Mercury teeth fillings may harm some: U.S. FDA
Article from Reuters By Susan Heavey
June 4, 2008

Silver-colored metal dental fillings contain mercury that may cause health problems in pregnant women, children and fetuses, the Food and Drug Administration said on Wednesday after settling a related lawsuit.

As part of the settlement with several consumer advocacy groups, the FDA agreed to alert consumers about the potential risks on its website and to issue a more specific rule next year for fillings that contain mercury, FDA spokeswoman Peper Long said.

Millions of Americans have the fillings, or amalgams, to patch cavities in their teeth.

"Dental amalgams contain mercury, which may have neurotoxic effects on the nervous systems of developing children and fetuses," the FDA said in a notice on its Web site.

"Pregnant women and persons who may have a health condition that makes them more sensitive to mercury exposure, including individuals with existing high levels of mercury bioburden, should not avoid seeking dental care, but should discuss options with their health practitioner," the agency said.

The FDA said it did not recommend that people who currently have mercury fillings get them removed.

The FDA must issue the new rules in July 2009, Long said.

Such a rule could impact makers of metal fillings, which include Dentsply International Inc and Danaher Corp unit Kerr.

The new rule will give the agency "special controls (that) can provide reasonable assurance of the safety and effectiveness of the product," Long said.

The lawsuit settlement was reached on Monday with several advocacy groups, including Moms Against Mercury, which had sought to have mercury fillings removed from the U.S. market.

While the FDA previously said various studies showed no harm from mercury fillings, some consumer groups contend the fillings can trigger a range of health problems such as multiple sclerosis and Alzheimer's disease. In 2006, an FDA advisory panel of outside experts said most people would not be harmed by them, but said the agency needed more information.

Mercury has been linked to brain and kidney damage at certain levels. Amalgams contain half mercury and half a combination of other metals.

Charles Brown, a lawyer for one of the groups called Consumers for Dental Choice, said the agency's move represented an about-face. "Gone, gone, gone are all of FDA's claims that no science exists that amalgam is unsafe," he said in a statement.

J.P. Morgan Securities Inc. analyst Ipsita Smolinski said the FDA is not likely to outright ban the fillings next year but will probably call for restrictions.

"We do believe that the agency will ask for the label to indicate that mercury is an ingredient in the filling, and that special populations should be exempt from such fillings, such as: nursing women, pregnant women, young children, and immunocompromised individuals," Smolinski wrote in a research note on Wednesday.

Fewer patients have been opting for mercury fillings in recent years, instead choosing lighter options such as tooth-colored resin composites.

Only 30 percent of fillings given to patients were mercury-filled ones as of 2003, according to the American Dental Association (ADA). Other options include glass cement and porcelain as well as other metals such as gold, but they cost more and are less durable, the group has said.

Read the full story on Yahoo!
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Should Patients Take Antibiotics Prior to a Dental Appointment?
Article from: American Dental Association
8:57 a.m. EST March 1, 2007

For decades, the American Heart Association (AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. The AHA’s latest guidelines were published in its scientific journal, Circulation, in April 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.

The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:

• mitral valve prolapse
• rheumatic heart disease
• bicuspid valve disease
• calcified aortic stenosis
• congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.

Preventive antibiotics prior to a dental procedure are advised for patients with:

• artificial heart valves
• a history of infective endocarditis
• certain specific, serious congenital (present from birth) heart conditions, including
  • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
  • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
  • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
• a cardiac transplant that develops a problem in a heart valve.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

The full report is available to download below, along with supporting charts. If you have any questions about these guidelines, please feel free to contact the ADA Division of Science via e-mail or by calling 312-440-2878. ADA members may use the Association’s toll-free number and ask for x2878.

View the original article at:
http://www.ada.org/prof/resources/topics/infective_endocarditis.asp

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