18-19th Dec, 2012 Acknowledgement The East Africa Dental Project



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3. EADAP Project Overview: Mercury negotiations and partnerships; project objectives, components, expected output


Desiree Narvaez

  • Mercury is a global concern as it is toxic to humans and the environment. It travels a long distance; it is persistent and bioaccumulates in fish. Methyl mercury is the most toxic form of mercury.

  • 2010 report shows various sources of mercury releases.

  • UNEP global mercury programme has two tracks: Negotiations for a globally binding treaty and partnerships.

  • The chair prepared a draft treaty text for consideration at INC5 in Geneva in January 2013. INC4 African group gave suggestions that went into the draft document.

  • The draft text includes restriction of production, import and export of mercury-added products,, promotion of use of alternatives, education of consumers on alternatives, and discouraging insurance policies that promote mercury added product.

  • 30% of mercury is used for mercury added products. Dental amalgam accounts for ¼ of demand of mercury added products.

  • A significant amount of mercury is released from use of dental amalgam e.g. incineration, crematoria, cemetery, and indirect diversion of dental amalgam into small scale gold mining.

  • The real cost of dental mercury, cost required to minimize releases, real cost greater than composites and other alternatives to amalgam.

3.1 Project Overview


Global mercury partnership was mandated in 2005 by Governments to minimize mercury pollution for different products including dental amalgam.

Objectives of the dental amalgam project in developing countries:

To explore essential conditions for a phase down in the use of amalgam

This is to be achieved through the following activities:



  1. Investigation of current supply and trade of dental amalgam and materials alternative to amalgam and make recommendations for future information systems.

  2. Asses the current waste management practices in the three east African countries.

  3. Create awareness of preventive dental care and encourage a switch to appropriate alternatives to dental amalgam, when clinically indicated among dentists and patients.

  4. Demonstrate environmentally sound management of dental restoration materials waste in selected dental facilities in the three countries.

3.2 Project components


  1. Trade study and survey of dental amalgam waste management practices

  2. Selection of national project coordinator and social preparation

  3. Development of awareness raising materials on disease prevention and available alternatives for dental restoration

  4. Inception workshop

  5. Demonstration activities

  6. Stakeholders/Interagency meetings

  7. Selection of Demonstration health clinics

  8. Coordination with local clinics

  9. Capacity building in the ESM of waste

  1. Results workshop

3.3 Expected project Outputs


  • Report on supply and trade flow data of all restorative materials

  • Report on dental waste management practices of all dental materials

  • Raised awareness amongst patients and dentists on preventive dental care and use of alternative restoration materials

  • Demonstration of best dental waste management practices for all dental restorative materials

  • Report of lessons learned providing recommendations for promoting the phase down approach

For more information you can email desiree.narvaez@unep.org

3.4 WHO policies on oral health and dental restoration


Dr Poul Erik Petersen, Global Oral Health Programme, Chronic Disease and Health Promotion, WHO, Geneva, Switzerland

  • Objectives of the presentations were outlined.

  • Denmark has moved from having high caries rates in the 1970s to a point where they have a very low caries rate due to a preventive campaign.

  • Dental caries is a major public health problem globally, with variations among countries. Despite much effort in health promotion and disease prevention, dental restorations are still necessary.

  • Social determinants-equity in oral health and oral health care, income, education and residence, living conditions and underserved populations.

  • Primary health care approach by WHO-essential care for disease control, maintaining health and quality of life.

  • National oral health programmes entail community, professional and individual strategies needed to improve oral health.

WHO 60.17 urges member states to take action(14 items)

  • National policies and public health programmes

  • Risk factors

  • Settings for health

  • Oral diseases and conditions

  • Preventive measures and health promotions

  • Financing oral health care

  • Workforce in oral health

  • Oral health research and information systems

  • Health personnel –train and retain

The poorest alternative in dental care is dental extraction. Extraction is failure of modern dentistry.

Future use of materials was discussed in a meeting in Geneva in 2009. Major concerns in use of restorative materials



    • Principal uses

    • Leakage and recurrent decay

    • Overall durability fracture and wear resistance.

    • Cavity preparation and clinical considerations

Choice of material based on:

  • The tooth

  • Site and size of caries lesion

  • Cost and health care financing

  • Patient preference

  • Health care provider preference

  • Technology

  • Environmental factors

Major conclusions of WHO meeting were:

  • A progressive move away from dental amalgam would be dependent on adequate quality of alternative , reiterative materials

  • Prudent to consider phase down instead of phase out of dental amalgams at this state due to limitations in durability, fracture resistance and wear resistance.

  • While GIC and resin based composites are promising, there remains a need to promote development of quality dental restorative materials for use in public health programmes.

  • Urgent need for research.

  • Alternative materials are desirable from an environmental perspective

  • Amalgam will be needed in the short and medium term.

  • Oral health promotion and dental caries prevention are best ways to reduce the need for dental restoration and phase down the use of amalgam

Recommended that providers:

  • Use of safe affordable materials.

  • Adopt minimal intervention approach to dental care.

  • Shift from a restorative to a preventive approach: Effective use of fluoride-clinical application, self care.

Need to use practical guide to integrating best management practices(BMPs) in dental care

3.5 Pilot project in East Africa.


Trade study and survey

Development of awareness

Key partners:


  • Policy makers and national authorities

  • Third party payment systems international association for dental research

  • FDI

  • Dental manufacturers

  • WHO and UNEP

Future tasks:

  • IADR-research and evidence

  • Evidence based Practice

  • Dental industry-product development

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