Speaker: Dr Gilbert Kuepouo PhD CREP/African Center for Environmental Health.

Highlights:

Minamata Convention on Mercury -COP. 3 and COP. 4 

Dental Amalgam Provisions in the Convention

Proposal of African Region to Amend Part II of Annex A.

Strategies to Implement the Children’s Amendment in Africa

Possible Challenges to Implementation.

Webinar 03 Part 3: Implementing the Children’s Amendment in Africa

Speaker: Prof. Morenike Oluwatoyin Afolayan BDS, FWACS Professor of Pediatric Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria.

Highlights: The Minamata Convention on Mercury. The Children’s Amendment. The Caries Burden in Africa. Implementation Strategies

Speaker: Dr Munro Hall BDS, (United Kingdom) Chief Medical Officer, World Alliance for Mercury Free Dentistry. Highlights: Dental Mercury Basics. Environmental Impact of Dental Mercury. Adverse effects on Health from Dental Mercury. Protecting Dental Personnel. Protecting the Patient from Dental Mercury.

Right-Click & Save As to Download our S.M.A.R.T files

• SMART protocol 12.6.16
• SMART Patient Dentist Checklist
• SMART Equipment 12.20.18
• Research-Report-Improving-Indoor-Air-Quality-in-Dental-Practices_v2

Right-Click & Save As to Download our S.M.A.R.T files

• INFRASTRUCTURE FOR MERCURY WASTE MANAGEMENT IN NIGERIA-CURRENT STATE OF AFFAIRS AND FUTURE PLANS
• Minamata Convention on Mercury
• NATIONAL POLICY on SOLID WASTE MANAGEMENT

Right-Click & Save As to Download our S.M.A.R.T files

• Human Toxicity of mercury dental amalgam- WHO fact-sheet 3
• Future Use of Materials for Dental Restoration
• WHO Report on Dental Amalgam for COP3
• What Restorative material is ideal for MID final 17.11.2019.pdf
• Prof. Godwin Arotiba: OBSERVATIONS RELATED TO WHO RELEASE FOR COP 3

Right-Click & Save As to Download our S.M.A.R.T files

DENTISTS’ COMMITTEE FOR A MERCURY FREE AFRICA

International Mercury Free Dentistry Seminar & Hands on Workshop

JUNE 15TH - 16TH, 2020
LAGOS, NIGERIA

• International Mercury Free Dentistry Seminar & Hands on Workshop.pdf

Right-Click & Save As to Download our S.M.A.R.T files

• Abuja Declaration for Mercury-Free Dentistry for Africa

Right-Click & Save As to Download our S.M.A.R.T files

• Promoting Dental Amalgam Phase-Down Measures Under the Minamata Convention and Other Initiatives, For “Especially Women, Children and,Through Them, Future Generations”
• Eco and Human Toxicity of Mercury Dental Amalgam
• PMaxson-latest presentation Bangkok 14 May 2018

Introduction

Minimata convention

The Minamata Convention on Mercury is an international treaty designed to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds. This Convention was a result of three years of meetings and negotiations, after which the text of the Convention was signed by delegates from 140 countries on 19 January 2013. The Convention is named after the Japanese city Minimata. This naming is of symbolic importance as the city went through devastating incident of mercury poisoning. It is expected that over the next few decades, this international agreement will enhance the reduction of mercury pollution from the targeted activities responsible for the major release of mercury to the immediate environment. 

The Minamata Convention on Mercury was ratified in August 2017. As stated in the Convention’s preamble, protection of human health and the environment includes awareness “of health concerns, especially in developing countries resulting from exposure to mercury of vulnerable populations, especially women, children and future generations,” In Part II of the Convention’s Annex A, Parties are to take measures to phase down the use of dental amalgam, including (but not limited to) “two or more” of the nine provisions listed, and taking into account “the parties’ domestic circumstances and relevant international guidance.”

Nigeria signed the Minamata treaty on 10 October 2013 in Kumamoto, Japan, and ratified it on February 1st 2018.  The Minamata Convention entered into legal force in August 2017.   Addressing every major use of mercury, the Minamata Convention calls for a phase down approach to the use of mercury dental amalgam; see Annex A Part II. This is because it recognizes the fact that the road to achieving a total phase out of mercury dental amalgam begins with a progressive phase down with provisions for introduction of alternatives and monitoring of progress.

Health and Environment interaction

The WHO has reported that environmental Hazards are responsible for an estimated 25% of the total burden of disease worldwide. In Sub-Saharan Africa however, the proportion is higher (35%). This is probably due to poor development of infrastructures for monitoring and control of environmental pollution.

The 9 provisions of the Minamata convention

Minamata Convention, Annex A, Part II:   The Nine measures to phase down the use of dental amalgam are:

1. Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration;
2. Setting national objectives aiming at minimizing its use;
3. Promoting the use of cost–effective and clinically effective mercury-free alternatives for dental restoration;
4. Promoting research and development of quality mercury-free materials for dental restoration;
5. Encouraging representative professional organizations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices;
6. Discouraging insurance policies and programmes that favour dental amalgam use over mercury-free dental restoration;
7. Encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration;
8. Restricting the use of dental amalgam to its encapsulated form;
9. Promoting the use of best environmental practices in dental facilities to reduce releases of mercury and mercury compounds to water and land.

Note: Parties are encouraged to take measures even beyond the above nine provisions.

The 6 top priorities for Africa

• (i).Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration;
• (ii).Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration;
• (iii).Encouraging representative professional organizations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices;
• (iv).Promoting research and development of quality mercury-free materials for dental restorations;
• (v).Discouraging insurance policies and programs that favor dental amalgam use over mercury-free dental restoration;
• (vi) . Encouraging insurance policies and programs that favor the use of quality alternatives to dental amalgam for dental restoration.

Recommendation for African governments

1.Reduce or remove import duty and taxes on glass ionomer and bioactive bisphenol free composite restoratives.

