Indonesian Dental Association Journal of Indonesian Dental Association http://jurnal.
id/index.
php/jida ISSN: 2621-6183 (Prin.
ISSN: 2621-6175 (Onlin.
Literature Review Dental Materials and Bisphenol-A Exposures Ridhayani Hatta1,3A.
Mohamad Arif Budiman Putra Pratama2, yslida Ortega Asencio3 1 Department of Dental Materials Science.
University of YARSI.
Jakarta.
Indonesia 2 Department of Dentistry.
Air Force Army.
TNI AU.
Jakarta.
Indonesia 3 Department of Dental Materials Science.
School of Clinical Dentistry.
The University of Sheffield.
United Kingdom Received date: March 10, 2022.
Accepted date: October 25, 2022.
Published date: January 9, 2023.
KEYWORDS
bisphenol-A exposure.
dental material.
health risk
ABSTRACT
The utility of dental materials to posing oral diseases have impact in the risk of Bisphenol A (BPA) exposure which can be harmful to human organs.
BPA used in dentistry is related to the production of polycarbonate plastics and epoxy resins.
For instance, composite filling materials and dental sealant are containing BPA that can promote risk to endocrine-disrupting, estrogenic effect, and renal exposure.
The current study reviews the BPA exposures of dental materials and its impact risk to the systemic health.
This systematic review critically evaluates data and gathers information from several literatures.
The source of these articles was Pub Med and Web of Science, and the search was done by the following terms: BPA of dental materials.
BPA exposure.
BPA and health risks.
BPA and oral health.
BPA exposure was found in oral mucosa and saliva after the application of BPA-containing dental materials.
BPA derivatives used in dental products have not been evaluated for the endocrine disruptor, and estrogenicity.
BPA exposures can be absorbed through the oral mucosa and may lead to internal exposures by the absorption of BPA from the gastrointestinal tract.
Manufacturers should be required to report complete information of the dental materialsAo chemical composition and strict precaution application techniques must be considered by the practitioner.
A Corresponding Author E-mail address: ridhayani.
drg@gmail.
com (Hatta R) DOI: 10.
32793/jida.
Copyright: A2023 Hatta R.
Pratama MABP.
Asencio ysO.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original author and sources are credited.
Journal of Indonesian Dental Association 2023 5.
, 115-123 Hatta R, et al.
companies as monomers such as polycarbonate, epoxy resin, polysulfone or polyacrylate.
INTRODUCTION
Bisphenol-A (BPA), is one of the chemicals known as the endocrine disruptor that can affect various biological processes in the body.
1 Several studies have shown the negative impact of BPA which has an impact on health problems, such as, reproductions, cancer, diabetes, and other metabolic problems.
Figure 1.
Chemical structure of Bisphenol-A Frequent BPA exposure may increase contribution to the health problems of the people who often interact with BPA-releasing materials.
Currently, the use of materials containing BPA and BPA derivatives is increasing in dental practice, especially in preventive oral health care and dental restoration treatments.
In addition, the use of composite resin filling as the replacement of amalgam ue to the toxic effect of amalga.
and higher
demand of aesthetic restoration in dental fillings are the enhancement factors of the popularity of resin-based STATE OF THE ART: CURRENT DENTAL
MATERIALS AND BISPHENOL-A
In dentistry, the commonly used BPA is BPAderivatives that are used as monomers in dental materials A variety of dental materials containing BPA components have been collected from various literatures as illustrated in Table 1.
Table 1.
BPA components in dental materials Meanwhile, dental practitioners believe that resin composite is better than amalgam and provide better esthetical results than other filling materials8, yet the possible negative effects should not be denied as the main concern is its contribution of BPA exposure to the human body.
The BPA content in dental materials is mainly BPA-derivatives.
1 However, there is still presence possibility of BPA exposure to the human body.
Therefore, studies about the possibility of side effects that can be generated from BPA-containing dental materials to human health are needed.
This systematic review will give an idea of the contribution of dental materials on BPA exposure to human body.
Composite Dental Filling METHODS Fissure Sealant Dental Materials Orthodontic Adhesives This systematic review critically evaluates and gathers information from several literatures.
The source of these articles was Pub Med and Web of Science, the search was done by the following terms: BPA of dental materials.
BPA exposure.
BPA and health risks.
BPA and oral health.
