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



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7. Training of Dental Personnel on BMP/ESM of Waste Amalgam and its Alternatives



Jean-Luc Eisele, World Dental Federation.

Threat to Oral Health: Oral health is not mentioned in WHO 2014-2015 work plan.

FDI vision 2020 has 5 priority areas


  • meet the increasing need and demand for oral healthcare

  • expand the role of healthcare professionals

  • shape a responsive educational model

  • mitigate the impacts of socio-economic dynamics

  • foster fundamental and
    translational research and technology

It was noted that the only caries that does not pollute is the caries that does not occur.

The Governing Council of UNEP tasked governments to negotiate the treaty through a series of five conferences, called Intergovernmental Negotiating Committee (INC) meetings.

The important decision about global oral health should not be compartmentalized within a narrow debate about individual products, but rather be comprehensive in its scope, and include a commitment to improving health and oral health, as well as protecting the environment.

FDI supports the WHO approach to amalgam phase down.

Points to be noted are:


  • Draft INC5, article 6 only mentions phase out not phase down.

  • Essential words are missing in the draft document including phase down, prevention , clinical indication.

  • In article 20, health aspects, the definition of populations at risk need to be changed.

Unfortunately, in many countries, amalgam phase out will be equivalent to extraction phase up.

7.2 FDI Curriculum on dental amalgam BMP, prevention and alternative materials.


Target audience: Dentists in East Africa, technicians, dental students and educators.

Aim: Provide education, training and capacity on:



  1. Mercury life cycle and global health and the UNEP political mandate. Responsible: Jean-Luc Eisele.

  2. BMP on dental amalgam usage and waste management. Responsible: Su Naidoo, South Africa. Pam Clark, Australia.

  3. Alternative filling material materials. Responsible: Dentist from Norway Dental Material Institute.

  4. Importance of prevention of dental caries.

7.3 Question and Answer Session


  1. Q: Who should be trained? How many should be trained?

A: The following suggestions were given in response to this question:

  • One (1) person per country is appointed to take over the call for preventive dentistry. It was noted that there was already an initiator in the form of the research team that conducted the research.

  • This is a joint dental and environmental project therefore it would be better to work with someone in government.

  • The FDI curriculum should be included in the university curriculum not just for dentists but for technicians. The response to this was that though school curriculum introduction was important, it would take too long to see results. As such, it is better to start with the project so as to learn what makes preventive dentistry work, or not work, in a short time.

  1. Q: Was the mercurial life cycle important? Are there toolkits for training?

  • A: It was stressed that Mercury Hygiene Essentials is already taught to students at the University of Nairobi Dental Hospital.

  • MEMR has a clear regulation in place.

  • Training and subsequent supervision of dentists could be conducted by the National Dental Associations

  1. Q: How long will the curriculum take to train? Will the curriculum apply to any other countries where FDI decides to implement it?

A: The main reason for FDI-WHO-UNEP partnership is to raise awareness on alternative materials. Dentists who trained in amalgam use for restorations are comfortable to continue using amalgam and not learn a new technique. Phase down encourages dentists to consider alternative materials even though there is a better historical knowledge of amalgam. It was also noted that composite restorations require maintenance, which provides a challenge in countries where patients do not go in for annual dental checkups.

The next step in the FDI training is to identify venues and select dates for the educational training.


19TH DECEMBER 2012, 2nd Day

Morning Session


The session opened at 8.30 with a word of prayer.

Overview of Day 1, Dr. Lucy

Points arising:



  • UNEP emphasized that phase down of dental amalgam and phase out was proposed and not yet adopted. The necessary changes would be made.

  • There will be provision of an email address through Ministry of Environment and Natural Resources through which to provide input for negotiation at INC5.


1. Awareness Raising on Materials Developed by the University of Copenhagen- WHO Collaborating Centre for Oral Health, Poul Erik Petersen.


The role of WHO is:

  • To coordinate the development of awareness raising materials on alternatives available for dental restoration. These are targeted at patients, dentists, health authorities and oral policy makers.

  • Encourage the development and use of restoration materials alternatives to dental amalgam

National Oral Health Programmes will be addressed at the following levels:

  • Community

  • Professional

  • Individual

The public health interventions for oral health are:

  • Healthy public policies and legislation are important upstream measures

  • Healthy settings

  • Risk factor approaches

  • Healthy lifestyles

  • Universal healthcare

The cornerstones in clinical preventive oral care are:

  • Effect use of fluoride: clinical application and self care.

