Children with limited exposure to fluoridated water and a high sugar intake are 70% more likely to develop cavities in their permanent teeth, according to a team of Australian researchers.

The study of 24,664 Australian children raised particular concerns, said Loc Do, PhD, professor in dental public health and research chair at the University of Queensland School of Dentistry.

“The coverage of water fluoridation in Queensland is the lowest in the country, while our intake of free sugars is among the highest,” Do said.

“We hope these results will convince policymakers in jurisdictions without fluoridated water to implement this effective and cost-saving community measure,” he continued.

“We also hope to see the promotion of healthy behaviors like reducing the intake of sugars, which would both improve dental health and help prevent other conditions such as obesity,” he said.

More than half of the 5- to 14-year-olds in the study were considered to have either low exposure to fluoridation (less than 25 of their life) or medium exposure (between 25% and 75% of their life).

Also, approximately 60% of the children analyzed consumed four or more daily servings of food or drinks high in free sugars.

Those who consumed more than four daily servings of high-sugar food or drinks but with high exposure to fluoridation were 40% less likely to develop cavities in their baby teeth than those with low or medium fluoridation.

Those with a diet rich in sugars but with high exposure to fluoridation were 50% less likely to develop cavities in adult teeth than those with lower levels of fluoridation.

It was well known that dental cavities are largely preventable, water fluoridation was effective, and high free-sugar intake was detrimental to child dental health, said lead author Diep Ha, PhD, a research fellow at the University of Queensland School of Dentistry.

“These facts are not surprising or new, but the results from almost 25,000 young people in this study show there is still a need to address these issues to improve child dental health in Australia,” said Ha.

“To achieve maximum prevention of dental decay, lack of exposure to fluoridated water and high intake of sugars should be targeted,” said Ha.

The research used data collected in the National Child Oral Health Study 2012-14, funded by a National Health and Medical Research Council Partnership Grant to the University of Adelaide and a collaboration with state/territory dental health services.

The study, “Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation,” was published by the Journal of Dental Research.

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The Australian Dental Association’s New South Wales (ADA NSW) chapter said it supports the Australian Medical Association’s call for a tax on sugary drinks to help safeguard the oral health and overall well-being of millions of Australians.

“Tooth decay is one of the most common chronic diseases in Australia and worldwide and is the second most costly diet-related disease in Australia. Consuming too much sugar is one of the main factors causing tooth decay and other oral health issues,” said ADA NSW president Dr. Kathleen Matthews.

According to the ADA NSW, 26% of all children and adults between the ages of 5 and 64 experience untreated tooth decay in one or more of their teeth. Spending on dental services accounts for approximately 20% of total health expenditures by individuals. Also, dental conditions account for the highest number of potentially preventable hospitalizations in children between the ages of 5 and 9.

“Almost one in two Australian adults and more than two-thirds of Australian children are consuming too much free sugar. Sugar-sweetened beverages (SSBs) are the largest source of added sugars in the Australian diet. Drinking a can of soft drink each day will significantly increase the risk of tooth decay and dental erosion,” said Matthews.

“There can be as much as 17 teaspoons of sugar in an energy drink. You wouldn’t dream of consuming that much sugar in one go. Why drink it?” Matthews said.

Young Australians consume particularly high numbers of SSBs, the ADA NSW said, especially males between the ages of 12 and 24. The prevalence of SSB consumption is higher among lower socioeconomic groups, with availability, price, and marketing all having a significant influence.

“ADA NSW has previously called for a tax on SSBs as part of a comprehensive program aimed at educating the public to limit their consumption of such drinks,” she said.

“A price increase from a 20% levy could provide an additional $400 million in government revenue and could help fund a public education campaign informing healthier purchasing and dietary habits, especially aimed at children,” she said.

“A levy would reduce consumption of SSBs and help lead to sustained reductions in the incidence of diabetes, cardiovascular diseases, and some cancers, resulting in thousands of healthy life years and millions of dollars saved in healthcare costs,” she said.

“ADA NSW welcomes the AMA’s proposals for a sugar tax and calls on the federal government to follow the example of dozens of countries across the globe and implement a sugar tax to help improve health outcomes for all Australians,” she said.

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The general public doesn’t know very much about dental caries, according to a survey by Colgate-Palmolive and the Oral Health Foundation (OHF), which is calling on dental professionals to raise awareness among patients to improve oral health.

