Follow us on:

facebooktwitteryoutubepodcast_logo4



Thursday, 12 September 2013 23:47

Influential Berkeley Dentist Misleads City Council About Mercury Filling Risks

MOSTAFA BARAKZOY DDS

Dr. Mostafa Barakzoy, DDS, Dental Director of LifeLong Medical Care in Berkeley, California appears to have played an integral part in influencing a key Berkeley City Council member to water down a set of proposals that were designed to get dentists in Berkeley to inform patients about the risks of mercury dental amalgam.

LifeLong is a low-fee/Medicare/Medicaid clinic in Berkeley, whose executive director and CEO, Marty Lynch, allegedly has significant clout with Mayor Tom Bates and City Council Member Laurie Capitelli.

Dr. Lynch asked Dr. Barakzoy, "Could you remind me of the argument why it is particularly hurtful to non-profit and public clinics???? is it expense for alternate materials or something else??", and sent Dr. Barakzoy's deeply flawed response to Council Member Capitelli.

Dr. Lynch, there are several arguments

1- Alt. material is very costly ( 3-4 times)and require more time to place ( labor cost) so pts have to pay more to get fillings ( restricts access to care)

2- Alt. material is difficult to put in , it does not work well if there is any moisture ( saliva or blood) most of our patient have poor gingival health and we encounter severe bleeding on daily basis.

3- Alt material is more technique sensitive( do not work in the hand of lousy dentist)

4- Amalgam restoration lasts longer and does not need to replaced as often

5- Mercury is in a bonded state in Amalgam and not in a free form , this material has been studied by CDC, WHO and other reputable organization , it is not toxic to humans.

Mostafa Barakzoy, DDS
Dental Director LifeLong Medical Care
510.231.9822 510.412.9867 Fax
This e-mail address is being protected from spambots. You need JavaScript enabled to view it

REBUTTAL BY Dr. DAVID KENNEDY

I have learned, via emails obtained through a Public Records Act request (see attached), that Bill Lewis, lobbyist for the California Dental Association, has met with a number of you.

The CDA is the point trade association for the mercury-denial dentists. Five years ago CDA was asked by the incredulous California Occupational Safety and Health Board why they had not informed their members on the appropriate legally mandated Occupational Safety and Health act requirements for using any toxic substance in a California business? Theresa Pichay, OSHA compliance spokesperson for the CDA, continued to deny that they were neglectful in informing their members claiming the information was on their website (it was not) and still today only a handful of the California Dental Association member, most of whom are also members of the IAOMT, are in compliance with long existing state and federal laws regarding employee protections.

The issue is simple. Enforce existing OSHA laws and the injury to personnel will cease and the risks to dental patients will be substantially reduced.

The attached emails also show that Marty Lynch, Executive Director of LifeLong Medical Care—which has a low-income dental clinic in Berkeley—has corresponded with a number of you, including you, Councilmember Capitelli, as well your aides (Calvin Fong and Sbeydeh Viveros-Banderas), Mayor Bates. I have also learned that Mr. Lynch's administrative office is in your district, Councilmember Moore, and that Mr. Lynch has expressed concerns to you, as well, regarding the dental amalgam issue.

As the attached emails show, LifeLong's Dental Director, Mostafa Barakzoy, DDS, made the following assertions to Mr. Lynch, which Mr. Lynch then forwarded to Councilmember Capitelli:

Here are Dr. Barakzoy's assertions:

1- Alt. material is very costly ( 3-4 times) and require more time to place (labor cost) so pts have to pay more to get fillings ( restricts access to care).

This is a gross exaggeration of the costs and it is a ploy to use fear mongering to retain a toxic material in dentistry. At the 2010 FDA expert panel hearings in Washington DC the experts from academia estimated a mere 10% difference in cost of using composite and that cost did not consider even one of the side effects of using mercury. The proven injury to kidneys is potentially far more costly both in terms of dollars and lives. Placing a mercury/silver filling requires the drilling away of an enormous amount of healthy tooth structure while the alternatives do not. That removal of good tooth results in a 75% decline in tooth strength. When the tooth eventually fractures down the middle it is often not restorable and thus extracted. At a minimum it will require extensive/expensive treatment if it to be salvaged. This would not have occurred if a conservative minimal cavity preparation were bonded in place instead of a 175 year-old expanding material.

