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Recent Actions By and Against the Dental Board of California

California Dental Association Urges Dental Board to Rely on Scientifically Valid Science in Protection of Public-State Dental Group Supports Use of Sound Science in Establishing Public Policy Amid 'Junk Science' Arguments



SACRAMENTO, Calif., Nov 5, 2002 /PRNewswire via COMTEX/ -- In an attempt to develop a consumer-friendly cover sheet to accompany its rather technical Dental Materials Fact Sheet, the Dental Board of California is holding an informational hearing on Thursday, November 7, 2002 in Los Angeles.

Of concern to the California Dental Association (CDA) is that the hearing may undo the credible process, which resulted in the development of the fact sheet by the Board. "We have no issue with the development of a cover sheet," stated Judith Babcock, director of Professional Development and Relations for CDA. However, since the Board's adoption of the fact sheet in 2001, there is no new science to review. Thursday's meeting will only provide another opportunity by those who are opposed to the use of amalgam and whose arguments are not supported by sound, reliable science, to have "junk science" reviewed and considered by the board in developing its cover sheet."

The stated purpose of this hearing is to provide an avenue for new Dental Board members to hear the positions and science that were presented during the two-year process during which the comprehensive Dental Materials Fact Sheet was developed. Originally required in 1993, the Dental Board adopted a revised fact sheet in October of 2001 based upon a thorough review of the current scientific literature and research by an independent contractor hired by the Board through a Request for Proposal process. New legislation in 2002 required that the Fact Sheet by distributed to patients. (The previous fact sheet was a tool for dentists to use in discussing restorative materials with their patients.) Because of this new requirement to distribute the fact sheet to the public, the Dental Board wants to create a consumer friendly cover sheet.

"The Dental Materials Fact Sheet holds no surprises for dental professionals," said Steve Chan, DDS, CDA president. "Hundreds of thousands of Californians rely on restorative filling materials to help restore their teeth following removal of decay. Materials like amalgam, gold, porcelain and composites assist dentists in helping their patients. Our concern is that the use and availability of these materials be based upon credible, reliable research. For medicine, and dentistry is certainly a part of the medical field, to rely on anything other than credible research is a disservice to the public. It is simply reprehensible to think that public policy could be established based upon questionable science. That would be a disservice to consumers as well as to the medical and dental community." Amalgam is the most thoroughly tested, longest lasting, durable, versatile and cost effective material. By eliminating a material as cost effect and useful as amalgam is, would have a serious impact on access to dental care in our communities.

"Education of the public regarding dental health is a high priority to the CDA and other health professionals," stated Ms. Babcock. CDA relies on scientific experts and evaluations conducted by federal health agencies, such as The Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institute of Dental and Craniofacial Research, the U.S. Department of Health and Human Services through its Agency of Toxic Substances and Disease Registry and a variety of worldwide health organizations to determine if dental materials are safe. No organization has determined that dental amalgam is harmful

Make Your Opinion Count - Click Here http://tbutton.prnewswire.com/prn/11690X15466849

SOURCE California Dental Association

CONTACT: Judith Babcock of California Dental Association, +1-916-443-3382, ext. 4360




By Ed Fletcher
Bee Capitol Bureau
Published on page 3 of the Sacramento Bee
Sunday, July 1, 2001

Saying a recalcitrant state Dental Board has failed to fulfill its duties, the Legislature is swiftly moving toward ousting the current members of the panel.

State Sen. Liz Figueroa, D-Fremont, decided it was time to "clean house" when the board last month canceled a meeting to roll out a long-overdue fact sheet on the possible dangers of mercury in dental fillings.

A defender of the dental panel, however, says the effort is driven by alternative-practice dentists, oral surgeons and hygienists, who have their own reasons to oppose actions of the board.

SB 26 would immediately strip funding from the current dental panel, temporarily hand its duties and funds to the Department of Consumer Affairs and reconstitute the board with new members in January.

With little formal opposition, the bill is moving rapidly. It is expected to be considered by the Assembly on Monday and could reach Gov. Gray Davis' desk as soon as Thursday.