Dental caries is one of the most chronic diseases in the world and affects about 2.3 billion people, the OHF said. In the United Kingdom, just under one in three adults suffers from caries, a problem that the OHF said has become worse during the pandemic.

Yet many people are unaware of the circumstances that could lead them to be at higher risk of developing dental caries or how they can prevent the disease from occurring, the OHF said.

For example, 33% of survey respondents were unable to identify “brushing teeth” as an action that could prevent dental caries.

Also, 54% did not associate “regular dental appointments” with lower caries risk, and 26% did not know that “high carbohydrate” diets could be responsible for higher caries risk.

There was a lack of awareness about other major risk factors including older age, drying mouth, and a history of oral health restorations as well.

Dr. Emanuele Cotroneo, scientific affairs project manager at Colgate, is concerned that without a good basic understanding of the risk factors of tooth decay, many people will struggle to take control of their oral health.

“What this new survey data shows is a clear need for education amongst patients,” she said. “Patients could be missing out on simple but really effective ways to minimize their risk of developing dental caries but are simply unaware of how their lifestyle choices are impacting their oral health.”

The survey is part of the OHF’s “The Truth About Tooth Decay” online hub created with Colgate-Palmolive. The platform hosts educational material for patients about dental caries as well as a dedicated area for dental professionals with tips and tools for educating patients about the symptoms and risk factors of dental caries.

Also, the survey revealed that people between the ages of 18 and 24 have the weakest knowledge when it comes to dental caries. For instance, 24% failed to highlight “brushing your teeth” as an effective way to prevent caries, compared to 4% of those age 55 and older.

Younger adults also were far less likely to know that fluoride prevents caries, with only 23% of 18- to 24-year-olds thinking that fluoride can be used as an effective way to prevent dental caries, which is significantly less than those over the age of 55.

But while young people seem the least knowledgeable when it comes to dental caries, 63% said they would like to receive oral health information in between appointments, with 65% preferring email for receiving this information.

OHF president Dr. Ben Atkins believes the results of the survey highlight a knowledge gap that needs to be addressed sooner rather than later.

“Certainly when it comes to caries, it is clear from this research that more work needs to be done to educate younger adults, both regarding prevention and what is likely to put them at higher risk,” said Atkins.

“Despite this, it is encouraging that most young people are keen to learn more about this area of their health and well-being. It presents dental professionals with a tremendous opportunity to engage with this audience, who we know are more likely to skip brushing and regular dental visits,” said Atkins.

“Dental professionals are in a great position to help patients of all ages better understand their oral health. This education can not only be done in the dental chair. It can also be done digitally on social media and through e-communications,” he said.

“The latter has become increasingly important given the restrictions from the pandemic. Digital learning is likely to play a key role in delivering the prevention aspects of the new dental contract,” he said.

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The Alliance for a Cavity-Free Future (ACFF) has published A Global Consensus for Achieving a Dental Cavity-Free Future. If adopted by both dental and health policymakers, the ACFF said, this comprehensive collection of policy recommendations would help secure the changes needed to push toward a future free from cavities.

Dental caries, which leads to tooth decay when left untreated, is the most prevalent noncommunicable disease in the world, the ACFF said. More than 2.3 billion people suffer from untreated caries of permanent teeth, the ACFF continued, with a further 530 million children suffering from untreated caries in primary teeth.

Caries affects people of all backgrounds, the ACFF said, but children and adults from disadvantaged backgrounds suffer disproportionately. Yet caries can be managed with appropriate measures, according to the ACFF, and the resulting cavities are largely preventable.

In 2020, the ACFF said it formed the Making Cavities History Taskforce, drawing on international experts across dental and public health to develop policy recommendations to change the way dental caries is managed. The results of this group’s work were published in A Global Consensus for Achieving a Dental Cavity-Free Future.

The report offers recommendations for policymakers at the national and global levels that would ensure effective caries prevention and management while offering the best opportunities to see improvements in oral and overall health, the ACFF said.

The recommendations cover the full scope of caries management to include both public and professional education, diet and nutrition, a shift to preventive dental medicine, and comprehensive data collection to monitor the issue, the ACFF said.

The ACFF is circulating the report in support of the WHO 2021 Resolution on Oral Health, which will be brought to the World Health Assembly this month. The report also has been endorsed by international organizations including the World Federation of Public Health Associations.

“Caries is a preventable disease that affects billions of people,” said ACFF chair Nigel Pitts. “The global response to the Consensus has already been hugely positive. Alongside the WHO 2021 Resolution on Oral Health, the policies laid out in the Consensus have the potential to radically impact the way caries is managed around the world and to change people’s lives for the better.”

