Page 18
academics, WHO CCs, ministries of health, Non-Governmental Organizations (NGOs), dental professionals, and UNEP. Following opening statements from Dr Ala Alwan, Assistant Director General, Non-communicable Diseases and Mental Health and Mr Per Bakken, Director, UNEP Chemicals, Dr Poul Erik Petersen outlined the scope, purpose, objectives and structure of the meeting. This was followed by a number of presentations and discussions. Day One discussed the availability of different restorative materials, and their advantages and disadvantages in dental care. Experiences from both developed and developing countries of all WHO regions were shared in Day Two, which highlighted the implications for oral healthcare and future challenges. The meeting considered the importance of strengthening oral health promotion and disease prevention as the strategy to reduce the use of restorative dental materials. In case of tooth decay, the best care possible should be provided to meet patients’ needs. The meeting recognized the variation in dental practice between countries and the challenges faced by middle- and low-income countries providing dental care. This will likely result in different approaches to dental caries management in countries that need to be considered in oral health policy, development and planning vi Oral Health Programme of public health programmes. Implications for training of dental personnel and costs to society as well as the individual are significant. The meeting noted that only a few countries had phased out the use of amalgam. If not existing, other countries require systems for waste management to prevent release of mercury to the environment. In several countries dental amalgam is still widely used. The choice of materials for dental caries management in these countries depends on a number of factors such as: the tooth, site and size of the caries lesion, as well as healthcare provision and financing, patient preference, health care provider preference, technology, cost and environmental factors. Following a review of existing evidence and much deliberation, the meeting recognized the huge challenges faced in dental restoration, disease prevention and oral health promotion globally. As a result, the meeting considered that all currently existing methods and materials to manage dental caries would need to remain available to the dental profession in the short- and mediumterms. Furthermore, the meeting noted that while alternative dental restorative materials are desirable from an environmental health perspective, a progressive move away from dental amalgam would be dependent on adequate quality of these materials. Existing alternative dental materials are not ideal due to limitation in durability, fracture resistance, and wear resistance. Therefore, the meeting recognized the need for strengthening of research into the long-term performance, possible adverse effects, and viability of such materials. It may be prudent to consider ‘phasing down’ instead of ‘phasing out’ of dental amalgam at this stage. A multi-pronged approach with short-, medium- and longterm strategies should be considered. Alternatives to dental amalgam exist but the quality of such materials needs to be further improved for use in public health care. The meeting suggested important strategies that can be put in place while waiting for new materials to be developed. The role of WHO, UNEP, NGOs such as the International Association for Dental Research (IADR) and the World Dental Federation (FDI), user groups and the industry is critical. A further meeting must be convened to discuss the way forward and to develop strategies to address issues in both developed and developing countries. 1 Future Use of Materials for Dental Restoration 1. Introduction 1.1 The global burden of dental caries Dental caries (tooth decay) has historically been considered the most important component of the global oral disease burden. Dental caries is still a major public health problem in most high income countries as the disease affects 60-90% of school-aged children and the vast majority of adults. At present, the distribution and severity of dental caries vary in different parts of the world and within the same region or country (1-4).