  • Diet and Nutrition

  • Fissure sealing. It is expensive and therefore may not be relevant in the East Africa setting.

  • Dental Plaque control

  • Choice of restorative materials

Oral health care and raising awareness about materials is targeted at:

  • Patients

  • Dentists

  • National Dental Associations/FDI

  • Ministry of Health – The Chief Dental Officer.

The structure of information is:

  • Brochure and flyer/poster

  • Relevant background

  • Key information about use of dental materials

  • Environment – BMP

  • Dental care in the wider oral health context

Communication Strategy:

  • Give materials to-

  • Ministries of Health and Environment

  • National Dental Associations

  • Dental Schools

  • Health colleges

  • Media, TV, Radio, Newspapers etc

  • WebPages

  • Community leaders- they serve as useful gatekeepers.

Information to patients is via brochures.

Brochures were developed and have the following areas:



  • Tooth decay

  • Need for treatment

  • Dental materials available

  • Advantages and disadvantages of each material

  • The role of the dentist

  • Cost sharing and health insurance

  • Prevention of oral diseases

  • Importance of dental visits

The Ministry of Health through the Chief Dental Officer should consider the following:

  • The burden of oral disease

  • Population’s need for oral care

  • Phasing down the need of dental amalgam

  • Alternatives to dental amalgam

  • The advantages and disadvantages of dental materials

  • Concern for the environment

  • Protection of the environment

  • Best Management Practices

National Dental Associations should consider:

  • Dental restoration materials

  • Best Management Practices

  • Advocacy

  • Capacity Building

  • Dissemination of information

The Dentist should be well informed on:

  • Burden of dental caries

  • Restoration materials and alternatives to amalgam

  • Prevention of dental caries

  • Outreach care

Patient brochures:

  • The brochure for patients is in different colors.

  • The brochure is a draft and the three countries should use them immediately and give feedback to WHO.

  • It would also be ideal to get them translated into the common local dialects.

Flyer 1:

  • This is the WHO Global Oral Health Programme.

  • It supports establishing national oral health policies on disease prevention and oral health promotion.

Flyer 2:

Focuses on BMP on safely managing amalgam waste.

Question and Answer Session:


  1. It was noted that the wording on the brochures seems to be very conclusive. An example of this is to say that “new materials are available and may be more expensive than silver fillings”. (as opposed to “new materials are available, but more expensive than silver fillings”)

  2. There is a need to have different brochures targeting different classes of dental patients. For example, brochures for illiterate patients.

  3. Lack of accessibility to care may hamper accessibility to brochure information. It is best for patient to get the information when sitting in the dental chair so that consideration is made by the patient and cost consideration can be discussed with the dentist.

  4. For the project, key persons need to use the brochures and then give feedback, preferably through a workshop, so that the brochures are revised and relevant to each country’s culture.

  5. It was suggested that a Kiswahili version of the current brochure before forwarded to WHO in the shortest time possible so that they would be printed and available for use.

  6. Experience was shared on brochures that have previously been used in the community to disseminate information. After looking at patients at two levels, the one who comes to the dental clinic and the one in the community, a focus group discussion was held to establish the community’s concern. These concerns were then included in the brochure.

  7. WHO wants to see the dentist get the patient to change behavior. It is not within the scope of this project to reach the community. Trying to reach the community would widen the scope of the project and make it unmanageable.

  8. It was suggested that the brochures be tested in the community for a week prior to printing the WHO final draft.

  9. There was concern about wording used in patients’ brochures. It should be revised to say that “silver fillings have been used successfully for 150 years”.

The mention of new materials and yet they have been around for 50 years.

It was also stressed that the brochures do not mention anything negative about the tooth colored materials.



  1. The brochures suggested to patients that they see their dentist for the information and yet dentists felt that the reality is that there may be no time for the dentist to sit and discuss the brochure within clinic hours. The amount of time that discussing the brochure would add to the consultation time was not quantified.

  2. The other reality is that most patients do not visit the dentist. The effect of the brochures on these patients was questioned.

  3. Most patients are more graphic and also many are illiterate. The brochure will need pictures showing the amalgam filling, the white fillings and caries. There should be a third section on the brochure showing oral hygiene instructions. Most patients brush their teeth to prevent caries yet they do it incorrectly.

  4. It was strongly agreed on that the final brochure that is sent out to patients is able to give information that will actually make a difference.

  5. The brochures should be reviewed by the Ministry of health, National Dental Associations and other stakeholder so that they come up with a realistic brochure.


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