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The University of the Pacific Arthur A. Dugoni School of Dentistry has launched a San Francisco Bay Area public service ad campaign to raise awareness that dental care is an essential part of overall health.

“The mouth is a window into the health of the body, and research continues to show the connections between oral health and overall health,” said Dr. Nader A. Nadershahi, dean of the school.

“For example, a growing set of evidence has linked oral conditions, particularly periodontal (gum) disease, to several chronic diseases, including diabetes, heart disease, and stroke,” Nadershahi said.

“Preventive dental care can reduce the complications of other diseases and prevent more serious and costly dental and medical conditions down the road,” he continued.

“As the Bay Area continues to reopen, we want to encourage people to get back on track with ongoing care and visit their oral healthcare professionals,” he said.

The initial theme of the public messages is the importance of children’s oral health, pointing out that dental cavities are the number one chronic disease among California’s children.

Posters were installed across San Francisco’s Muni and San Mateo County’s SamTrans public transit systems to run during the summer.

As ridership starts to increase with the local economy reopening, the school said, the posters will be a visible reminder about keeping mouths healthy and about the school’s dental clinics, which serve the public.

Each year, nearly 18,000 patients of all ages receive care at the clinics, which are located in downtown San Francisco, the school said. 

Dugoni’s marketing and communications team worked to secure advertising space at no cost to the school thanks to the transit agencies’ pro bono PSA program for nonprofit organizations.

The school also is working on additional messaging opportunities to run across online, local television, and other Bay Area media outlets this summer and fall.

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The US Preventive Services Task Force has posted a draft recommendation statement on screening and interventions to prevent dental caries in children younger than 5 years old.

The Task Force recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children and prescribe oral fluoride supplementation to children 6 months and older whose water supply doesn’t include enough fluoride.

Also, the Task Force determined that there is not enough evidence to recommend for or against primary care clinicians screening for cavities in children younger than 5 years old.

According to the Task Force, cavities are the most common chronic disease in children in the United States, and rates are on the rise, particularly among children between the ages of 2 and 5. If left untreated, the Task Force said, cavities can lead to pain and tooth loss. They also can negatively affect speech, appearance, and growth.

Primary care clinicians can easily provide fluoride varnish and fluoride supplementation in their offices to help prevent tooth decay, the Task Force said.

“Children regularly visit a primary care setting for checkups, which provides an important opportunity for clinicians to play a role in helping reduce and prevent cavities,” said Task Force member Michael Cabana, MD, MA, MPH.

“Primary care clinicians can help keep children’s teeth healthy by using fluoride in those younger than 5 years old,” continued Cabana, who also is a professor of pediatrics and chair of the Department of Pediatrics at the Albert Einstein College of Medicine. He is physician in chief at the Children’s Hospital at Montefiore as well.

Any child whose teeth have come in can develop cavities, the Task Force said, but Hispanic and Black children and children in low-income households are at higher risk for tooth decay and often experience more severe tooth decay than other children.

Additional factors that put children at higher risk for cavities or tooth decay include frequent sugar exposure, level of fluoride in their water, previous tooth decay, and developmental defects of tooth enamel, the Task Force said.

“Using fluoride to help prevent cavities in young children is simple and easy for primary care clinicians to do,” said Task Force member Martha Kubik, PhD, RN, professor and director of the School of Nursing, College of Health and Human Services at George Mason University.

“Since tooth decay can negatively affect children’s growth and development, these interventions are important to helping maintain children’s health and well-being,” said Kubik, who also is a nurse scientist, researcher, and past standing member of the National Institutes of Health’s Community-Level Health Promotion Study Section.

The Task Force also reviewed the evidence on screening exams for tooth decay in primary care and found that more research is needed to determine if having primary care clinicians regularly screen young children for tooth decay improves their future health.

The Task Force’s draft recommendation statement and draft evidence review have been posted for public comment on the Task Force website. Comments may be submitted online through June 7, 2021.

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

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A dental survey of three-year-olds in England has revealed drastic inequalities, according to the Oral Health Foundation (OHF), which believes that community water fluoridation is essential to bridging the gap and is calling on the government to act.

The Public Health England survey investigated nearly 20,000 three-year-olds from across the country and found that 10.7% of them already have tooth decay. On average, each child had three decayed teeth.