BPA Component diglycidyl ether methacrylate .
isGMA)11 triethylene glycol dimethacrylate (TEGDMA)1 ethoxylated bisphenol-A dimethacrylate .
is-EMA)1 dimethacrylate .
is-DMA)1 diglycidyl ether methacrylate .
isGMA)12 hydroxyethyl-methacrylate (HEMA)12 diglycidyl ether methacrylate .
isGMA)1 urethane-modified bis-GMA BPA derivatives in dental resins are solid materials from liquid monomers that is maximally polymerized by using light curing or chemically.
The most frequently used BPA-derivative as resin base is glycidyl dimethacrylate .
is-GMA).
The hydroxyl groups of BPA are bonded to the methyl methacrylate groups by using a glycidyl spacer.
BISPHENOL-A
Bisphenol-A .
4'-isopropylidene-2-dipheno.
known as plasticizer materials in the manufacturing process of polycarbonate plastics and epoxy resins (Figure .
BPA is composed of carbon bridging which has two unsaturated phenolic rings.
9 BPA is a synthetic chemical formed by the condensation of the phenol group and one molecule of acetone.
BPA was first synthesized in 1891, and its estrogenic effect was known since 1938.
Since 1940 BPA was used in the polymer manufacturing Other monomer used in resin-based dental materials include BPA dimethacrylate .
is-DMA).
BPA
(BADGE),
BPA
is-EMA) and urethane-modified bisGMA.
(Figure .
Other monomers are used to increase viscosity of the resin include triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA).
Journal of Indonesian Dental Association 2023 5.
, 115-123 Hatta R, et al.
WHO WILL BE AFFECTED?
The U.
Environmental Protection Agency (U.
EPA) provides safe BPA levels within the body of 50g/kg/day.
This range is used as a reference because it is the minimum amount of BPA exposure that does not cause any impact to the body.
Figure 2.
Chemical structures of BPA and BPA In dental practice, the use of a substance .
containing BPA or BPA derivatives may have an adverse effect on the person exposed to the substance, including .
the patients, dental materials applied directly to the human tissue may release the BPA compound.
dental practitioners .
entists, nurses, and dental technician.
, may be exposed to residual monomers containing BPA during dental care and dental manufacturing process.
48-49 Nevertheless, there have been no studies that directly calculate the amount of BPA exposure associated with the use of BPA-contained dental materials, such as composite resin and sealant.
The selling composites and sealants (Tables 2 and .
did not include the specific monomer compositions of their resins in the material safety data sheets (MSDS).
Some manufacturers that provide product composition data often use unexamined unique monomers of their estrogenic effects, e.
, urethane modified or merely listing generic names of monomers used.
METABOLISM OF BISPHENOL-A
Metabolism of BPA begins after oral phase.
the first metabolic phase in the gastrointestinal tract and liver.
Once absorbed completely in the gastrointestinal tract.
BPA will be conjugated with glucuronic acid in the liver to become an inactive form.
A small percentage of BPA reacts with sulphate to form BPA-sulphate.
Conjugated BPA will undergo a process of detoxification, and the BPA-free form indicates estrogenic properties.
The conjugated BPA forms into the circulation, reaches the kidneys and is excreted in the urine.
35,36,37
PROBLEM CAUSED BY BISPHENOL-A
BPA as an Endocrine Disrupting Compounds/ Chemicals (EDC) is a substance present in dental materials that can interfere with biosynthesis, metabolism, and hormonal action, which may lead to homeostatic or reproductive disorders.
41 An estrogenic toxin from BPA has a potential to cause disease (Table Table 4.
Potential disorders caused by BPA Inhaled BPA, through mucosa or dermal contacts will not pass metabolism in gastrointestinal tract and liver, will be eliminated slowly, so that it will produce concentrations in the blood greater than the hepatic BPA.
Potential Disorders Effect Reproduction1,2 Growth, functioning, and differentiation of the reproductive systems in male/female Cancer2,3 Increase the risk of protein mutations BPA exhibits estrogenic properties in many studies and is described as Endocrine Distrupting Chemicals (EDC).
39 This compound specifically binds and activates estrogen receptors with an affinity capacity 1000-5000 times weaker than endogenous estradiol.
40 In vitro BPA shows an effect of about 1000-10,000 times weaker than 41 However, in vivo experiments show that BPA has an equally strong effect over estradiol, presumably due to non-genomic activation.