Davis has not taken a position on the bill, said a spokeswoman for the governor. Even without the bill, Davis could change the board's makeup substantially. He has the ability to appoint five new members who, along with four appointees he has already named, could control the 14-member board.

A new board with more Davis appointees would be more consumer-friendly and more responsive to the Legislature, say backers of the bill.

"The message is that if boards are not meeting the obligations of their statutes, this body will take every step necessary to make sure they are doing their job," Figueroa said. "In this case, I think the best assistance is to clean house and start over."

The board, which certifies and disciplines dentists, has wrangled for years with consumer advocates who contend the dangers of using mercury in "silver" fillings are greatly understated by the board and the American Dental Association.

Legislation passed in 1992 required the board to develop a fact sheet on the possible dangers of using mercury in dental fillings and distribute the information to dentists. Unhappy with the sheet the board produced, critics successfully petitioned for a new version in 1999. They are still waiting.

The final straw was the board's failure to meet June 14, when it was scheduled to release a draft of the fact sheet, Figueroa said. The meeting was canceled because board officials did not expect a quorum.

"When teeth decay and rot, they must be pulled out. Now it's time to extract the Dental Board because all it's been doing is protecting organized dentistry, not consumers," said Anita Vazquez Tibau of Consumers for Dental Choice.

The consumer group is also suing the ADA, saying the organization is deceiving the public by supporting the use of mercury in fillings. Amalgam fillings are about 50 percent mercury.

Mercury is powerful neurotoxic element that environmentalists say can lead to developmental problems in children and fetuses. The ADA contends that amalgamated fillings with mercury and silver are safe.

"There is no sound scientific evidence supporting a link between amalgam fillings and systemic diseases or chronic illness," ADA President Robert M. Anderton said in a statement responding to the lawsuit. The mercury fact sheet is a no-win situation for the board, said Peter Hartmann, a former member of the Dental Board.

Consumers for Dental Choice, supported by a group of dentists who oppose the use of mercury in fillings, won't stop criticizing the board until mercury is banned outright, Hartmann said. He said the Dental Board is not qualified to address a question the U.S. Food and Drug Administration has yet to authoritatively answer.

State officials argue that the mercury issue is just one example of the board's reluctance over the years to respond to legislators' concerns, including cracking down on dentists who illegally perform cosmetic surgery and allowing dental hygienists to perform certain dental procedures.

"The sunset proposal is the consequence of years of poor performance and non-responsiveness by a board with significant responsibility for the health and well-being of Californians," said Kathleen Hamilton, director of the Department of Consumer Affairs. Dental Board President Kit Neacy, a Covina periodontist, defended the board's actions.

"I think it is outrageous," Neacy said of the prospect of disbanding the panel, a move she called political "bloodletting." She said the state contracting process delayed efforts to produce an updated mercury fact sheet, and noted that Dental Board staff on Tuesday presented members of the Assembly Health Committee with proposed language.

Hartmann said some outside groups have "ganged up" on the board, including dental hygienists and oral surgeons unhappy with its actions. He and Neacy said it also has lost the political support of the California Dental Association, which they said disagreed with "consumer-friendly" actions taken by the panel. "We have not done the CDA's bidding and have taken their wrath," Neacy said.

A dental association representative said the group does "not oppose" efforts to disband the current board.

Under the Figueroa bill, the Dental Board would be re-established Jan. 1, 2002, with the current membership formula of eight practicing dentists, one dental hygienist, one dental assistant and four public members. The Bee's Ed Fletcher can be reached at (916) 326-5548 or efletcher@sacbee.com.


by Roger Simonian, DDS

(Published in the Quarterly News and Action Report, by The Dental Board of California,  June 30, 2000)

In recent editions, this column has been reserved for the President to share information about the Board. In keeping with that tradition, I would like to discuss the action of the Board took in December 1999, regarding a petition from Consumers for Dental Choice.The petition addressed five major points relative to Business and Professions Code Sections 1648.10 and 1648.20 of the 1992 statutes. At that meeting, the Board took action on four of the five points made in the petition.

