a phase-down. Led by the Responsible Officer for the WHOGlobalOralHealthProgramme,Dr Poul Erik Petersen, a coalition of con- cerneddentalorganisationswasableto show country negotiators that a ban wouldbedetrimentaltopopulationoral health.Dentalamalgamisasafeandef- fective dental restoration and remains thebestrestorativechoiceinmanyclini- cal situations or health system situa- tions. As with any complex negotiation, theoutcomehasmetmanypeople’sex- pectations, but there are those who would have preferred a phase-out of dental amalgam and those who would havepreferrednolimitationssetonden- talamalgam. Another area of discussion was the needforbestenvironmentalpracticesin dental facilities to reduce releases of mercury and mercury compounds to water and land. Dentistry must be a good steward of the environment and implement best environmental prac- tices for dental amalgam, as well as for all other dental materials, medical wasteandconsumables. Youmentionthatinthedentalcommu- nity amalgam is still considered to be effectiveandsafe.Sowhyphasedown itsuseatall? Dental amalgam is a safe and effec- tive restoration. The US National Insti- tuteofDentalandCraniofacialResearch fundedtwolarge-scalerandomisedclin- icaltrialsonthesafetyofdentalamalgam inchildrenandfailedtofindanyadverse healtheffects.Thereasonfortheagreed- upon phase-down is solely the environ- mental and health effects of mercury in theenvironment,notthedirecthealthef- fectsoftheuseofdentalamalgam. Mercury poisoning from amalgam is mostly found in countries where recy- cling of the material is insufficient. Is this not a more pressing issue that shouldbeaddressedglobally? Theproperhandlingofdentalamal- gamanditswastemustbeadheredtoby thedentalprofessionandthehealthfa- cilitiesinwhichtheywork.Inadditionto the provision in the Minamata Conven- tioncallingforbestenvironmentalprac- tices,thereisaprovisioncallingforden- talamalgamtobeusedonlyinitsencap- sulated state. Only some countries re- quire the use of dental amalgam separators and many more dental pro- fessional organisations are calling for theiruniversaluse. Even if we were successful with our oral health promotion programmes however and could stop using dental amalgamtomorrowbytheintroduction of next-generation dental restorative materials, dental facilities would need dental amalgam separators in place for atleastagenerationascurrentlyplaced dental amalgams come to the end of theirlifecycleandneedtobereplaced. AccordingtotheConvention,anumber ofproductscontainingmercurywillbe bannedfrom2020.Doyoubelievethat amalgam will still play a major role in restorativedentistrybythattime? Seven years is a short time frame when we are relying on a research and development pipeline to deliver im- proved dental restorative materials. Withoutbeingtoopessimistic,atypical research and development time frame fromdiscoverytoclinicaluseinthephar- maceutical arena is 17 years. So, I be- lievedentalamalgamwillstillbewithus in2020,butIamoptimisticitwillplaya much-reduced role in restorative den- tistry. Alternatives to mercury-containing dental filling material were discussed last year at an IADR–FDI workshop on dentalmaterials.Isthereanyviableal- ternative,andwhatneedstobedoneto implementandsustainitsuseinthefu- ture? ThesymposiumattherecentFDIAn- nual World Dental Congress in Istanbul was actually a much-condensed sum- mary of a two-day workshop held in December 2012 at King’s College Lon- don.Inbrief,yes,wecanhavemuch-im- proved, innovative dental restorative materials,butitisgoingtotakeasignif- icant commitment from government funders,academiaandindustry.Keepin mindthatevenifanewmaterialcouldbe developed within a one- or two-year timeframe,clinicalsafetyandeffective- nesstrialsandregulatoryapprovalswill take significantly more time. Practising dentists have an important role here too, as they can participate in research networksevaluatingnewmaterialsand identifying research questions, not to mention advocating for research fund- ingwithpolicymakersintheircountry. Foramorecompleteanswertoyour question, I would refer your readers to the proceedings, which have just been published in the November issue of the AdvancesinDentalResearch,ane-sup- plement to the Journal of Dental Re- search. With the advent of preventative den- tistry, stem cell research and the so- phistication of tooth replacements, will restorative materials become ob- soletesomeday? Dental restorative materials are al- ready obsolete or nearly obsolete for the socially advantaged post-fluoride generation. Our greatest challenge is addressing the oral health needs of so- cially disadvantaged and vulnerable populations. The IADR has a research agenda to reduce these oral health inequalities across populations and hopefully we will reach a point at which dental restorative materials are rare for everybody. Thankyouverymuchfortheinterview. for global oral health The FDI Data Hub for global oral health is a Vision 2020 project supported by: DATAHUB STRATEGY STRATEGY STRATEGY ANALYSIS ANALYSIS ANALYSIS PLANNING LANNING EVALUATION ALUATION EVALUATION MISSION M ON MISS MISSION MISSION GOALS GOA GO SOCIAL SOCIAL GOALS SOCIAL IDEAS IDEAS ORGANIZING ORGANIZING ANIZING ORGANIZING PLANNING PLANNING IDEAS IDEAS IDEAS IDEAS ZING INNOVATION INNOV DENTISTRY DENTIS DENT DE SUCCESS VISION SION SUCCE ORAL HEALTH ORAL HEALTH ORAL HE TEAMWORK AMWORK GENERAL HEALTH IMPLEMENTATION DEVELOPMEN PROGRESS NCDs NCDs N AD “Reachapointwheredentalrestorative materialsarerareforeverybody” IAninterviewwithChristopherH.Fox,ExecutiveDirectoroftheInternationalAssociationforDentalResearch IChristopherH.Fox