42,43
Obesity2,4 Heart Disease5 Hypertension6,7 Sakurai, et al.
44, exhibits that BPA not only works through endoplasmic reticulum (ER) membrane alone but is also suspected through nuclear receptors.
BPA is also suspected to work through non-classical membrane ER .
cmER).
45,46 In addition.
BPA interacts with thyroid hormone receptors, and Peroxysome ProliferatorActivated Receptor Gamma (PPAR).
Diabetes1,3 Unmetabolized BPA remains attached to plasma proteins interact with biological process Diabetes and dyslipidemia as risk factors of heart disease Obesity and diabetic Hyperinsulinemia, worsening glucose tolerance, and decreased insulin sensitivity Cause Xenoestrogen mimics the structure and function of estrogen Higher rate of mRNA leads overproduction of Unconjugated BPA converted to BPASulfate Lipid accumulation .
dipocytes, hepatoma Insulin resistance, thyroid, and endothelial Insulin resistance caused by BPA Journal of Indonesian Dental Association 2023 5.
, 115-123 Hatta R, et al.
Table 2.
The monomer compositions in MSDS data of dental sealants Manufacturer Ultradent Dental Selant UltraSeal XTE plus Clinical Application Pit and fissure sealant MSDS Monomer Composition Bis-GMA (CAS No.
1565-94-.
dimethacrylate (CAS No.
41137-60-.
Hazard statements Allergic skin reaction, rash/ skin irritation, if the dust inhaled lead Irritating, eyes, respiratory system, ingestion, and skin Reference No.
Ultradent
PermasealA
Composite sealant
Ultradent
OpalE SealE
Orthodontic Primer & Sealant
3M ESPE
Clinpro Sealant Dental sealant Bis-GMA (CAS No.
1565-94-.
Triethylene Glycol Dimethacrylate (CAS No.
109-16-.
2-dimethylaminoethyl Methacrylate (CAS No.
2867-47-.
Hydroxypropyl Methacrylate (CAS No.
27813-02-.
Methacrylic Acid (CAS No.
79-41-.
Bis-GMA (CAS No.
1565-94-.
TEGDMA
(CAS No.
109-16-.
Severe skin burns and eye damage, respiratory Eye irritation, allergic skin reaction, toxicological Skin, eyes, and respiratory irritation, causing genetic Mucosa, skin, and eyes Dentsply Preventive Care Delton Pit and fissure sealant Dentsply Milford FluroShieldA Pit and fissure sealant Pulpdent Corporation EmbraceE Pit and fissure sealant 2,2'-ethylenedioxydiethyl dimethacrylate (CAS No.
109-16-.
Eyes, respiratory system, skin irritation or skin Eyes, respiratory system, skin irritation or skin Eyes, skin, respiratory Pulpdent Corporation Seal-RiteE Pit and Fissure Sealant Pit and fissure sealant Uncured acrylate ester monomers (Proprietar.
Kerr Corporation OptiGuard Surface sealant Ivoclar Helioseal F Fissure sealant Bis-GMA (CAS No.
1565-94-.
TEGDMA
(CAS No.
109-16-.
dimethacrylate CAS No.
72869-86-.
Skin, eyes, respiratory irritation, allergic skin reaction, carcinogenic.
Aromatic and aliphatic dimethacrylate ethyl 4-dimethylaminobenzoate (CAS No.
10287-53-.
Urethane-modified bis-GMA dimethacrylate (CAS No.
126646-17-.
Bis-GMA (CAS No.
1565-94-.
Uncured acrylate ester monomers (Proprietar.
*CAS: Chemical Abstracts Service Journal of Indonesian Dental Association 2023 5.
, 115-123 Hatta R, et al.
Table 3.
The monomer compositions in MSDS data of dental composites Manufacturer 3M ESPE Dental Composite 3ME FiltekE Supreme Ultra Universal Restorative Clinical Application Nanocomposite esthetics and strength universal restoration Hazard statements Allergic skin reaction Reference No.
Allergic skin reaction, damage fertility or the unborn child Allergic skin reaction, reproductive toxicity Eye irritation, allergic skin Allergic skin reaction, reproductive toxicity Micro matrix universal Low shrinkage flowable composite MSDS Monomer Composition BPA ethoxylate dimethacrylate (CAS No.
41637-38-.
diurethane dimethacrylate (CAS No.
72869-86-.
bis-GMA (CAS No.