Also, the survey highlights regional differences. Three-year-olds living in the Yorkshire and Humber area are more than twice as likely to experience tooth decay (14.7%) as children living in the east of England (6.7%).

OHF president Dr. Ben Atkins believes these statistics highlight an urgent need to address the oral health of children in the country and would like the government to do more.

“These statistics are worrying indeed, especially when looking at the stark regional differences. The last survey of this nature was carried out in 2013, and since then very little progress has been made,” Atkins said.

“This stagnation is due to a lack of action and clear direction from government, both at a local and national level, when it comes to addressing oral health inequalities in the UK,” he said.

“As a charity, we believe that community water fluoridation holds the key to improving the oral health of children up and down the country,” he said.

“Under new NHS reform plans announced earlier this year, the government pledged to take back control of community water fluoridation in order to make the process of implementing schemes both more efficient and less costly,” he said.

“We need to hold the government accountable for this and hope that in years to come, we will see more and more community water fluoridation schemes,” he said.

Fluoride has been researched extensively for decades now and has been found time and time again to be very effective in protecting teeth from decay and erosion, the OHF said.

When added into the water supply, studies have shown that community water fluoridation can reduce tooth decay but up to 35%, the OHF continued.

The OHF believes that water fluoridation would be especially effective for those living in more deprived areas where access to dental care may be limited.

The report also revealed that children living in the most deprived areas of the country were almost three times as likely (16.6%) to experience tooth decay as those living in the least deprived areas (5.9%).

Atkins said that while the nation waits to see improvements made, everyone can take steps to improve their oral health by following a strong oral health routine at home.

“There is still a lot of work to be done when it comes to addressing oral health inequalities in this country,” he said.

“However, while we strive towards that goal, we would encourage everyone, including children, to brush their teeth with a fluoride toothpaste for two minutes twice a day,” he said.

“This, along with cleaning in between your teeth daily, can set you and your children up with a healthy smile for life,” he said.

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More than 45 million British adults are at an increased risk of tooth decay, according to the Oral Health Foundation (OHF) and Colgate-Palmolive Dental Caries Awareness Survey, which found that 84% of all adults in the United Kingdom fall into groups that put them at higher risk of the disease.

Additionally, the survey found that 21% of Brits have moderate to high sugar diets, 21% have not visited the dentist in the last two years, and 19% do not brush their teeth twice a day, all of which increase their changes of developing tooth decay, which can lead to expensive fillings, root canal treatment, or tooth extractions.

Meanwhile, the OHF notes that the latest data from National Health Service (NHS) Digital shows there are 9.7 million band-two treatments in England each year, including fillings, tooth canal work, and extractions.

Dr. Nigel Carter, OBE, chief executive of the OHF, said that tooth decay can have a devastating effect on a person’s quality of life and more must be done to reduce the number of people affected by the disease.

“Tooth decay remains the most common chronic disease in the UK, yet it is entirely preventable. Anybody can suffer from tooth decay, but there are a few things that can increase the risk,” Carter said.

“Tooth decay is caused by poor oral hygiene, as well as eating or drinking too much sugar too often. It is also linked with not having regular dental checkups,” Carter said.

“Those on medications containing sugar or that cause dry mouth can also put a person at greater risk. We also know that diabetics and orthodontic patients are also more likely to have tooth decay. Together, these make up a significant proportion of the population,” said Carter.

“In its early stages, tooth decay can cause mild pain, but in extreme cases it can have a debilitating impact on a person’s life. For a better quality of life, it is critical to know how to identify tooth decay in the early stages or prevent it from happening at all,” he said.

Toothache and tooth sensitivity to sweet things are two of the most likely signs of tooth decay. Dark spots on the surfaces of the teeth and an unpleasant taste in the mouth are further signs to look out for, the OHF said.

“If anybody falls into one of the high-risk groups or notices the early signs of tooth decay, they should book an appointment with their dental team for an assessment,” said Carter. “They will be able to help somebody lower their risk and offer a range of different options for preventing and treating tooth decay at home or while at work, one of which may be prescribing a high-fluoride toothpaste.”

In the United Kingdom, approximately eight in 10 adults have one or more teeth with decay, that are filled, or have been pulled out due to decay, according to the Office for National Statistics Adult Dental Health Survey. It also is extremely common in children, with more than one in five showing signs of tooth decay.

To help more people identify their risk of tooth decay and how to spot the early warning signs, the OHF has partnered with Colgate-Palmolive to launch “The Truth About Tooth Decay,” which provides advice for preventing the disease.