While the actual composite material may be significantly more expensive than amalgam to the dentist, it is not the case that patients have to pay significantly more for composite fillings, to the point that access to care would be restricted. A call to LifeLong Dental Care in Berkeley confirmed that for the lowest-income patients, the clinic charges $75 for a one-surface amalgam restoration, and $88 for a one-surface composite restoration. Similarly, LifeLong charges $96 for a two-surface amalgam restoration, and $110 for a two-surface composite restoration. This is approximately a 15% difference in price, which does not seem to restrict access to care to any significant degree. Besides, none of the proposals currently on the table prevent patients from choosing amalgam fillings; they simply require dentists to provide patients with information that the state of California already requires dentists to provide to patients, so that patients may make an informed choice about what to put in their mouths.

Furthermore if the CDA offices were California OSHA compliant then they would not be nearly so cavalier about the low cost of mercury fillings. The use of mercury legally require many more protections and monitoring than they are currently doing which makes the CDA dentists law breakers.

The picture below is what they would look like if employees were being adequately protected. Dental schools do not teach this but OSHA requires it.

2- Alt. material is difficult to put in , it does not work well if there is any moisture ( saliva or blood) most of our patient have poor gingival health and we encounter severe bleeding on daily basis.

This is actually two points. One is the deplorable oral health of their patients _ a matter which should definitely be addressed as poor oral health is linked to numerous severe health problems including cancers, stroke and heart attack. Clearly placing a toxic mercury restorative will have little beneficial impact on any of these issues. Sadly it dose not appear as if Dr. Barakzoy has any intention of addressing this pressing problem.

The second is a call for sloppy carless dentistry where mercury/silver fillings are stuffed into wet cavity preparations with either blood or saliva. No dental school teaches the student to use any material In the presence of moisture. It is in my opinion except to place a temporary filling it is malpractice to do so. Mercury/silver fillings expand in the presence of moisture and thus the tooth will be even more likely to suffer fracture. It is already weakened by the excessive drilling required to use the thick amalgam and now the expansive forces of the wetted filling break apart the roots. Below the average filling below had fractured off a significant portion of the tooth and you can see additional cracks in the rest of the tooth. This is direct the result of using an inexpensive material that expands with heat or moisture.

3- Alt material is more technique sensitive. (do not work in the hand of lousy dentist)

It is truly sad that some in the dental profession have not bothered to keep their skills up to the standard of care. I know of no dentists in my wide circle of acquaintances who cannot use the new materials. Several nations are entirely mercury-free and a recent survey found that the majority of dentists do not use mercury.

Lets for a moment translate this argument into a recent aviation disaster. How comfortable would you be with a pilot who did not know how to operate the computer driven electronic airplanes and at the same time keep their hands on flying ability skills proficient? San Francisco saw recently how technique sensitive the Asiana Airlines Airbus was on approach. Not one pilot I've spoken with is sympathetic to the plight of the Asiana pilots who failed to properly fly their passengers to a safe landing without using their autopilot. This is exactly the same argument in reverse. Dr. Barakzoy claims disingenuously that it is too hard to use the new materials. I recommend continuing education in the use of rubber dam, posterior composite and oral hygiene for Dr. Barakzoy

4- Amalgam restoration lasts longer and does not need to replaced as often

This is untrue and more scare mongering.

Steffen Mickenautsch et al., Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review Clinical Oral Invest 14:233-240, 2010
McCracken, et al., A 24-month evaluation of amalgam and resin-based composite restorations Findings from The National Dental Practice-Based Research Network JADA 2013;144(6):583-593.

5- Mercury is in a bonded state in Amalgam and not in a free form , this material has been studied by CDC, WHO and other reputable organization , it is not toxic to humans....

This too is untrue. You can see elemental mercury vapor coming off a 25 year-old mercury/silver filling when heated or even rubbed with a pencil eraser. I challenge Dr. Barakzoy to support his assertion that the delta phase of amalgams in non existent. If the mercury is not in a free form then he should be required to explain how the horribly unethical Casa Pia experiments determined that the amount of mercury in the orphans urine was dependent on the number of such fillings the child had in his/her teeth.