Since that time, several reports have been written regarding the petition and the Board's action. This article is intended to clarify what was requested and how the Board responded to that request. Since this was a complex petition making several requests of the Board, for the benefit of the reader, the following information contains the legal basis for the petition, the specific requests, and the action taken by the Dental Board.

Business & Professions Code Section 1648.10 mandated the Dental Board of California to develop and distribute a Dental Materials Fact Sheet (Fact Sheet) which described and compared the risks and efficacy of the various types of dental restorative materials that may be used to repair a dental patient's oral condition or defect.

The law required the fact sheet to contain specific information and be updated as deemed necessary by the Board. Section 1648.20 exempts any dental tool or instrument used during the dental procedure from the provisions of Section 1648.10, and clarifies the language so the Fact Sheet focuses on those dental materials that remain in a patient's mouth after completion of a procedure. These can include, but are not limited to, removable and fixed restorative materials, orthodontic appliance materials, and materials used in the restoration of teeth.In May 1993, a two-page Fact Sheet containing the pros and cons of various dental restorative materials was developed and distributed by the Board.

The petitioner requested the revision of the Dental Material Fact Sheet to (1) rid the Fact Sheet of misleading language on amalgams; (2) include in the fact sheet all statuatory requirements regarding the dentist's responsibility to fully inform the patient of available options of dental restorative materials. The Fact Sheet should also encourage dentists to discuss with their patients the various advantages and disadvantages of the various dental filling materials; (3) the Fact Sheet update should cover the past six years of research documenting hazards of all dental filling materials and; (4) the Fact Sheet should provide dentist's with guidance on properly warning patients about the reproductive toxicity of the mercury contained in amalgam (see reproductive effects). The Fact Sheet should also address ways in which practitioners may determine patient sensitivity to mercury, i.e. a comprehensive health questionnaire. Any interested party should have the opportunity to review and comment on the Fact Sheet prior to its distribution.The Board's goal is to have a new Fact Sheet for distribution by December 2000, The Board voted to approve all of the above referenced recommendations.

The petitioner has requested the Board, as part of the licensure process, to require all participants in the dental licensure examination to complete a questionnaire on the various types of dental restorative materials.Board staff recommended that, in lieu of a questionnaire, the California Law Examination be revised to include questions on Business & Professions Code Section 1648.10. The Board voted to approve the above recommendation.

In addition, the petitioner requested a number of items the Board considered to fall under the general heading of informed consent. The petitioner requested that (1) the dentist advise patients of the different types of filling materials; (2) the dentist advise patients and staff that amalgam contains mercury (see amalgam composition), a substance designated under Proposition 65 and found to be hazardous. The petitioner also requested the dentist provide copies of the revised Fact Sheet to any patient requiring a restoration.

The Board voted to include an article in the newsletter encouraging dentists to discuss with their patients the different restorative materials. The article should also suggest that dentists discuss with their patients the percentage of mercury in amalgam  and that mercury and other substances used in dental offices are designated hazardous under Proposition 65.

The Board encourages discussion between dentist and patient regarding the potential sensitivity and allergic or adverse reactions to mercury by some patients. The Board further approved the distribution of the revised Fact Sheet to all licensed dentists.  The petitioner requested the Board to clarify its position on mercury-free practice. The Board agreed to plublically clarify that it has no position either pro, or con, on the various dental restorative materials. The dentist is free to decide what type of restorative materials he/she may use or not use in practice. However, the Dental Board of California encourages dentists to discuss the choice of restorative materials with their patients.


Do amalgam fillings contain mercury? Yes.

Does mercury escape from amalgam fillings? Yes.

Have the levels of mercury released by amalgam fillings been shown through controlled scientific study to be dangerous? No.

Clearly, we need to be sensible about the information we provide to the public. Anecdotal information and simple facts quoted out of context without qualification and without correct interpretation can be misleading and alarming.

