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fluoridated drinking-water, salt, milk, mouth rinse or toothpaste, as well as from professionally applied fluorides; or from combinations of toothpaste containing fluoride with any of the other fluoride sources. Thirdly, development of healthy lifestyles including proper general and oral hygiene behaviour, and healthy environments such as access to clean water and sanitation are essential to oral health (1). Several high income countries having established preventive programmes demonstrate a systematic decline in dental caries in children and improved dentate status in adult populations (3,5). In most middle and low income countries oral disease prevention programmes are not yet organized. In addition, the vast majority of people are underserved and the need for comprehensive oral health care is growing dramatically, including dental restorative care. In response to the Bangkok 6th World Conference on Health Promotion (13), the Liverpool declaration in 2005 formulated guidelines on appropriate interventions for oral health (14). The World Health Assembly in 2007 agreed on a resolution (WHA60.17): Oral health: action plan for promotion and integrated disease prevention (15).The resolution gives directions to countries in identifying the opportunities for oral health and the development or adjustment of oral health systems (16). The World Health Report 2008 on Primary Health Care (17) is a vital instrument to countries in their efforts to 3 Future Use of Materials for Dental Restoration ensure universal coverage and the provision of essential health care to populations. Effective primary oral health care - particularly in middle and low income countries – will focus on the unmet needs for dental care and dental restoration. 1.3 Dental restoration In spite of the success in the prevention of dental caries, caries in need of restoration still occur. In the case of dental treatment, diseased tissue is removed and teeth restored with appropriate material(s). In high income countries, dental amalgam has been widely used over decades as a dental restorative material. Providers of oral health care in low- and middle income countries also generally consider amalgam of relevance in serving their patients. However, the limited availability of oral health manpower, service facilities and materials for dental restoration, and the high cost of dental restorative treatment induce radical treatment with the extraction of teeth among people suffering from pain and illness. Consequently, unless the access to dental restorative treatment is further improved, the growing burden of dental caries in low and middle income countries will result in even higher numbers of people becoming edentulous in the near future. 1.4 WHO Consultation 1997 1.4.1 Dental amalgam and alternative direct restorative materials Dental amalgam is widely used in restorative care and is a compound of mercury and silver-based alloys; however, some concerns have been expressed about the possible health effects of mercury in amalgam and to contamination of the environment from mercury. In 1997, the WHO held a Consultation Meeting on the use of dental amalgam (18) The objective of this consultation was “To provide more information to the Member States, WHO/ORH was requested to review again the WHO/FDI Consensus Statement and if necessary draft a relevant document on dental amalgam use, taking into account the benefits, but also risks for individual, occupational, and environmental health of restorative materials. The project was thoroughly scrutinized by the WHO Programmes on Environmental Health and Occupational health.” The consensus statement on restorative dental care also emphasized the need for further research on alternatives to dental amalgam. 1.4.2 Research agenda to improve health The participants of the WHO Consultation in 1997 devoted considerable time to a discussion of a research agenda related to dental restorations (18). The Consultation unanimously agreed to establish the following research topics: 4 Oral Health Programme § Global registry of biological and adverse health effects for monitoring of dental material related symptoms/diseases in various populations (patients and