1565-94-.
TEGDMA (CAS No.
109-16-.
Bis-GMA (CAS No.
1565-94-.
TEGDMA
(CAS No.
109-16-.
BPA ethoxylate dimethacrylate (CAS No.
41637-38-.
BPA ethoxylate dimethacrylate (CAS No.
41637-38-.
diurethane dimethacrylate (CAS No.
72869-86-.
bis-GMA (CAS No.
1565-94-.
TEGDMA (CAS No.
109-16-.
Bis-GMA (CAS No.
1565-94-.
TEGDMA
(CAS No.
109-16-.
Aromatic Urethane Dimethacrylate (CAS No.
1431303-59-.
UDMA (CAS No.
72869-86-.
Urethane-modified bis-GMA dimethacrylate (CAS No.
126646-17-.
polymerizable dimethacrylate resin (CAS109-16-0 and 24448-20-.
Urethane-modified bis-GMA dimethacrylate (CAS No.
126646-17-.
Uncured methacrylate ester monomers (CAS No.
109-16-.
3M ESPE
3ME FiltekE Supreme Flowable Restorative Composite restorative 3M ESPE
FiltekE Z250
Microhybrid universal composite restoration 3M ESPE
FiltekE Z100
3M ESPE
FiltekE One Bulk Fill Microhybrid universal composite restoration Nanocomposite bulk fill posterior restoration Dentsply Sirona Pty Ltd TPH 3Spectra Universal composite Dentsply Sirona Pty Ltd Kerr Corporation Esthet-XA HD Kerr Corporation Herculite XR Microhybrid universal Ultradent Vit-l-escenceE Ultradent Composite wetting resin Esthetic restorative Dental liquid resin Premise Indirect Allergic skin reaction Skin irritation Eyes, skin, respiratory Uncured methacrylate ester monomers (CAS No.
109-16-.
Eyes, skin, respiratory Tetramethylene Dimethacrylate (CAS No.
2082-81-.
Triethylene Glycol Dimethacrylate (CAS No.
109-16-.
Diurethane Dimethacrylate (CAS No.
72869-86-.
Allergic skin reaction Allergic skin reaction *CAS: Chemical Abstracts Service Journal of Indonesian Dental Association 2023 5.
, 115-123 Hatta R, et al.
manufacturer is mandatory to provide appropriate information in the material safety data sheets (MSDS) for each manufactured product, so that dentists and other users can easily determine the type of considerably safe dental materials.
BISPHENOL-A EXPOSURES IN HUMAN SALIVA
However, the component of resin-based dental materials is not pure BPA.
De Nys, et al.
48 and LopesAaRocha, et al.
49 found that after dental resin placement.
BPA were detected in saliva due to the hydrolysis of bis-DMA.
Resin Application Fleisch, et al.
1 recommended the application technique as a precaution to the BPA exposure.
This technique basically refers to the residual monomer removal, including .
using cotton roll with pumice to rub the monomer layer, .
gargling for 30 seconds and spitting after resin-based dental materials application, .
rinsing with water syringe on the operative field, and .
using rubber dam to limit the potential exposure of BPA to the other area.
Regarding the sensitivity effect of foetus to BPA and other developmental prenatal effect due to BPA exposure, it is recommended to minimize and control the use of resin-based dental materials during 55,56 Over the years, various studies have shown mixed results on the evaluation of BPA, bis-GMA, and bisDMA content in saliva after the application of dental composites and sealants.
In vitro studies showed BPA and BPA derivatives were detected in saliva.
49,50 These results in line with numerous in vivo studies that tested the BPA and BPA derivatives content in saliva.
48,51,52
Nevertheless, some studies detect the BPA decreased in saliva after placement of dental sealants during several weeks observation period.
53,54
Study conducted by Joskow, et al.
52 showed that mean BPA level in the saliva after sealants application which contained bis-DMA 26.
5 ng/mL immediately after treatment and decreased 1 hour after treatment with 5.
ng/mL mean BPA level.
BPA exposure found in oral mucosa and saliva after the application of BPAcontaining dental materials.
BPA derivatives used in dental products have not been evaluated for the endocrine disruptor, estrogenicity.
Additional Study Preliminary requirement of the research is to assess the estrogenicity and BPA absorption to body fluids .
saliva, urine, bloo.
of the all-current resin-based dental Additional studies are also demanding for the further observation on the concentration of BPA exposure to the saliva through clinical procedures.
