ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Bisphenol-A Exposure From Dental Sealants Is Minimal and Does not Cause Increased Morbidity or Mortality
Clinical Question Do dental sealants cause increased bisphenol-A (BPA) levels in the body that could result in increased morbidity and/or mortality?
Clinical Bottom Line Although further research is warranted, dental sealants can result in increased salivary BPA concentrations but do not pose a risk to the patient’s morbidity or mortality.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18353205Azarpazhooh/200811 studies evaluating sealant placement, release of materials and effects.Systematic Review
Key resultsThe evidence suggests that dental sealants do not place patients at risk for BPA exposure. In the case of possible exposure, providers can use a mild abrasive (such as flour of pumice) to clean the sealant surface among other methods.
#2) 20579427Zimmerman-Downs/201030 adultsRandomized controlled trial
Key resultsSalivary BPA levels were significantly elevated above baseline immediately following placement of dental sealants in adults. BPA levels in the saliva returned to baseline at 24 hours post placement. At no time during the study was BPA present in the blood of the patient.
Evidence Search “Dental Sealant” AND “Bisphenol”
Comments on
The Evidence
The first article is a systematic review that covered clinical and in vitro trials. It was reported that BPA (when present) did not have any adverse effect on patients. One article examined how to reduce BPA levels post placement and examined causes of increased BPA levels (ex: inadequate cure). This article presented options to treat the dental sealant to minimize BPA elution. The second article is a more recent randomized controlled trial that showed a significant increase in salivary BPA levels after placement of dental sealants but did not examine adverse effects on the patients. It appears that BPA may elute from dental sealants into the oral cavity, but at this time it is unclear if there is any particular mechanism of action or effect it may have on the human body.
Applicability Based on the evidence, the clinician can better respond to patient concerns regarding bisphenol-A in dental sealants. Clinicians can also greatly reduce the exposure to bisphenol-A in dental sealants using proper precautions and finishing such as placing with a rubber dam, completely curing and either pumicing, rinsing for 30 seconds or having the patient gargle for 30 seconds as recommended by Azarpazhooh, et al.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Restorative Dentistry) (Basic Science)
Keywords Bisphenol-A, dental sealants, resin, BPA
ID# 2313
Date of submission: 08/07/2012spacer
E-mail JohnsonRI@uthscsa.edu
Author Russell Johnson
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Daniel Bakko, DDS
Faculty mentor/Co-author e-mail bakko@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Russell Johnson (Seattle, WA) on 09/17/2012
The biologic basis for this question relates to the structure and form of bisphenol-A (BPA) in dental materials. BPA is a hormonally active xenoestrogen, which is a synthetic chemical known to mimic the functions of estrogen and disrupt normal endocrine function (PMID: 20579427 ). BPA is a precursor in the setting reaction to Bis-GMA and bisphenol A dimethacrylate and can be present in cured composite materials when the reaction does not go to completion or during hydrolysis breakdown by salivary esterases (PMID: 22629496 , 10649872). This supports the CAT findings that newly placed sealants have decreased detectable BPA when pumiced as this may remove an unpolymerized oxygen inhibited layer.
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