2.Update dental schools’ curriculum and upgrade their simulation station with Professor’s station, interactive smart boards and e-learning software.

3.Update the knowledge of general dental practitioners with mercury free seminars and hands on workshop

4.Plan to set up the required infrastructure for managing wastes using www.chemi.se as a template.

Our Goal and Objectives

Goal:  To motivate African Dentists to practice 21^st century dentistry (minimum intervention dentistry) which is mercury free.

Objectives:

1. To safeguard human health and the environment from mercury pollution for future generations of Africans.
2. To promote mercury free dentistry (minimum intervention dentistry/21^st century dentistry) in Africa through seminars, curriculum update and hands on workshops. 
3. To collaborate with interested governments, parties, agencies and associations/societies locally and globally in advancing our goal and objectives.

There will be 4 wings of the mercury free dentistry initiative in Nigeria / Africa:

1. The Political wing- Ministries and Parastatals (Environment, Health, Education, Women Affairs etc.) NGOs (e.g. World Alliance, SRADEV), NDA, AGDPN etc. Public relations and advocacy.

2. The Dental Education wing -Training future generations of Dentists in mercury free Dentistry.-Faculties of Dentistry/Association of Dental School Deans, Dental Education / Curriculum experts.

3. The Expert / Training Wing -Conservation and Pediatric dentistry specialists - hands on workshop/seminar resource persons/Instructors. APD, ARD etc

4. The general dental practitioners wing- reputable, experienced, general dental practitioners who are committed to mercury free Dentistry.

Membership Categories

Faculty Board Members

Members who have participated as faculty in at least 2 workshops or seminars will be eligible for admission into this category of membership. Faculty board members will be the highest decision making organ of the committee. They will be required to chair standing committees and act as course or seminar directors/evaluators.

Faculty members

Faculty members will be consultants / specialists in conservative dentistry or pediatric dentistry or any other relevant dental specialty who have indicated interest in joining the Committee but who have not taken part in at least two hands on workshops or seminars. Outstanding general dental practitioners who are committed to mercury free dentistry may also be admitted as faculty members.

Associate membership

Associate membership shall be granted to residents in training in conservative dentistry, pediatric dentistry, community dentistry and other dental specialties. Associate membership will also be granted to general dental practitioners. It may also be granted to non-dentists who have demonstrated exceptional commitment to our goal and objectives. 

Trustees.

Reputable general dental practitioners will be recommended by the Chairperson to the board for election as a Trustee and will be inducted formally at a meeting of the committee. The Trustees will constitute an advisory body and shall be expected to use their wide connections to support the goal and objectives of the committee. Chairpersons who have served the committee meritoriously shall on leaving office be  elected by Foundation Board members as a trustee.

Dissolution

The committee may be dissolved by a resolution of at least 2/3^rd of the members of the Board and the Trustees.

Officers of the Committee

The day to running of the committee shall be vested in the following officers:

Chairperson

Shall be responsible for all administrative and strategic planning of the committee’s activities. He shall be in responsible for all internal and international communications.

Vice-Chairperson

Shall assist and understudy the chairperson in all his responsibilities. Shall coordinate all practical hands on workshops.

Secretary.

Shall be responsible for all secretarial activities of the committee under the direction of the chairperson.

Shall take and keep the records of all minutes of meetings.

2 Assistant Secretaries.

Shall assist the secretary in the performance of his duties.

TreasurerS

Shall be in charge of all financial activities of the committee including fund raising events

Financial Secretary.

Shall keep the financial records and instruments of the association.

Public Relations Officer.

Shall be the public face of the committee. He shall be responsible for all press releases and shall interface with the press and other media on behalf of the committee.

Standing Committees

1. Academic Planning

This will be chaired by the chairman. The course director (s) and 3 other members of the faculty of the seminars or workshops shall be members.

2. Finance

This will be chaired by the Chairman. The treasurer and 3 other members of the committee shall be members

3. Public relations

This will be chaired by the Public relations officer with 3 other members of the committee.

4. Local Logistics

This shall consist of at least 3 members who are resident at the various workshop and seminar venues and who are qualified to be admitted as members of the committee. They shall be responsible for the direct organization and all venue arrangements.

5. Research

This shall consist of at least 2 Board members and 2 other member in the universities or research institutes. It will solicit for support to mercury free dentistry researches.

6. International relations committee

Shall relate with subregional committees in other countries in Africa with regards to achieving our objectives

I. Amalgam (50% mercury) is an environmental disaster, a health risk, and a workplace danger. 
II. Superior to amalgam, the alternatives are 21st-century dentistry for Africa
III. Across Africa & the world, big successes + enormous progress!

To the European Commission, amitsios@deloitte.fr, &   Env-Mercury@ec.europa.eu

RE:  47 NGOs from Africa, Asia, and Africa ask you to recommend a ban on dental amalgam exports 
Support banning dental amalgam exports from the EU

 We, the undersigned NGOs from non-EU countries, support the workshop background document Assessment of the Feasibility of Phasing Out Dental Amalgam's conclusion that dental amalgam should not be exported to other countries: “The phase-out in OP1, OP2 and OP3 would not be applied only on the use of dental amalgam in restoration, but also the manufacturing, export and import of dental amalgam (including encapsulated items).” [i] We urge the Commission to recommend a ban on amalgam exports to our countries because:

 1.      Developing countries cannot control mercury waste from amalgam: Amalgam waste management is not affordable or practical in developing countries that have neither the infrastructure to collect, transport, and store mercury waste from amalgam, nor the resources to enforce regulations requiring it for generations to come.  If the EU continues to export amalgam, it will contribute to the costly and dangerous mercury waste problem in other countries. 

2.      Dental mercury pollution crosses national borders: The largest user of dental mercury in the world is the European Union at 90 tonnes per year. [ii]  The resulting mercury pollution crosses national borders, making it a concern in our countries too.  Currently, amalgam use is low in many developing countries. If the EU continues to export amalgam, its use will increase and a part of the resulting mercury pollution could very well end up right back in the EU.  

