Dental Board of California
President's Message

Roger Simoan, DDS--June 30, 2000

In recent editions, this column has been reserved for the President to share information about the Board. In keeping with this tradition, I would like to discuss the action of the Board took in December 1999, regarding a petition from Consumers for Dental Choice. The petition addressed five major points relative to Business and Professions Code Sections 1648.10 and 1648.20 of the 1992 Statutes. At that meeting, the Board took action on four of the five points made in the petition. Since that time, several reports have been written regarding the petition and the Board's action. This article is intended to clarify what was requested and how the Board responded to that request. Since this was a complex petition making several requests of the Board, for the benefit of the reader, the following information contains the legal basis for this petition, the specific requests, and the action taken by the Dental Board.

Business & Professions Code Section 1648.10 mandated the Dental Board of California to develop and distribute a Dental Materials Fact Sheet (Fact Sheet) that described and compared the risks and efficacy of the various types of dental restorative materials that may be used to repair a dental patient's oral condition or defect. The law required the fact sheet to contain specific information and be updated as deemed necessary by the Board. Section 1648.20 exempts any dental tool or instrument used during the dental procedure from the provisions of Section 1648.10, and clarifies the language so the Fact Sheet focuses on those dental materials that remain in a patient's mouth after completion of a procedure. These can include, but are not limited to, removable and fixed restorative materials, orthodontic appliance materials, and materials used in the restoration of teeth. In May 1993, a two-page Fact Sheet containing the pros and cons of various dental restorative materials was developed and distributed by the Board. The petitioner requested the revision of the Dental Material Fact Sheet to:

(1) Rid the Fact Sheet of misleading language on amalgams;

(2) Include in the fact sheet all statutory requirements regarding the dentist's responsibility to fully inform the patient of the available options of dental restorative materials. The Fact Sheet should also encourage dentists to discuss with their patients the advantages and disadvantages of the various dental filling materials;

(3) The Fact Sheet update should cover the past six years of research documenting hazards of all dental filling materials and ;

(4) The Fact Sheet should provide dentists with guidance on properly warning patients about the reproductive toxicity of the mercury contained in amalgam. The Fact Sheet should also address ways in which practitioners may determine patient sensitivity to mercury, i.e, a comprehensive health questionnaire. Any interested party should have the opportunity to review and comment on the Fact Sheet prior to its distribution. The Board's goal is to have a Fact Sheet for distribution by December 2000. The Board voted to approve all the above referenced recommendations.

The petitioner has requested the Board, as part of the licensure process, to require all participants in the dental licensure examination to complete a questionnaire on the various types of dental restorative materials. Board staff recommended that, in lieu of a questionnaire, the California Law Examination be revised to include questions on Business & Professions Code Section 1648.10. The Board voted to approve the above recommendations.

In addition, the petitioner requested a number of items the Board considered to fall under the general heading of informed consent. The petitioner requested that (1) the dentists advise patients of the different types of filling materials; (2) the dentist advise patients and staff that an amalgam contains mercury, a substance designated under Proposition 65 and found to be hazardous. The petitioner also requested the dentist provide copies of the revised Fact Sheet to any patient requiring a restoration.

The Board voted to include an article in the newsletter encouraging dentists to discuss with their patient the different restorative materials. The article should also suggest that dentists discuss with their patients the percentage of mercury in amalgam and that mercury and other substances used in dental offices are designated under Proposition 65. The Board encourages discussion between the dentist and patient regarding the potential sensitivity and allergic or adverse reactions to mercury by some patients. The Board further approved the distribution of the revised Fact Sheet to all licensed dentists.

The petitioner requested the Board to clarify its position on mercury-free practice. The Board agreed to publicly clarify that it has no position either pro, or con, on the various dental restorative materials. The dentist is free to decide what type of restorative materials he/she may use or not use in the practice.

However, the Dental Board of California encourages dentists to discuss the choice of restorative materials with their patients.

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