Sound Science Times Three

Recently we reviewed some of the key issues facing the American Dental Association and California Dental Association during the current year. We were not surprised to find that several controversial matters currently facing the dental profession require that our dental representatives or spokespeople carry an identical message to those who oppose our view. That message is succinct -- show us the sound science. We refer to allegations by regulators or other public-minded groups that materials or devices that are used or promoted by dentistry may present dangers to the safety or well-being of the public.

Too often in the past two decades, outside interests have challenged the scientific foundation upon which the profession has developed treatment techniques and dental health recommendations. Frivolous or unsubstantiated claims have created doubts in the minds of the public about the safety of the dental treatment environment and dental health issues.

Important benefits of membership in the dental profession include the continuing efforts by volunteer leaders and staff of our organizations to educate regulators and public servants about the valid scientific information central to these issues. We can only imagine what the increased requirements on the practice of dentistry might be if we did not possess the resources to defend practical, scientifically based treatment protocols on our behalf.

The three current issues that will continue to grab the spotlight this year are water quality in dental unit waterlines, fluoridation, and latex allergy. The issue of water quality is very much on the California legislative agenda due to Assembly Bill 498, authored by Assemblyman John Longville. Despite the fact that serious health effects associated with exposure to water from dental units have not been documented, if AB 498 passes in its original form, it would be unprofessional conduct for dentists to allow water exiting a dental unit waterline to contain more than 200 colony forming units, or cfu, per ml after January 1, 2001. On the surface, this seems to be an arbitrary, dentistry-specific mandate that would not be supported by current science. Without any doubt, biofilm exists in other environments that would not be addressed by this particular legislation. CDA will continue to support further research and any approach validated by sound scientific information leading to increased water quality.

Fluoridation of public water supplies in California, while not a dental office issue, has been a major goal of the profession in California for many years. While buoyed by the passage of state law in 1995 and, more recently, the decision by the city of Los Angles to move forward to fluoridate the water for 3.3 million city residents, CDA and other proponents still have been facing an uphill battle against a vocal minority of public-minded" individuals in efforts to educate citizens in cities throughout the state about the benefits of fluoridation. Instead of presenting sound evidence against fluoridation, opponents cleverly focus discussion on peripheral matters such as "98 percent of European countries don't fluoridate." These tactics have undoubtedly contributed to safety concerns that have led to the adoption of bans against fluoridation by the city of Santa Cruz and a couple of communities in San Diego County. Dentistry will need to focus the attention of the public on sound scientific data on the effects of fluoride to continue to win converts such as Los Angeles, Sacramento, Mountain View, and Yuba City.

The American Dental Association continues to provide testimony to a House subcommittee on the matter of latex allergy and its effect on patients (the public) and health care professionals. This controversy is particularly interesting in that two federal agencies, the Food and Drug Administration and the Occupational Safety and Health Administration, have taken positions that seem to be in conflict, resulting in the potential to alarm the public about the safety of gloves. The net effect, similar to that experienced by dentistry during the height of the AIDS dilemma, might be to heighten public fears resulting in a limitation of the barrier choices available to practitioners.

The last update on the latex issue reported that the ADA leans toward what they view as the more "reasonable" approach of the FDA. The ADA position on this matter should serve as the guiding principle for management of all three issues we have described:

These three issues again confirm that sound science is dentistry's best defense against such professional challenges as undesirable regulations and public health safety fears. Sound science also represents the best offense in the profession's continuing efforts to improve dental health and the safety of dental care delivery methodologies.