Dental amalgam has been used as a restorative material in dentistry for over 150 years. The Food and Drug Administration (FDA) stated that there is “more significant human experience with dental amalgam than any other restorative material.” The National Dental Association (NDA) supports the findings of the FDA, The National Institutes of Dental and Craniofacial Research (NIDCR), the National Institutes of Health Technology Assessment Conference, The U.S. Public Health Service (USPHS) and the World Health Organization (WHO) that dental amalgam is a safe and effective restorative material.

Dental amalgam is an alloy formed by combining various metals including silver, copper, tin and mercury. Mercury chemically binds these components into a hard, stable and safe substance. Under the Code of Federal Regulation Title 21-Sec. 872-3050 amalgam alloy is identified as a medical device that is used to form a filling material for the treatment of dental caries. Under standards set by the Occupational Safety and Health Administration (OSHA), the maximum “safe” occupational dose of mercury-vapor concentration that the most sensitive of workers can be chronically exposed without suffering adverse effects is approximately three hundred (300) to five hundred (500) micrograms (ug) per day. A microgram is one millionth of a gram. Estimates predict that people with moderate to large number of amalgam fillings are only exposed to one (1) to three (3) micrograms of mercury vapor daily.

In addition, USPHS scientists analyzed approximately 175 peer-reviewed studies submitted in support of amalgam in response to three (3) citizens petitions received by the FDA after the 1993 scientific report about the safety and use of dental amalgam. There is no scientifically valid evidence correlating systemic disease with dental amalgam. Consequently, the relative risk of mercury anaphylaxis is negligible.

Managed care is a term that is often misunderstood and used incorrectly. Relative to dentistry, dental managed care plans are usually thought of as capitation programs (HMO’s or DHMO’s). However, they also include PPO’s. There has been a rapid proliferation of plans designed to organize and control health care costs since 1990.

For many African-Americans capitation programs, PPO’s and Medicaid are the only means by which dental care is affordable and accessible. For others, employers and the state, Medicaid agencies have disrupted patient-doctor relationships without consent or consideration.

In 1996, state requirements allowed Medicaid and Medicare to come under state regulated managed care plans. Medicaid waivers give states complete control over Medicaid funds with no federal regulation. The states’ growing reliance on managed care to provide health service to the nations poor, elderly and disabled populations will have a profound impact on African-American Medicaid beneficiaries.

In 1995, one out of three (11.6 million) Medicaid recipients was a member of a managed care plan. For Medicaid beneficiaries, 11% or 4.2 million were managed care enrollees in 1996. Currently, data on Medicaid enrollee satisfaction with managed care organizations, and the impact on the African-American health providers is being compiled. Access, quality and the efforts of essential community providers are critical issues.

• The NDA supports programs that will increase access to dental care and improve oral health in African-American communities

• The role of the NDA will be to educate consumers, policymakers and providers on the various types of managed care programs; quality assurance; and mechanisms for regulating, monitoring and oversight of these Managed care organizations

• We believe that patients deserve quality care and that providers deserve fair and equitable compensation

• We believe that optimum health care management is dependent on collaborative efforts, including consumers, plan administrators, providers and legislators

• The NDA believes that positive health outcomes are achieved when patients receive quality care from culturally competent providers in their own communities; and when patients can make informed choices. We endorse plans that adequately fund benefits and are designed to maximize member utilization, promote prevention, offer acceptable standards of care and scope of services, and monitor both patient and provider satisfaction

• The NDA upholds the right for any dentist to enter into managed care agreements, with the understanding that under no circumstances shall contract obligations justify compromised care or excuse them from their ethical duty to put the welfare of the patient first

• We believe that for profit managed care plans have an obligation to reinvest in the communities they serve; include traditional and essential community providers in their network; market the plan to target populations (traditionally underserved and vulnerable); encourage optimal utilization, and provide incentives/rewards for positive health outcomes and patient and provider satisfaction.