 3.      Our children deserve as much protection as EU children: The European Union has banned amalgam use in children, pregnant women, and breastfeeding mothers in addition to taking steps to protect them from future dental mercury pollution by phasing out all amalgam use. But if the EU continues to export amalgam, our children will be subjected to a double dose of amalgam's mercury: first when it is implanted in their teeth and a second time when it contaminates their environment.   
 We applaud the EU for working to phase out its own use of dental amalgam.  But in order to lead the world effort to stop mercury pollution, we urge the EU to stop dumping dental amalgam in other countries via exports, especially to developing countries.  Thank you in advance for taking our perspective into consideration. 
                   
 Sincerely,

Dr. Shahriar Hossain, World Alliance for Environmental Health (Alternative Secretariat, Dhaka)

1. Environmental pollution is responsible for 35 % of human diseases in Sub Saharan Africa compared to 25% worldwide (NEP/WHO health and environment interactions).
2. Africa has poor infrastructure for managing wastes generally and mercury wastes in particular. It will take several years and huge financial costs for Africa to build such an infrastructure (Arotiba et al 2017).
3. In most African countries there are no organized systems for sorting, collection, transport, and treatment of mercury wastes generated by dental clinics (Arotiba et al 2017).
4. Mercury dental amalgam belongs to GV Back’s era of ‘drill and fill dentistry’ of 19th and 20th century. The drill and fill approach to managing tooth decay treated the symptoms of the disease rather than the causes and resulted in destruction of healthy tooth tissues, progressively larger and more complex restorations, increased costs, eventual loss of the tooth and poor oral health outcome (Ismail et al 2013,2015).
5. The current evidence based 21st century approach to management of tooth decay is minimum intervention dentistry (MID). The cornerstones of MID include early caries diagnosis and risk assessment, oral health promotion, targeted preventive non-surgical treatments, minimally invasive restorative treatments and frequent recall visits to re-evaluate caries risk. (Domejean et al 2017, Ismael et al. 2015).
6. Adhesive bioactive restorative materials (glass ionomers, bioactive bisphenol free composites) are the preferred restorative materials for minimum intervention dentistry (Domejean et al. 2009, 2017, Ismael et al.  2013, 2015).
7. Faculties of Dentistry in Africa should be supported to educate future generations of African dentists in MID  which is mercury free, run update courses for general dental practitioners in MID, and carry out regular public awareness campaigns and community out reaches.

African governments should commence phase down as soon as possible by:

1. Drawing up a national action plan if they have not done so already.
2. Putting in place the necessary legislations to support phase down in vulnerable groups (pregnant and lactating women, children from 1-15 years).
3. Removing or reducing import duties and taxes on glass ionomer restoratives (high viscosity) and bioactive bisphenol free composite restoratives.
4. Updating dental schools/training institutions curricula.
5. Supporting the training of dental students’ simulation laboratory (400level) and clinical dentistry training (500 and 600 levels).
6. Updating the training of general dental practitioners in mercury free dentistry (MID) through seminars, conferences and hands on workshops.

European Parliament voted for phase down…till 2030 in 2017!

The European Parliament has voted in favor of a gradual phase down in dental amalgam. The move has ended months of speculation over whether the dental filling material faced an outright ban by 2022. The so-called great reform act should mean that this will be incorporated into UK law and after 2022, decisions will be made by UK parliament.

Worldwide environmental concerns over mercury pollution had led the United Nations Environmental Program (UNEP) to draw up The Minamata Convention, agreed in 2012. The treaty recommends a phase-down of amalgam alongside a number of other measures to be pursued in tandem including prevention of dental disease and research into new materials. 

The vote in the European Parliament and the expected ratification by the European Council will formalize the EU’s own approach to these recommendations, including an assessment of the feasibility of phasing out amalgam entirely in the future, preferably by 2030.

Dental amalgam makes a small contribution ??? to environmental mercury pollution but has been used as a durable, stable and cost effective restorative dental material for more than 150 years. The vote means that dentists will continue to have the full range of filling materials at their disposal to enable them to address the individual needs of each patient. In some patient groups the use of amalgam is considered to be less frequently necessary, in accordance with the general principle of minimizing intervention.

For ten years the BDA has worked closely with international partners to move the debate from an unworkable blanket ban towards a gradual reduction in the use of dental amalgam. UK dentists have been at the forefront of meeting EU standards on use of pre-capsulated amalgam and amalgam separators.

BDA Chair Mick Armstrong said: “For ten years the prospect of an unworkable outright ban of dental amalgam has left health systems worldwide facing real uncertainty. A knee-jerk ban would have caused chaos. The UK dental profession has shown its commitment to a phase down, and with a sensible policy we now have the freedom to deliver on it, based on our clinical judgment and while acting in our patients’ best interests.”

See the chart of countries that have phased down

Scotish Dental Magazine.

Published: Thursday, 30 March 2017 07:42

Written by News Editor

Nordic countries experienced some initial resistance from the dental industry and this was largely because they were:
1. Unaware of the environmental impacts of mercury from amalgam, and the social benefits of reducing mercury emissions.
2. Reluctant to invest in new equipment required to reduce mercury pollution or to support mercury-free fillings.
3. Unconvinced of the durability of alternative filling materials.
4. Inconsistent with their skills and knowledge in applying mercury-free. techniques. @Health Care without Harm (HCWH) Europe

To read more, download PDF FILE: Lessons from Nordic Countries

Signatories

1U.S. FDA, Final Rule for Dental Amalgam, http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalga m/UCM174024.pdf, p.86.

2 UNEP, http://www.unep.org/chemicalsandwaste/Mercury/tabid/434/Default.aspx (“Mercury is a notorious heavy metal of global concern and known to be a potent poison of the human nervous system since Greek and Roman times.”)