  • Mercury is a component of the amalgam used in silver-colored fillings. The other major ingredients are silver, tin, copper, and zinc. When mixed, these elements bond to form a strong, stable substance. The average content of mercury in an amalgam restoration is slightly less than 50 percent.
  • For more than 150 years, billions of amalgam restorations have been placed and a National Institutes of Health report states that only 50 documented cases of allergy to mercury have been reported in scientific literature since 1906. One hundred million people in the United States have amalgam fillings and 100 million amalgam fillings are placed each year.
  • Studies show that no filling material has been proven superior to amalgam in safety, durability, and cost effectiveness. Amalgam has been researched worldwide and no study has ever caused a professional dental organization or agency to recommend a ban of amalgam.
  • The amount of mercury ingested by someone with amalgam restorations is miniscule – well below established health safety standards. Mercury also enters the body through the ingestion of food (i.e., fish) and water, and through breathing air. Eventually, the body rids itself of mercury, but there is always a very low level of mercury present in the body.
  • In 1995, following a meeting of government health officials from nine European nations, the United States and Canada, the U.S. Public Health Service released a statement reiterating that there are "no scientifically compelling reasons either to discontinue or to curtail the clinical use of dental amalgam or to recommend removal of existing amalgam fillings," without clear evidence of allergy or intolerance in individual patients.
  • A 1999 article in the Journal of the American Dental Association, reported that researchers found "no significant association of Alzheimer’s Disease with the number, surface area or history of having dental amalgam restorations." Other claims that the removal of amalgam fillings leads to recovery from multiple sclerosis or that the use of amalgam leads to arthritis are unsubstantiated and without scientifically established cause and effect.
  • The CDA does not believe that a dentist should prey upon the fears of people who have serious medical conditions by selling them dental treatment that may cost thousands of dollars and for which no cure has been proven.
  • In 1997, the World Health Organization stated that no controlled studies have been published demonstrating systemic adverse effects from amalgam restorations.
  • The long-term cost of two- or three-surface gold or composite restorations in permanent teeth is about four times greater than for amalgam restorations.
  • There is no sound scientific evidence to support any health benefits from the removal of amalgam. The ADA Council on Ethics, Bylaws and Judicial Affairs has stated that "Based on available scientific data, the ADA has determined…that the removal of amalgam restorations from the non-allergic patient for the alleged purpose of removing toxic substances from the body, when such treatment is performed solely at the recommendation or suggestion of the dentist, is improper and unethical." Replacing dental amalgam for aesthetic purposes has its own risks and the dentist should discuss all of the risk/benefits with the patient before replacing serviceable amalgam restorations.
  • The Dental Board of California is currently finalizing a Dental Materials Fact Sheet that describes the various restorative materials available to the dental profession for restoration of an oral condition or defect. The relative benefits and detriments of each group of materials are also provided. This information is being provided by an independent, qualified scientific consultant and will be available to all licensed dentists in California to make available to their patients.

 June 14, 2001

Dentistry, amalgam, and pollution prevention.

Johnson WJ, Pichay TJ.

California Dental Association, 1201 K St., 14th Floor, Sacramento, CA 95814, USA.

J Calif Dent Assoc (2001) Jul;29(7):509-17


California has issued fish consumption advisories because of mercury in lakes, reservoirs, creeks, rivers, and bays. Mercury in these waterways leads to the formation of methylmercury, which is toxic and bioaccumulative. Dental practices and other health care settings contribute a portion of this mercury. Government agencies are implementing programs to reduce mercury pollution. Dentists can reduce their contributions by implementing best management practices. They may also consider using pretreatment technologies as more information becomes available about their use and effectiveness.

Mercury Pollution Prevention

From the City of Palo Alto, CA


Each year, about 20 pounds of mercury arrive at the Regional Water Quality Control Plant (RWQCP). Sources of mercury discharge to wastewater include laboratories, hospitals, dental offices, human waste, food waste, household products, and storm water inflow. Since 1997, the RWQCP has quantified the relative importance of mercury sources using local sampling information in conjunction with data from other wastewater treatment plants and the scientific literature. The source identification study was updated in March 2001, leading to the pie chart presented here.



CDA Press Room


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December 13, 2002 -- The California Dental Association Addresses False Statements by Environmental Group
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