Salivary bisphenol-A levels due to dental sealant/resin: a case-control study in Korean children

Impact of bisphenol A and analogues eluted from resin-based dental materials on cellular and molecular processes: An insight on underlying toxicity mechanisms

Dental resin systems, used for artificial replacement of teeth and their surrounding structures, have gained popularity due to the Food and Drug Administration's (FDA) recommendation to reduce dental amalgam use in high-risk populations and medical circumstances. Bisphenol A (BPA), an endocrine-disrupting chemical, is an essential monomer within dental resin in the form of various analogues and derivatives. Leaching of monomers from resins results in toxicity, affecting hormone metabolism and causing long-term health risks. Understanding cellular-level toxicity profiles of bisphenol derivatives is crucial for conducting toxicity studies in in vivo models. This review provides insights into the unique expression patterns of BPA and its analogues among different cell types and their underlying toxicity mechanisms. Lack of a consistent cell line for toxic effects necessitates exploring various cell lines. Among the individual monomers, BisGMA was found to be the most toxic; however, BisDMA and BADGE generates BPA endogenously and found to elicit severe adverse reactions. In correlating in vitro data with in vivo findings, further research is necessary to classify the elutes as human carcinogens or xenoestrogens. Though the basic mechanisms underlying toxicity were believed to be the production of intracellular reactive oxygen species and a corresponding decline in glutathione levels, several underlying mechanisms were identified to stimulate cellular responses at low concentrations. The review calls for further research to assess the synergistic interactions of co-monomers and other components in dental resins. The review emphasizes the clinical relevance of these findings, highlighting the necessity for safer dental materials and underscoring the potential health risks associated with current dental resin systems.

Environmental-relevant bisphenol A exposure promotes ovarian cancer stemness by regulating microRNA biogenesis

Bisphenol A (BPA) is a ubiquitous environmental xenobiotic impacting millions of people worldwide. BPA has long been proposed to promote ovarian carcinogenesis, but the detrimental mechanistic target remains unclear. Cancer stem cells (CSCs) are considered as the trigger of tumour initiation and progression. Here, we show for the first time that nanomolar (environmentally relevant) concentration of BPA can markedly increase the formation and expansion of ovarian CSCs concomitant. This effect is observed in both oestrogen receptor (ER)-positive and ER-defective ovarian cancer cells, suggesting that is independent of the classical ERs. Rather, the signal is mediated through alternative ER G-protein-coupled receptor 30 (GPR30), but not oestrogen-related receptor α and γ. Moreover, we report a novel role of BPA in the regulation of Exportin-5 that led to dysregulation of microRNA biogenesis through miR-21. The use of GPR30 siRNA or antagonist to inhibit GPR30 expression or activity, respectively, resulted in significant inhibition of ovarian CSCs. Similarly, the CSCs phenotype can be reversed by expression of Exportin-5 siRNA. These results identify for the first time non-classical ER and microRNA dysregulation as novel mediators of low, physiological levels of BPA function in CSCs that may underlie its significant tumour-promoting properties in ovarian cancer.

Sequential process optimization for a digital light processing system to minimize trial and error

In additive manufacturing, logical and efficient workflow optimization enables successful production and reduces cost and time. These attempts are essential for preventing fabrication problems from various causes. However, quantitative analysis and integrated management studies of fabrication issues using a digital light processing (DLP) system are insufficient. Therefore, an efficient optimization method is required to apply several materials and extend the application of the DLP system. This study proposes a sequential process optimization (SPO) to manage the initial adhesion, recoating, and exposure energy. The photopolymerization characteristics and viscosity of the photocurable resin were quantitatively analyzed through process conditions such as build plate speed, layer thickness, and exposure time. The ability of the proposed SPO was confirmed by fabricating an evaluation model using a biocompatible resin. Furthermore, the biocompatibility of the developed resin was verified through experiments. The existing DLP process requires several trials and errors in process optimization. Therefore, the fabrication results are different depending on the operator’s know-how. The use of the proposed SPO enables a systematic approach for optimizing the process conditions of a DLP system. As a result, the DLP system is expected to be more utilized.