3 UNEP/AMAP, Technical Background Report to the Global Atmospheric Mercury Assessment (2008), p.20

4 Data from UNEP.

5Concorde East West, The Real Cost of Dental Mercury (March 2012), http://www.zeromercury.org/index.php?option=com_phocadownload&view=file&id=158%3Athe-real-cost-of- dental-mercury&Itemid=70

6 http://www.epa.gov/hg/exposure.htm

7United States Environmental Protection Administration,http://yosemite.epa.gov/opa/admpress.nsf/d0cf6618525a9efb85257359003fb69d/a640db2ebad2 01cd852577ab00634848!OpenDocument (2010).

8 Mahmood A. Khwaja and Maryum Shabir Abbasi, Mercury Poisoning Dentistry: High level indoor air mercury contamination at selected dental sites. REVIEWS OF ENVIRONMENTAL HEALTH (New York Academy of Sciences, April 2014)

9 American Academy of Pediatric Dentistry, Guideline on Pediatric Restorative Dentistry (revised 2008) (“Amalgam restorations often require removal of healthy tooth structure to achieve adequate resistance and retention.”); World Health Organization, FUTURE USE OF MATERIALS FOR DENTAL RESTORATION (2011), http://www.who.int/oral_health/publications/dental_material_2011.pdf, p.16 (“Adhesive resin materials allow for less tooth destruction and, as a result, a longer survival of the tooth itself. Funding agencies should take the initiative and encourage the replacement of amalgam as the material of choice for posterior teeth with adhesive systems.”)

10 Minamata Convention (2013)

11 Lars D. Hylander & Michael E. Goodsite, Environmental Costs of Mercury Pollution, SCIENCE OF THE TOTAL ENVIRONMENT 368 (2006) 352-370; Concorde East West, The Real Cost of Dental Mercury (March 2012), pp.3-4

12 Pan American Health Organization, Oral Health of Low Income Children: Procedures for Atraumatic Restorative Treatment (PRAT) (2006), http://new.paho.org/hq/dmdocuments/2009/OH_top_PT_low06.pdf,

p.xii. (“The costs of employing the PRAT approach for dental caries treatment, including retreatment, are roughly half the cost of amalgam without retreatment. PRAT as a best practice model provides a framework to implement oral health services on a large scale, and it can reduce the inequities for access to care services.”); S. Mickenautsch, I. Munshi, & E.S. Grossman, Comparative cost of ART and conventional treatment within a dental school clinic, JOURNAL OF MINIMUM INTERVENTION IN DENTISTRY (2009), http://www.miseeq.com/e-2- 2-8.pdf (“ART is also a cost-effective means of oral health care within a modern dental clinic. The ART approach can be undertaken at approximately 50% of the capital costs of conventional restorative dentistry.”)

13 World Health Organization, FUTURE USE OF MATERIALS FOR DENTAL RESTORATION (2011),http://www.who.int/oral_health/publications/dental_material_2011.pdf, p.11

14 http://www.afro.who.int/fr/downloads/doc_download/2224-declaration-de-libreville-sur-la-sante-et- lenvironnement-en-afriquelibreville-le-29-aout-2008.html

15 World Health Organization, FUTURE USE OF MATERIALS FOR DENTAL RESTORATION (2011),http://www.who.int/oral_health/publications/dental_material_2011.pdf, p.16

16 AMAP/UNEP Technical Report for the Global Mercury Assessment” (2013), http://www.amap.no/documents/doc/technical-background-report-for-the-global-mercury-assessment-2013/848,      at p. 103

DOWNLOAD PDF VERSION

The African region has put her weight behind a proposal that seek an amendment to Annex A to the Minamata Convention on Mercury by moving dental amalgam from Part ll to Part l of Annex A. Besides, the region has also said it needs more financial support to implement its obligation under the Convention particularly in introducing alternatives to the use of mercury in artisanal and small scale gold mining which is a common practice across the continent.

These were part of the resolutions reached at the end of the two-day African Regional Preparatory meeting held penultimate week in Accra, Ghana’s capital city from 15-16 October 2019 which the group will push at the forth coming third Conference of the Parties (COP3) in November.

By the amendment, the region is calling for a phase out of dental amalgam for use in deciduous teeth, children under 15 years, pregnant women, and breastfeeding women by year 2021 as well as dental amalgam, except where no mercury-free alternatives are available by year 2024.

On 8 May 2019, six countries including Botswana, Chad, Gabon, Guinea Bissau, Niger and Senegal submitted a proposal to the Secretariat seeking to amend Annex A to the Convention by moving dental amalgam from Part ll to Part l of Annex A.

The move by the six countries received an overwhelming support by nearly 27 Parties from the African region that attended the regional preparatory meeting held in Ghana. Not only that, the Secretariat has also scheduled the proposal on the agenda for consideration during COP3.

Parties that attended the Ghana meeting are: Benin, Togo, Botswana, Burkina Faso, Chad, Comoros, Congo, Cameroon, Republic of Congo, Gambia, Gabon, Eswatini, Lesotho and Ghana.

Others are Nigeria, Kenya, Niger, Namibia, Cote d’Ivoire, Senegal, Sierra Leone, Mauritius, Mali, Zambia and Zimbabwe. The meeting was also attended by other observer groups including Non-Governmental Organisations, United Nations agencies and media among others.

To ensure that the proposal scale through during the COP, the group has set up a team to re-frame the Conference Room Paper (CRP) that will be review and once approved, would be submitted after the opening ceremony of COP3 in Geneva, Switzerland in November.

Co-Chair of the African group meeting, Mr. Serge Molly Allo’o, who spoke with Ecogreen News at the end of the two-day meeting in Ghana, explained that the meeting was an opportunity to harmonise the positions of the region before the Conference of the Parties. He added that during the meeting, the proposal submitted by six countries earlier within the region to amend Annex A of the Convention on dental amalgam received support of the region to submit it at COP3.

“The amendment of the convention on Annex A, six African countries proposed the amendment but after this meeting, we received the support of our region to submit the amendment. This amendment concern the use of dental amalgam, it’s a big issue for the region but am very glad we receive support of the region.