“The best way to prevent tooth decay is by brushing the teeth thoroughly last thing at night and at least one other time during the day, with a 1,450-ppm fluoride toothpaste. This should take around two minutes,” said Emanuele Cotroneo, scientific affairs project manager at Colgate.

“When brushing, make sure the inner, outer, and biting surfaces of the teeth are brushed carefully, and remember to brush along the gumline. Using interdental brushes, or dental floss or tap, also helps to remove plaque and food from between the teeth. These are areas an ordinary toothbrush can’t reach. Daily use of a fluoride mouthwash in between brushing can also help,” Cotroneo said.

The OHF also offers its Dental Helpline, which provides free advice by phone at 01788 539780 and by email at helpline@dentalhealth.org.

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The anniversary of the COVID-19 shutdown has caused reflection on its impact on the economy, our social lives, and the way we work and learn. For nonprofit organizations, however, the pandemic has shown just how wide the chasm is between low-income families and everyone else.

While most parents were inconvenienced by transitioning their kids to online school, families from marginalized communities scrambled to access not only the technology their kids needed to attend class, but also necessities such as food and childcare.

The number of kids who depend on schools for the basics like these that most people take for granted is not a surprise for organizations like America’s ToothFairy, a nonprofit that supports safety-net dental care providers across the nation.

School-Based Dental Care

Most people don’t associate school with dental care. But for America’s ToothFairy, school closings are a major problem. Up to 80% of the nonprofit dental clinics participating in the America’s ToothFairy Dental Resource Program (DRP) provide dental services through school-based programs.

For impoverished communities, these programs can be the only way for families to access dental care and are an effective way to prevent tooth decay in children. A recent study by NYU College of Dentistry showed that school-based dental programs reduced students’ cavities by more than 50%. That’s a big deal considering that dental disease is among the top reasons for school absence and, when left untreated, costs billions of dollars each year.

“At the onset of the pandemic, it became clear that the shutdown would have an enormous impact on access to dental care,” said America’s ToothFairy executive director Jill Malmgren. “A majority of the Dental Resource Program member clinics that rely on our resources closed for a period of time, and a handful are still not operating. Even a year later, getting into schools to provide essential dental services is nearly impossible.”

For families with single parents working multiple jobs to get by, or rural families that lack access to public transportation, or for others who live in areas where there simply aren’t enough dentists, school-based dental programs aren’t just nice to have, they are essential to the overall health and well-being of children. Students with untreated tooth decay often struggle to concentrate at school, have difficulty eating and sleeping, and even risk dangerous infections that can spread to the brain.

In addition to further restrictions on access to care, according to reports submitted to America’s ToothFairy by its DRP clinic members in August, the COVID-19 shutdowns caused a 20% decrease in the number of children who received oral health education.

“We had 15 schools scheduled for their spring school-based dental clinic days,” reported Let’s Smile Inc, a clinic located in Minnesota. “They had to cancel due to COVID-19 school closings.”

In a last resort attempt to compensate, the clinic’s executive director offered dental hygiene kits to children who completed simple oral health education activities. Dressed as “The Smile Fairy,” she left the kids’ rewards on their front porches.

Some organizations, including Sonrisas Dental Health in San Mateo, California, partnered with schools at food distribution locations.

“We utilized the schools’ hot lunch drive-through pickup program during the shelter-in-place mandate,” the clinic reported. “We provided students who picked up lunches with a take-home oral health kit that included a toothbrush, paste, floss, a 2-minute timer, and an informational flyer including a link to our web-based oral health programming.”

Despite valiant efforts like these, little could be done to accommodate for the 24% drop in the number of students who received screenings and for the 15% fewer kids who received sealant applications compared to the previous year. For those who already had tooth decay, the closures caused a delay in care with devastating consequences.

“We were unable to provide our free dental program at 15 different school locations,” reported Kids’ Community Dental Clinic (KCDC), a safety-net dental care provider located in Burbank, California. “Because of the length of time that we were closed to restorative treatment, the number of emergencies increased. What were two surface cavities in February turned into pulpotomies or root canals and crowns by June.”

With fluoride varnish donated by 3M Oral Care through America’s ToothFairy, KCDC is holding drive-through dental events called “Tacos and Toothbrushes.” Through events like these, some children are receiving preventive care along with other resources, but not in the high numbers seen at school-based events.

