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Sealants: minimal evidence to prove toxicity of BPA in dental sealants Critical Summary Prepared by: Analia Veitz-Keenan DDS 

OVERVIEW

  • Systematic Review Conclusion:

    Patients are not at risk of toxic exposure to bisphenol A (BPA) in dental sealants.

  • Critical Summary Assessment:

    A narrative assessment of a systematic search provides little evidence to resolve the issue.

  • Evidence Quality Rating:

    Limited

A Critical Summary of:

Is there a risk of harm or toxicity in the placement of pit and fissure sealant materials? A systematic review

Azarpazhooh A, Main PA. J Can Dent Assoc. 2008;74(2):179-83

  • Clinical Questions:

    Does the placement of pit and fissure sealants cause toxicity, and thus harm patients?

  • Review Methods:

    The authors conducted a comprehensive database search in English through March 2007. Working independently, they identified 377 potential articles, of which a total of 11 in vitro and in vivo studies were selected for review.

  • Main Results:

    The authors divided the studies into two groups. In one group, a total of eight in vitro and in vivo studies reported “no significant levels of BPA” after sealant placement. In the other group, a total of six in vivo and in vitro studies reported that detectable levels of BPA were found after sealant placement.

  • Conclusion:

    Based on these studies the authors indicate that patients are not at risk for toxic exposure to BPA after sealant placement. To reduce potential for BPA toxicity exposure, the authors recommend procedures to clean the surface of the new sealant and eliminate any uncured resin.

  • Source of funding:

    Not stated.

Commentary:

  • Importance and Context:

    BPA is widely used in the manufacture of many consumer plastic products. Laboratory testing in animals suggests that BPA may affect reproduction and development. Concerns exist that some polymers used in dental sealants or composites may contain trace amounts of BPA.

  • Strengths and Weaknesses of the Systematic Review:

    An extensive and comprehensive search informed the review. However, the review failed to present an explicit search strategy or inclusion and exclusion criteria. The review failed to present an evidence table and it did not critically appraise the identified articles for evidence level or validity. The search identified 11 studies, but the narrative portion of the manuscript included 15 studies. Also, the authors did not stratify the studies by study type, and instead grouped them by in vivo and in vitro trials.

  • Strengths and Weaknesses of the Evidence:

    The limited evidence from the included studies did not offer a clear conclusion. Only three human studies were identified in the review, but the review was not specific about the methodology and the quality of the research used by each included study.

  • Implications for Dental Practice:

    Based on these findings, the amount of human exposure to BPA from dental sealants appears small and currently there is minimal evidence of a health risk.

  • Critical Summary Publication Date: 6/25/2009

These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association ©

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