“The other issue is on how to implement our obligation under the Convention, we are facing many problems like financial support and so on, but here we addressed these issues and we adopt methodologies and strategies to mobilize more funding to implement the Convention. The other issue is secretariat issue because if you read the convention, we have a team on the secretariat to manage any action to move the convention. Our view is that we do not have enough people to work in the secretariat, we need something we can put in parallel but at this point I am not in position to clarify the strategy to mobilse before the COP.”

Basel Convention Coordinating Centre for the African Region expert and  distinguished Professor of Chemistry, Babajide Alo, said the two-day meeting was quite productive and the African region has taken good positions on each of the issues particularly those that are relevant to the region’s own interest.

“For example, we do know that mercury emissions from Artisanal and Small-scale Gold Mining (ASGM) is a major issue for us because, several of our countries still have extensive artisanal gold mining going on and we are taking a position that we would continue to consider minimizing the use of mercury in artisanal mining, we don’t want to get our people off their jobs and their means of livelihood and it should be a gradual  face-out of the use of mercury by introducing alternatives to our mining.

On dental amalgam, Prof. Alo said, “another key issue to us in Africa is dental amalgam, the use of amalgam in dentistry. Amalgam containing mercury in dentistry and the African group out of this meeting is taken to COP in November, the necessities for us to consider rather than phase out, that we should move it into the book of devices that we think it should be total elimination, it won’t be phase down but complete phase-out for the use of amalgam because in Africa, dental amalgams continue to be in frequent use. In fact, women and even some men take it as ornament to have gold teeth without their realizing that, that gold tooth they have, contains mercury which continue to leach gradually into their bloodstream.

“So, we from the African region have also at this meeting, unanimously agreed that we should go and push for a phase out of the use of dental amalgam rather than the phase down, which the present article of the convention stipulate. So on other issues, particularly financing, the African region has taken a position that we need more support, on special intervention projects we need more of countries that have applied for that grant to be approved so that we can continue to have intervention on mercury in our different countries,” he said.

The BCCC-Africa expert expressed optimism that the position of the African region on dental amalgam phase out will receive the support of other regions at COP3.

Vice-President Africa, World Alliance for Mercury-Free Dentistry, Dominique Kpokro, said, “One of the key achievements for the dental amalgam at this meeting is that we have the full support of all African Parties, now it is no longer the six African countries which submitted and since it’s the whole African region that will submit the amendment.

“The secretariat has suggested we should re-frame the title of the amendment so that it will not be the six African countries, and the way to do that is to write a Conference Room Paper (CRP) that will be submitted just after the opening ceremony at COP 3. So, based on that, we are going to develop a CRP and African Centre for Environmental Health, some NGO’s working under the umbrella of World Alliance for Mercury-Free Dentistry and Parties such as Senegal, Gabon, Sierra Leone, Botswana, Chad, Burkina Faso and Niger will be the countries that will review the draft CRP and after approval, it will be endorsed by the whole region at the regional meeting in Geneva.

“The amendment is going to cover the children, women in child bearing age and the request for countries to ban amalgam in children in all ages by the year 2021, which is the request of the amendment and the proposed date by African region for total ban of dental amalgam is 2024. Now, that date need to be debated by all the Parties to know what is achievable by all so that it will be an agreed document. So, we would negotiate these dates at COP3.”

The World Alliance for Mercury-Free Dentistry (WAMFD), the global advocate for mercury-free dentistry in its position on dental amalgam said across the continent, west to east and south to north, African are moving toward mercury-free dentistry right now for children, and with a phase-down leading to a phase out for all.

The group said “If amalgam is phased out, Minamata can be the model environmental treaty for the 21st century. If amalgam is not phased out, then the world is failing t address major use f mercury- and Minamata is not a model treaty. The African Amalgam Amendment, on the agenda for COP3, would bring amalgam in line with other products covered under the Minamata Convention on Mercury.”

As at Friday 25th October 2019, 114 countries have ratified as Parties to the Convention. Out of these, African region is leading with 31 Parties to the Convention and nearly 27 of the Parties attended the regional meeting held in Ghana.

The Minamata Convention on Mercury, a global treaty that seek to protect human health and the physical environment from the dangers of emissions and releases of mercury and mercury compounds entered into force in August 2017.

The third Conference of the Parties to the Convention (COP3) will be coming up in Geneva, Switzerland from 25-29 November, 2019.

NOTE:

At least 2 officers of the Federal Ministry of Environment were present at this meeting.  There at least 2 other Nigerians at this meeting who are experts on this issue at this meeting as well.

Mercury Free Dentistry Seminar & Curriculum Update Workshop, July 24th 2019, Abuja, Nigeria

This session (preconference seminar and curriculum update workshop) was chaired by the Registrar of the Medical and Dental Council of Nigeria Dr. T.A.B. Sanusi. The Seminar/workshop was organized in partnership with the World Alliance for Mercury Free Dentistry, SHRAdeV, Association of Nigerian Dental School Deans and the Nigerian Dental Association. The morning session (Mercury Free Dentistry Seminar) was for both General Dental Practitioners (GDPs) and lecturers in faculties of Dentistry. For GDPs it serves as an introduction to Minimum Intervention Dentistry (MID). For lecturers of Faculties of Dentistry it served as both an introduction to MID and a foundation for the curriculum update workshop in the afternoon session.

International facilitator, Prof. Jo E. Frencken, the inventor of Atraumatic Restorative Dentistry (ART) from Netherlands, Europe presented two seminars: The use of glass hybrid materials for restorations and Integrating Minimum Intervention Dentistry in Dental Curriculum. Both presentations generated interesting questions from the participants.

Prof Jo Frencken advised that Nigeria should first ensure the wide availability of mercury free restorative materials before the restriction of the use of Dental Amalgam in vulnerable groups by January 2020.