Even as clinics have reopened, access to children through schools is still restricted, adding hundreds of thousands of kids to the already high one-in-five who have not received a dental exam in the last year.

“We’ve been affected rather drastically,” said Genise Kelley, community dental health coordinator at Charlotte Community Health Clinic (CCHC).

In the year before COVID-19, the organization provided full exams, x-rays, and cleanings for 600 students at elementary schools in Charlotte, North Carolina, and referred students with more extensive needs to their clinic for restorative care. A year after the pandemic hit, the organization still lacks direct access to the students who rely on school programs for care.

In response, CCHC created an educational program that included videos to help students learn about oral health topics including how to brush properly. It also worked with teachers to teach students about the importance of oral health during virtual learning.

“We provided schools with 430 kits that contained two apples, toothpaste and floss, and toothbrushes donated by America’s ToothFairy, so that students who are learning from home can conduct experiments with the apples that replicate the effects of tooth decay,” Kelley said.

The clinic also began using telehealth for children who are in need of care to help address their dental needs. Kelley is hopeful that CCHC will be allowed to return to the schools it serves at the beginning of the new school year.

The Need for Solutions

What can be done in the meantime? While America’s ToothFairy acknowledges that efforts to educate communities about the importance of oral health throughout the pandemic are commendable, they cannot replace access to care programs for families in need.

“Oral health education and prevention programs have always been a major part of our mission, and even more so during the pandemic,” Malmgren said.

“However, it is essential to the health of our nation’s kids to get access to dental care back on track. School-based dental programs are not a luxury. They are essential for the hundreds of thousands of children who depend on them to stay healthy,” she said. 

“It is imperative that we do not overlook the proven, positive impact that school-based dental care has on the health of students. Local government, school systems, community leaders, and health professionals must work together to find new solutions to increase access to care to avoid long-term consequences that inhibit students’ ability to be healthy and thrive,” she said.

To learn more about America’s ToothFairy and discover how to get involved to help children in underserved communities access dental care, visit AmericasToothFairy.org/get-involved.

Ms. Badger is the communications manager for America’s ToothFairy. She can be reached at communications@ncohf.org.

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BDA Northern Ireland has urged the European Commission to reconsider its plan for a full phase-out of amalgam by 2030. The organization believes that a phase-down, rather than a phase-out, is the only viable way forward that can avoid destabilizing health systems already under considerable strain and exacerbating health inequalities.

A report by the European Commission to the European Parliament and Council says that the phase-out of dental amalgam, which is the largest remaining intentional use of mercury in the European Union, “is technically and economically feasible before 2030.”

Even though the United Kingdom has left the European Union, under the Northern Ireland Protocol, European proposals on amalgam would apply to Northern Ireland but not to England, Scotland, or Wales.

Alongside the Council of European Dentists and the FDI World Dental Federation, BDA Northern Ireland said that it supports a phase-down approach to dental amalgam use.

However, BDA Northern Ireland said, dentists must continue to have the full range of restorative materials at their disposal and that at present, there is no direct replacement for amalgam for durability, cost-effectiveness, and ease of use.

Alternative materials also are much less extensively researched for their impact on the environment and direct effects on human health, BDA Northern Ireland said.

COVID-19 has dramatically altered the dental landscape, BDA Northern Ireland continued, meaning that the feasibility study undertaken before the pandemic must be reviewed in respect of the different context that dentistry finds itself in.

A phase-down, not phase-out, of dental amalgam is the only viable way forward, BDA Northern Ireland said. This would avoid destabilizing health systems already under considerable strain, the organization continued, and exacerbating health inequalities.

BDA Northern Ireland also said that it wants to see an increased focus on prevention as well as additional research into mercury-free alternative materials.

Further, BDA Northern Ireland said that it is concerned about many aspects of the feasibility study undertaken by Deloitte that underpins the basis of these phase-out proposals, not least the data being incomplete.

Any move to phase out dental amalgam as a low-cost restorative material will have the greatest impact on those most disadvantaged patients, increasing inequalities, BDA Northern Ireland said.

These issues go to the heart of the right to access affordable healthcare and must be properly considered in a full impact assessment, BDA Northern Ireland said, adding that its response urges the European Union to take a more considered phase-down approach to what is largely an environmental issue.

Regardless of what happens, BDA Northern Ireland said, this serves as an important reminder of the need for governments closer to home to step up in prevention. The organization said it will continue to liaise with officials to mitigate any impact of these developments on the profession.

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