RECOMMENDED APPLICATION TECHNIQUES
Product Development According to the results of various studies showing the amount of BPA contained in saliva after dental material application are significantly below from the maximum tolerance level of acceptable BPA exposure in the human body.
Nevertheless, prevention to a minimum BPA exposure should still be an essential concern.
The best way to solve this problem as a user is to put more concern in how the safe application techniques that recommended for BPA-related dental materials.
The development of BPA-free-based dental materials should be the priority in the product manufacturing.
Furthermore, the alternatives of BPA-used should be guaranteed to be safe and biocompatible by toxicological testing during the dental materials development.
CONCLUSION
The contribution of dental materials to the BPA exposure seems uncertain, yet it potentially can be Several findings have shown the adverse effects of BPA exposure to humans, yet these can be used as reference to the safe application on BPA-related dental materials to minimize BPA exposure as the effect precaution on the human health.
The described precaution techniques should be a primary consideration to reduce BPA exposures during resin-based dental materials applications.
Product Choice Product selection is necessary, especially related to monomer content of dental materials.
Users should pay attention to the data provided by the manufacturer regarding the estrogenicity effects of monomers that are corresponding to the various studies conducted.
The current limitation of this point is the combination of bis-GMA with other monomers which used by manufacturers that potentially have estrogenicity effect, such as urethane-modified bis-GMA.
The combination of these monomers is still in question, regarding the effect of BPA exposure that can be affected due to it has not been well tested by toxicological testing.
1 The Manufacturers have to report complete information on the chemical composition of dental materials and strict precaution application techniques must be considered by the practitioner.
Journal of Indonesian Dental Association 2023 5.
, 115-123 Hatta R, et al.
Am J Orthod Dentofacial Orthop.
:4918.
Jun SK.
Cha JR.
Knowles JC.
Kim HW.
Lee JH.
Lee HH.
Development of Bis-GMA-free biopolymer to avoid estrogenicity.
Dent Mater J.
:15766.
Material Safety Data Sheets.
Ultradent Products Inc.
Available https://w.
com/Resources/GetSds?key=2 5-001-16-en-eu.
Accessed November 30, 2022.
Material Safety Data Sheets.
Ultradent Products Inc.
Available https://w.
com/Resources/GetSds?key=8 5-001-07-en-eu.
Accessed November 30, 2022.
Material Safety Data Sheets.
Ultradent Products Inc.
Available https://w.
com/Resources/GetSds?key=2 65-001-09-en-eu.
Accessed November 30, 2022.
Material Safety Data Sheets.
3M ESPE.
Available https://sd.
com/sdmedia/msds/376ck06.
Accessed November 30, 2022.
Material Safety Data Sheets.
Dentsply Pty Ltd.
Available https://multimedia.
com/mws/mediawebserver?m wsId=suUn_zu8l00xMx_Bl8mBlv70k17zHvu9 lxtD7s--.
Accessed November 30, 2022.
Material Safety Data Sheets.
Dentsply Milford Ltd.
Available https://chemmanagement.
com/9/60bCFAFE39-4844-A79D-86123E2EAD1B/pdf/VGE375.
Accessed November 30, 2022.
Material Safety Data Sheets.
Pulpdent Corporation.
Available at: https://w.
com/wpcontent/uploads/2022/06/GHS-SDS-EmbraceProduct-Line-r.
Accessed November 30, 2022.
Material Safety Data Sheets.
Pulpdent Corporation.
Available at: https://w.
com/wpcontent/uploads/2021/03/GHS-SDS-Seal-Rite.
Accessed November 30, 2022.
Material Safety Data Sheets.
Kerr Corporation.
Available https://w.
com/resourcecenter/optiguard-us-sds.
Accessed November 30.
Material Safety Data Sheets.
Ivoclar.
Available https://w.
com/medias/Helioseal-F-SDSau.
Accessed November 30, 2022.
Material Safety Data Sheets.
3M ESPE.
Available https://multimedia.
com/mws/mediawebserver?m wsId=suUn_zu8l00xM829oYtx4v70k17zHvu9 lxtD7s--.
Accessed November 30, 2022.
ACKNOWLEDGEMENTS
This work has been supported by funds from the The Indonesian Endowment Fund for Education (Lembaga Pengelola Dana Pendidikan / LPDP) is gratefully REFERENCES