In his presentation on “Phase down of dental amalgam: The Training of 21st century Dentists”, Coordinator, Mercury free dentistry in Nigeria, Prof. Godwin Arotiba said there is no more  scientific  backing for the continued use of dental amalgam as a tooth filling material in the 21st century. He emphasized that ‘Mercury Dental Amalgam’ belonged to the 19th and 20th century Dentistry and has no place in 21st century dentistry.”

Prof. Arotiba highlighted the definitions, principles and clinical strategies of Minimum Intervention Dentistry (MID) and informed the gathering that MID is focused on early caries diagnosis, caries risk and activity assessments/classifications, targeted preventive treatments based on CRA classification, frequent recall visits to evaluate compliance with counselling, caries control and oral health outcome, minimally invasive restorations and repair rather than replacement of defective restorations. He submitted that the goal of MID is to keep oral tissues healthy and functional for life. In addition, he pointed out that MID has applications in periodontology, oral surgery and oral rehabilitation and that all branches of dentistry will soon embrace it.

In his presentation on “Dental Amalgam phase-down: The imperative of curriculum review and update in dental schools in Nigeria” Dr. Adolphus Loto said curriculum update is a necessity in the ever-changing world owing emerging new knowledge and techniques through research and technological development/advances. Dr. Loto, who urged dental practitioners to embrace change, stressed that curriculum update will involve update of courses at almost every level of a typical 6 years Bachelor of Dental Surgery programme.

Other presentations include Curriculum development, review, update and evaluation by Dr. O.A Loto; The European Core Cariology curriculum by Prof. M.A Sede; The Association of Nigerian Dental School Deans (ANDD) Cariology curriculum by Prof. M. Ukpong;

Prof G T Arotiba also presented a modified color-coded GC Corporation Minimum Intervention Treatment Plan (MITP) framework for implementing MID in General Dental Practice and in Dental Education. This modified MITP framework was adapted for student’s clinical assessment in MID (see Fig.  X)

Fig. X:  The Modified color-coded GC Corp. MITP framework 

Godwin Toyin Arotiba   Seminar / Workshop Director & Coordinator of Mercury Free Dentistry in Nigeria.

Presented on 8th July, 2019 Abuja, Nigeria.

Goodwill Message from Attorney Charlie Brown,

President, World Alliance for Mercury-Free Dentistry

To Professor Arotiba, Professor Frencken, the Deans and Professors of the Colleges of Dentistry, the Dentists of Nigeria, Government Officials federal and state, NGO leaders Adogame, Bally, and Aneni, and all other stakeholders:

Congratulations for your work to implement the Minamata Convention on Mercury.

Congratulations for the far-sighted decision to end amalgam use for children under 15 and for pregnant and breastfeeding women as of 1 January 2020, in less than six months!  You are saving an entire generation of Nigerians from exposure to toxic mercury.  Arise, O Compatriots!

Nigeria is the leader for Africa – what you do will affect the entire continent.  It is the reason I have been to your great nation for each of the past three years, four times in all, to work for mercury-free dentistry.

We attribute the enormous progress at the federal level to the excellent quality of men and women at the environmental and health ministries, especially my friends Dr. B.O. Alonge, Chief Dental Officer of Nigeria and Director Charles Ikeah, Pollution Control and Environmental Health, Federal Ministry of Environment, who leads your government’s delegation at the Minamata Convention negotiations.

The World Alliance for Mercury-Free Dentistry is proud to work with the esteemed Professor and former Dean Godwin Aritoba, and we salute his leadership to bring 21st century dentistry to Nigeria.  I am pleased that you are joined by Professor Jo Francken, whose well-known work as a pioneer of A.R.T. I have been reading about for at least a decade.

 Progress toward mercury-free dentistry is succeeding in Nigeria, Africa’s colossus state, because of the work of our excellent NGO team, led by Leslie Adogame in Lagos and including Tom Aneni in Benin and Joy Eziallor in Enugu.  I am most pleased that Monsieur Dominique, the founder of the African Center for Environmental Health and the vice president for Africa of the World Alliance, came over to Abuju from Abidjan to speak.

The World Alliance works at the federal level for mercury-free dentistry, plus has “model state” campaigns in Edo State and Lagos State.  Having done a regional conference in the South-South Region in 2017, later this year we will a regional conference in Enugu for the South East Region.  

My warmest wishes to the people of Nigeria and to today’s visitors to Nigeria:

Charlie Brown

23 July 2019

Activities completed in 2019

The following activities were completed in 2019 in partnership with the Nigerian Dental Association:

1. National Policy on phase down of dental amalgam steering committee meeting organized by dentistry division, federal Ministry of Health, Abuja, Nigeria.
2. Mercury free dentistry seminar for general dental practitioners and faculties of dentistry in Nigeria (organized by the Nigerian Dental Association and the Association of Nigerian Dental School Deans).
3. Curriculum update workshop for faculties of Dentistry in Nigeria. (organized by the Nigerian Dental Association and the Association of Nigerian Dental School Deans).
4. Minimata convention on mercury – phasing out dental amalgam in Nigeria (organized by the Nigerian Dental Association).

Nigeria sets to get National Policy on phase down of dental amalgam

Photo Caption: Participants in a group photograph during the Steering Committee on development of National Policy on phase down of dental amalgam held in Abuja on Tuesday July 23, 2019.

In continuation of her efforts to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds, Nigeria will soon get a National Policy on phase down of dental amalgam in line with the objective of the Minamata Convention on Mercury.

Essentially, the goal of the document tagged “National Policy on Phase- Down of Dental Amalgam in Nigeria” is to phase down the use of dental amalgam in vulnerable groups by June 2020 and phase out in all age groups by 2022 on a consensus-based timetable.

Dental amalgam is a mercury-added product containing about 50 per cent of mercury, forming a metallic alloy with silver and tin. It is widely used in the restoration of teeth affected by dental caries which about the most common dental disease worldwide and it has been available for over 150 years.

