FDI World Oral Health Forum:

Are you ready for amalgam phase-down?

How the Minamata Convention impacts your

Dental Practice.Why we need to commit to the phase down of dental amalgam

use

September 9, 2016

Christopher H. Fox, DMD, DMSc

Executive Director

International Association for Dental Research

cfox@iadr.org

Disclosure

Neither I nor my immediate family have any

financial interests that would create a

conflict of interest or restrict my independent

judgment with regard to the content of this

presentation

Minamata Convention Origins

• United Nations Environmental Program (UNEP)

– 25th Session of UNEP Governing Council, Nairobi, Kenya, February 2009 (Section III of Decision 25/5)

• Global Legally-binding Treaty on Mercury– To reduce the supply of mercury and enhance the capacity for its

environmentally sound storage;

– To reduce the demand for mercury in products and processes;

– To reduce international trade in mercury;

– To reduce atmospheric emissions of mercury;

– To address mercury-containing waste and remediation of contaminated sites;

– To increase knowledge through awareness-raising and scientific information exchange.

http://www.unep.org/gc/gc25/

Health Advocacy in an Environmental

Treaty• Country Delegations

• World Health Organization– Vaccines (Thiomersal)

– Medical products (thermometers and sphygmomanometers)

– Herbal/traditional/homeopathic medicines

– Cosmetics (skin lightening products)

– Oral Health (dental amalgam)

• Civil Society– GAVI Alliance

– Oral Health: FDI, IADR, IDM

– Anti- Groups: Zero Mercury Working Group, Health Care without Harm, Mercury-Free Dentistry, etc.

WHO Meeting on Dental Materials

• WHO Global Oral Health Programme with UNEP Global Mercury Partnership– Geneva, November, 2009

– WHO CCs, FDI, IADR, National Dental Associations, etc.

– Meeting: Future Use of Materials for Dental Restoration (Published 2011)

– Origin of the “Phase down” versus the more aggressive “Phase out”

http://www.who.int/oral_health/publications/en/

Advocacy from the NGO Oral

Health Community• FDI Dental Amalgam Task Force

– Including representatives from ADA, ADA, BDA

• IADR (especially Dental Materials Group)

• International Dental Manufacturers

• IADR Dental Materials Innovation Workshop

– London, UK, December 2012

– King’s College London, IADR, FDI, WHO, UNEP, Industry

– Advances in Dental Research (November 2013)

http://adr.sagepub.com/

Dental Materials Innovation Workshop

INC Process

INC Process

The Minamata Convention on

MercuryArticles:

1. Objective

2. Definitions

3. Mercury supply sources and trade

4. Mercury-added products

5. Manufacturing processes

6. Exemptions available

7. Artisanal and small-scale gold mining

8. Emissions

9. Releases

10. Storage

11. Mercury Wastes

12. Contaminated Sites

13. Financial resources and mechanism

14. Capacity-building, tech assistance and transfer

15. Implementation and compliance committee

16. Health aspects

17. Information exchange

18. Public information, awareness and education

19. Research, development and monitoring

20. Implementation plans

21. Reporting

22. Effectiveness evaluation

23. Conference of the Parties

23. Secretariat

24. Settlement of disputes

25. Amendments of the Convention

26. Adoption and amendment of annexes

27. Right to vote

28. Signature

29. Ratification, acceptance, approval or accession

30. Entry into force

31. Reservations

32. Withdrawal

33. Depository

34. Authentic texts

Annex A: Mercury-added products

Part I: Products subject to Article 4, paragraph 1

Part II: Products subject to Article 4,

paragraph 3

Annex B: Manufacturing processes

Annex C: Artisanal and small-scale gold mining

Annex D: Point sources of atmospheric emissions

Annex E: Arbitration and conciliation procedures

Annex A; Part II Dental Amalgam

ProvisionsMeasures to be taken by a Party to phase down the use of dental amalgam shall take into account the Party’s domestic circumstances and relevant international guidance and shall include two or more of the measures from the following list:

i. Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration;

ii. Setting national objectives aiming at minimizing its use;

iii. Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration;

iv. Promoting research and development of quality mercury-free materials for dental restoration;

v. Encouraging representative professional organizations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices;

Annex A; Part II Dental Amalgam

ProvisionsMeasures to be taken by a Party to phase down the use of dental amalgam shall take into account the Party’s domestic circumstances and relevant international guidance and shall include two or more of the measures from the following list: (continued)

vi. Discouraging insurance policies, and programmes that favourdental amalgam use over mercury-free dental restoration;

vii. Encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration;

viii. Restricting the use of dental amalgam to its encapsulated form;

ix. Promoting the use of best environmental practices in dental facilities to reduce releases of mercury and mercury compounds to water and land.

“The Convention also calls for a phase-down approach

to dental amalgam (Annex A, Part II) through greater

emphasis, notably on prevention, research into new

dental materials and best management practice. FDI is

on record as supporting the provisions of the Minamata

Convention on Mercury”

So Why the Phase-down of Amalgam

Use?• The Minamata Convention will be a legally-binding

treaty of nations– Recognizes the importance of Prevention and Research!

– The dental profession, while not legally bound, will have a moral obligation to assist governments comply with the Convention

• Prevention First

• Research into Alternatives

• Best Management Practices

– Data needed to document progress of the phase down

– If we don’t “own” the phase down, others are waiting to limit our restorative choices with potentially adverse consequences for public health.

Thank You - Dziękuję Ci

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Alexandria, Virginia, USA