Geier DA, et al., A significant dose-dependent relationship between mercury exposure from dental amalgams and kidney integrity biomarkers: a further assessment of the Casa Pia children's dental amalgam trial. Human and Experimental toxicology 1-7 (2012)

This was the most recent time Dr. Barakzoy was shown to be false. The best study I recall the 1987 the autopsy study by USC Professor David Eggleston that found the amount fo mercury in your brain or kidney is proportional to the number of mercury/silver fillings in your mouth the day you died.

Eggleston DW, Nylander M, Suffin SC, Martinoff JT, Rieders, MF. Correlation of dental amalgam with mercury in brain tissue. J Pros Dent 58:704-7, 1987

[6-] If this resolution [requiring dentists to inform patients about the risks of dental amalgam] passes from city council it would limit our ability to use amalgam for restoration of dental caries and for public health clinic this will be a major impediment since we rely on this material for most of the posterior fillings.

This is a very obvious fear mongering ploy and an argument for gross malpractice on poor uneducated clients. He doesn't want to tell them the truth because it might allow them to choose a safe filling material.

How would you like it if your doctor concealed from you the true nature of the materials implanted in your body. After all informed consent is the law. I can assure you that if Dr. Barakoz tells his clients the same misinformation that he is telling you then his clients are at great risk of harm at his hands.

The CDA handiwork is clearly visible in the Capitelli/Maio "compromise" proposal is not a compromise at all, but rather, a weaker proposal than the three proposals of which it was supposed to be a compromise. The dentists should be required to tell the truth.

I hope that all of you—including Councilmembers Capitelli and Maio—will set the "compromise" proposal aside, and instead get behind Councilmember Arreguin's proposed work session (to discuss this issue in greater detail), as well as his proposed ordinance (which would require that the risks of amalgam be disclosed before every filling is placed, and close the loophole in Prop. 65 that exempts businesses with less than ten employees from having to display warning signs in their offices).

The issue before this city council is simple. To tell the recipient of mercury/silver fillings that they contain an leak) substantial amounts of mercury or not. The advocates for mercury are resistant to telling the patient about the known facts and have tried to paint this a draconian and onerous. Why they find is so onerous is surprising to me since I was able to stop using any mercury some 30 years ago and with Arnold Schwarzenegger's help even got the requirement for California dental students to be tested on this material to be removed. Recently the New York School of Dentistry adopted a mercury-free education plan. The ADA threatened to remove their accreditation if they followed through with the proposal.

This is clearly economic black mail by the trade association closely associated with mercury and who at one time actually owned the patent on a brand of mercury/filling. The ADA argued successfully they owe no duty of care tot he public and as such I do not believe it is prudent or even reasonable to allow the education system to be "accredited" by this biased trade association. You are witness to the results here in your council chambers.

Please take a few moments to inquire of those who come before you why they wish to avoid telling the patient the truth.

And be sure to ask how they have complied with the laws of this state with regard to employee's protections? If they claim to be in compliance then just ask them to bring in their Hazard Communications Notebook (legally required) with the latest monitoring of their employees and the results of monitoring during the previous 100 incidents of exposure i.e. (every mixing, condensing, polishing of a mercury/silver filling).

If they have no records of monitoring, employee informed consent, training, work practices, protective equipment, or engineering controls then you are dealing with a criminal who does not deserve your confidence or vote.

The US Occupational Safety and Health Act (OSHA) requires that:

When it is reasonable to assume that exposure [to mercury vapor] is likely the employer shall:

1. Provide employee with informed consent (1987 Right to Know Act)

2. Provide training in protection and how to avoid exposure.

3. Provide protective equipment which for mercury includes:

a. Airway protection

b. Full skin covering

e. Eye protection

4. Institute work practices to minimize release

5. Engage engineering controls to minimize worker exposure

6. Monitor both the workplace and employee for mercury

7. Record steps 1 through 6 in the Hazard Communication Workbook available for unannounced inspection at any time and retained for a minimum of 30 years after each incident of emission.

Sincerely,

David Kennedy, DDS

David Kennedy, DDS

d-kennedy-rDavid Kennedy, DDS Fluoride Information Officer, Past President International Academy of Oral Medicine and Toxicology Mercury-free since 1984 and a member of the IAOMT since the first general meeting in Colorado in 1985. I've attended every meeting ever held by the IAOMT except the one held at the same time as the Germany meeting which I attended with my father and wife Betty.

Website: www.sdsdw.org

Leave a comment

Make sure you enter the (*) required information where indicated.
Basic HTML code is allowed.

Activism Menu