The NDA strongly supports proper seat belt usage. Thousands of devastating fatalities and numerous severe facial and intraoral injuries can be prevented with proper use of seat belt restraints. Traffic deaths are the leading cause of death to children in America. This is of particular concern to our organization, as young African Americans are especially at risk of dying in a car crash, and seat belt use remains lower among this group as a whole. As dentists, we are often key members of the health care team, which repairs injuries. The NDA strongly supports government agencies and other organizations in the campaign to increase seat belt usage.

Our goals are to:

• Increase the availability of safety education, training, expertise, knowledge, special skills, credible research and information about traffic safety issues

• Increase the credibility and attention focused on seat belt use among African Americans and

• Provide state agencies and legislatures with a uniform guide for structuring and enacting comprehensive seat belt laws that will include data collection, and deterrents for racial profiling and other rogue behavior by law enforcement officials.

Fluoride occurs naturally in the earth’s crust in combination with other minerals in rocks and soil. Small amounts of fluoride appear naturally in our water and much of the food we consume. The concentration of fluoride in the water found to be most effective in combating dental decay is between 0.7 parts per million to 1.2 ppm

Water Fluoridation has been recognized by the center for Disease Control and Prevention and other organizations as a critical variable in preventing dental decay in adults and children. David Satcher, Surgeon General, wrote in his report, Oral Health in America, “Community water fluoridation is safe and effective in preventing dental disease in both children and adults”. In addition, over one hundred national and International organizations recognize today the public health benefits of community water fluoridation.

As a result of water fluoridation half of all children ages 5 to 17 have never had a cavity in their permanent teeth.

Despite the overwhelming evidence of the value of water fluoridation 34% of the population still does not have access to fluoridated water. Water fluoridation would save over 1.5 billion dollars per year.

It is therefore, the position of the National Dental Association that Community Water Fluoridation is safe, beneficial and cost effective and should be encouraged and supported under the following conditions:

• Community water supplies should contain the optimal fluoride levels as recommended by the U.S. Public Health Service (a range from 0.7 – 1.2 parts per million)

• Local communities and dental societies should be in agreement with and support the fluoridation project in their communities.

• Appropriate resources monitoring capabilities should be available to ensure that the appropriate water fluoride monitoring infrastructures are in place at all times in the impacted communities.

The National Dental Association is committed to working with other dental organizations, government agencies, dental societies and individual dentists to encourage and facilitate the use of water fluoridation in local municipal water supplies, especially underserved areas, in an effort to impact as large a number of individuals as is possible.

Our role in the health care reform process is to elevate the oral health status of the African American community. In order to diminish Black/White disparity in health and achieve the true goals of Health Care Reform, we endorse a plan that will accomplish the following:

• Cover ALL persons and provide universal access regardless of race, gender, employment status or pre-existing conditions.

• Provide basic primary oral health benefits for children and adults to include preventive services, emergency care conservative restorative care, periodontal maintenance, provisions for the “phase-in” of complete and partial dentures.
• Make oral health promotion and disease prevention a priority, to include: community water fluoridation, sealant, protective sports equipment (mouth guards), oral cancer screening, and community outreach.
• Establish community ratings and “risk adjusted rates” for providers who treat high-risk (underserved, disadvantaged, elderly, etc.), so that these providers receive higher compensation, because the cost to provide care is greater.
• Invest in community-based infrastructures in underserved areas and provide incentives for providers in the underserved areas to develop other community-based delivery alternatives.
• Provide financial incentives for providers in underserved areas, i.e., educational loan forgiveness programs, small business tax credits, and other tax incentives.
• Abolish the existing Medicaid bureaucracy, privatize the administration of this federal program, improve the efficiency, increase reimbursement levels, and expedite payments.

Demonstrate through legislative mandate the commitment Federal Government to stimulate and assure diversity such that ethnic providers will be appropriately represented in the ownership and control of any managed care system.