At a-day long Steering Committee meeting on development of the National Policy held at the nation’s capital, Abuja on Tuesday July 23, 2019 facilitated by the Federal Ministry of Health in conjunction with Federal Ministry of Environment in partnership with Sustainable Research and Action for Environmental Development (SRADev Nigeria) and World Alliance for Mercury Free Dentistry, USA, stakeholders reviewed and made recommendations to the draft document.

In her welcome address at the meeting, Director, Dental Services, Federal Ministry of Health, Dr. B.O. Alonge, provided an overview of mercury as a toxic substance posing a global threat, noting the damaging effects on health and environment. She noted that the Minamata convention calls for a phase down and subsequently a phase out of the use of Dental amalgam which Nigeria is taking step in that direction.

She added that Nigeria is a Party to the Convention and the Ministry initiated the process of developing a National Policy on dental amalgam phase down in line with the Convention objective.

Representative of the Federal Ministry of Environment and a Deputy Director, Mr. Olubunmi Olusanya, said dental amalgam phase down is a cross-cutting issue which the ministry has carried along all the parastatals under it along in ensuring that they are all well informed including the private sector.

He explained that the Ministry has been fully involved in the process right from the onset leading to the signing in 2013 and ratification of the Convention in 2018.

Olusanya added that Nigeria was the first country to conduct the Mininamata Initial Assessment (MIA) report in the world, which was completed in 2018 and received commendation from the international community on it.

He listed several other efforts that the Ministry has made as the Secretariat of the Minamata Convention since the country ratified the Convention last year.

Regional Environment Expert, United Nations Industrial Development Organization (UNIDO) Mr. Oluyomi Banjo, in his goodwill message commended the cooperation between the Federal Ministry of Health and Environment on the Minamata Convention on Mercury, adding that the cooperation led to Nigeria been the first to successful complete the Minamata Initial Assessment (MIA).

“This would not have been possible without the cooperation of the two ministries”, Banjo stated.

Banjo urged the two ministries to ensure that the cooperation continues in the implementation stage of the Minamata Convention, stressing that the MIA had earned Nigeria recognition in the international community which others are now following.

He added that Nigeria has made a lot of progress in the phase down of dental amalgam and in the mining sector to eliminate mercury pollution.

President, Nigeria Dental Association (NDA), Dr. Omoshibo Eshikena said the association has being part of the process for implementation on the phase down of dental amalgam in the country.

Dr. Eshikena who expressed her delight on the development of the policy hope that Nigeria will soon be mercury free.

In his goodwill message, Vice President Africa for World Alliance for Mercury-Free Dentistry (WAMFD), Mr. Dominique Bally, an Ivorian, commended Nigeria for the efforts towards making dental amalgam history in the country.

He explained that like all the countries that participated in the negotiations of the Minamata Convention on Mercury and even those who have not ratified it, is clear that the question of dental amalgam elimination remained one of the priorities for Africa region.

Bally, who extended the greetings of the WAMFD president, Charlie Brown to the meeting said, “Nigeria has not been left out of this whole process. Indeed, it is since here that in 2014, African civil society organizations have enacted the Abuja Declaration calling on Africa to be the first continent to eliminate mercury amalgam in dentistry. Since then, how many activities have not been carried out to achieve this noble goal that protects the health of our valiant populations who are longing to live in a healthy environment, which is a mercury-free one.

“Today’s meeting is intended primarily to bring to the table the finalization of the policy documents leading Nigeria to achieve the dental mercury elimination in a very short time, starting with children under 15 years old and women of childbearing age”, he said.

The WAMFD Africa Vice President said the Africa region has rightly submitted, through the governments of Gabon, Guinea, Senegal, Niger, Madagascar and South Africa, a proposal for an amendment of Annex A, Part II, of the Minamata Convention with a view to reaching a precise date for the banning of dental amalgam in children and women of childbearing age at COP 3.

“In my turn, I, would like too, to call on the Government of Nigeria to take ownership of this proposed amendment so that Africa speaks with one voice, as it has always been, and whose palpable example goes back to this vibrant echo calling for consideration of pollution questions and public health ones generated by dental amalgam at COP 2 in 2018”, Bally added.

Erudite scholar and Professor of Chemistry, Babajide Alo, said Nigeria is leading globally in the process of eliminating dental amalgam through the submission of MIA in 2018.

He stressed that the “Abuja Declaration” in 2014 is widely recognized and that the country is making progress in the phase down of dental amalgam. He urged the dental practitioners to change to the alternatives to amalgam, which he said it will take time but “it is achievable because there are alternatives to amalgam”.

In a communiqué, the committee unanimously agreed that in alignment with global standard documents, the national policy should be further updated to drive the phase down of amalgam use in Nigeria as a road map and implementation plan.

The National Policy draft was developed by former Dean, Faculty of Dental Sciences, College of Medicine of the University of Lagos, Prof. Godwin Arotiba.

In his vote of thanks to the committee members, Executive Director of SRADev Nigeria, Dr. Leslie Adogame, commended them for their commitment towards the project as well as the support of WAMFD for making the meeting possible.

NDA backs dental amalgam phase down, seeks partners on implementation

Photo Caption: Cross section of participants at the 52nd AGM/SC of Nigerian Dental Association (NDA) held in Abuja from 24-26 July 2019.

Members of the Nigerian Dental Association (NDA) have put their weight behind dental amalgam phase down in Nigeria. Besides, they have called on all stakeholders to partner with them towards its implementation in dentistry practice in Nigeria in line with the objective of the Minamata Convention on Mercury.

President of the association, Dr. Eshikena Evelyn stated this in Abuja on Thursday during the 52nd Annual General Meeting /Scientific Conference themed “The Minamata Convention on Mercury-Phasing Down of mercury Dental Amalgam in Nigeria” held from 24th-26th of July in Abuja.

According to her, the federal Ministry of Environment and Health need to develop the country’s national action plan around the convention to set realistic targets around dental amalgam phase down, adding that the Ministry of Science and Technology need to direct the research institutes/parastatals to collaborate with NDA, Faculties of Dentistry and Universities to conduct research into mercury free dental restorative materials with a view to explore the possibility of local manufacture.

Besides, the NDA President also request that the necessary legislation be put in place to restrict the importation of dental amalgam into the country, proscribe the use of dental amalgam in the vulnerable group by January 2020, and obtain duty free concession/reduction on mercury free restorative materials.

Dr. Eshikena, in her welcome speech at the conference said, “NDA calls on all stakeholders here present and those we have invited to partner with us. Our dental schools need equipment and an upgrade of the simulation laboratories of the 13 Dental Schools in Nigeria with ICT, Interactive smart boards and e-learning facilities”.

She added that through the Scientific Conference, the NDA would promote update of dental schools curricula, retrain general dental practitioners in Minimum Intervention Dentistry and increase public awareness of the harmful effects of mercury in dental amalgam.

Nigeria is a signatory and 88th Party to the Minamata Convention on Mercury. The Convention which came into force on 16 August 2017 aimed at protecting human health and the environment from anthropogenic emissions and releases of mercury compounds.  The Convention focused on the entire life cycle of mercury, including controls and reduction across a range of products, processes and industries where mercury is used, released or emitted.

Approximately 50% of dental amalgam is elemental mercury by weight. Mercury can damage the child’s brain even before they are born. The World Health Organization considers it one of the top ten chemicals of major public health concern.

Already, the Federal Ministry of Health has commissioned a consultant to develop a National policy on phase down of dental amalgam in Nigeria, a document that will guide towards the implementation of the Convention.

In his good will message, Vice- President Africa of the World Alliance for Mercury-Free Dentistry (WAFMD) Mr. Dominique Bally, congratulated Nigeria for the work done to implement the Convention and the far-sighted decision to end amalgam use for children under 15 and for pregnant and breastfeeding women by January 1, 2020. “Doing that, you are saving an entire generation of Nigerians from exposure to toxic mercury”, he said.

“Nigeria is the leader for Africa – what you do will affect the entire continent.  It is why World Alliance for Mercury-Free Dentistry has been present in this great nation for each of the past three years, four times in all, to work for mercury-free dentistry.

“like all the countries that participated in the negotiations of the Minamata Convention on Mercury and even those who have ratified it, it is clear that the question of dental amalgam phase down remained one of the priorities for Africa region. So many progresses have been made in Africa on this question and Nigeria as well.

“These enormous progress at the federal level are attributed to the excellent quality of men and women at the environmental and health ministries, at this point, allow me please to nominate Dr. B.O. ALONGE, Chief Dental Officer of Nigeria and Director Charles IKEAH, Pollution Control and Environmental Health, Federal Ministry of Environment, who leads your government’s delegation at the Minamata Convention negotiations.

“The World Alliance for Mercury-Free Dentistry is proud to work with the National Dental Association these past five years led at this day by Dr Eshikena OMOSHIBO. We are most proud to closely work with the esteemed Professor and former Dean Godwin ARITOBA, and we want once again to salute his leadership to bring 21st century dentistry to Nigeria.  I am pleased that you are joined by Professor Jo Frencken, whose well-known work as a pioneer of A.R.T. I have been reading about and promoting in African continent for at least a decade”, Bally said.

Bally, who expressed greeting from the President of WAFMD, Charlie Brown, said Progress toward mercury-free dentistry is succeeding in Nigeria, Africa’s colossus state, because of the work of her excellent NGO team, led by Dr Leslie Adogame in Lagos and including Dr Thomas Aneni  in Benin City and Mrs. Joy Eziallor in Enugu.

In her goodwill message, Director, Family health, Federal Ministry of Health, Dr Adebimpe Adebiyi, who congratulated NDA on the occasion of her 52nd AGM/SC, urged participants to probe into the wisdom of phase down of dental amalgam.

International facilitator, Prof. Jo E. Frencken, said Nigeria should not be fast in phasing down of dental amalgam but should consider national economy in the area of availability of alternatives to dental amalgam.

He went further “you don’t destroy your old house, when you have not built a new one”.

Implementing The Minamata Convention on Mercury in Africa

2020 –2024

Phase down of mercury amalgam

2 days Mercury Free Dentistry Hands on Workshop

June 11-12^th 2020 Lagos, Nigeria, June 2021 Abuja, Nigeria, (October 2020 Enugu, Nigeria –to be confirmed)

Train the Trainers International Workshop

Highlights:

• Use of composite materials for restorations Dr. Faycal Iratni GC Corp Europe, Headquarters Belgium
• Layering Techniques in conservative dentistry – Dr. Faycal Iratni GC Corp Europe, Headquarters Belgium
• Mercury Free Dentistry Hands on Workshop – GC Corporation Europe Headquarters Master trainer

Click here to register

Implementing The Minamata Convention on Mercury in Africa

2020 –2024

Phasing Down Dental Amalgam

2 days Mercury Free Dentistry Seminar/curriculum update workshops 2020-2024

Nigeria:  Lagos, Ibadan, Enugu, Kano, Maiduguri, Port Harcourt

Africa: Rabat, Cote Devoir, Kampala, Nairobi, Gaborone, Cape Town etc.

Highlights:

• Environmental and human health impact of mercury in dental amalgam
• Caries Management Pathways
• Caries activity and risk assessment
• Caries Management by risk assessment
• ICDAS-ICCMS caries management pathway
• Minimum Intervention Dentistry in General Dental Practice (Brostek and Walsh)
• Minimimum intervention Treatment Plan (MITP)
• Caries management System for Adults
• Caries Management System for Children
• The Modified Minimum Intervention Treatment Plan (Integrated MITP)
• The Modified Minimum Intervention Treatment Plan (Integrated MITP) in General Dental Practice
• Phase down of dental amalgam - Training the 21st century dentists in Africa.  
• Mercury free dentistry (MID) Curriculum update workshops

Click here to register