Influence of BPA exposure, measured in saliva, on childhood weight

INTRODUCTION

Endocrine disruptors such as bisphenol A (BPA), BPA glycidyl methacrylate, and other BPA acrylate-based derivatives have been related to type 2 diabetes, the metabolic syndrome, and obesity, among other metabolic disorders. The objective of this study is to examine the influence of BPA exposure by saliva analysis and daily physical activity on the risk of overweight/obesity in schoolchildren from southern Spain.

METHODS

The study included 300 children (53.5% girls) aged 7-10 years. Participants completed a questionnaire with four sections: participant data, including demographic information and life and family habits; semi-quantitative food frequency questionnaire; anthropometric variables; and physical activity variables. All participants underwent dental examination, when the presence of sealants/composites in each tooth and other dental alterations was recorded, and samples of whole saliva were collected for UHPLC-MS/MS analyses.

RESULTS

Risk of overweight/obesity was significantly influenced by body fat composition (OR = 10.77), not walking to and from school (OR = 1.38), lesser energy expenditure in sedentary activities (OR = 12.71), greater energy expenditure in sports (OR =1.62), and exposure to BPA from dental sealants/composites (OR = 1.38; p = 0.058).

DISCUSSION

Further research is warranted on this issue in children, who may be especially vulnerable to the negative health effects of endocrine disruption.

Assessing the estrogenic activity of chemicals present in resin based dental composites and in leachates of commercially available composites using the ERα-CALUX bioassay

OBJECTIVE

The biocompatibility of resin based dental composites has not yet been fully characterized even though certain monomers used in these composites are synthesized from Bisphenol A (BPA), a well-known estrogenic endocrine disruptor. As a result, they show structural relationship to BPA and can contain it as an impurity. Therefore, the estrogenic activity of 9 monomers, 2 photoinitiators, one photostabilizer and leachates of 4 commercially available composites was determined.

METHODS

The ERα-CALUX bioassay was used to determine both agonistic and antagonistic estrogenic activities of the pure compounds (BPA, BisDMA, BisGMA, BisEMA(3), BisEMA(6), BisEMA(10), TEGDMA, TCD-DI-HEA, BADGE, UDMA, HMBP, DMPA, CQ) and the leachates of cured composite disks. The leachates of 4 commercially available composites (Solitaire 2, Ceram.x Spectra ST, G-ænial Posterior and Filtek Supreme XTE) in water and 0.1 M NaOH (pH = 13, 'worst-case scenario') were tested for estrogenic activity (pooled leachates from 10 cured composite disks).

RESULTS

Agonistic estrogenic activity was found for the monomer BisDMA, the photostabilizer HMBP and photoinitiator DMPA. All leachates from the 4 tested composites showed significant agonistic estrogenic activity higher than the DMSO control, and the highest activity (potency and efficacy) was found for Solitaire 2, followed by Ceram.x Spectra ST. Furthermore, antagonistic estrogenic activity was found in the leachates from G-ænial Posterior.

SIGNIFICANCE

These results show that significant estrogenic activity was found in all leachates of the cured composite disks, and that this estrogenicity is most likely due to a mixture effect of multiple estrogenic compounds (including BPA, HMBP and DMPA). This indicates that further research into the endocrine activity of all the compounds that are present in these composites (even at low quantities) and their possible mixture effect is warranted to guarantee their safe use.

Biodegradation of orthodontic composites by Streptococcus mutans: An in vitro qualitative and quantitative assessment

Objectives:

The purpose of this study was to evaluate the degradation products of orthodontic composites (Grengloo, Blugloo, Transbond XT, and Transbond LR) by Streptococcus mutans and then to quantify the levels of released bisphenol A (BPA) using gas-phase chromatography and mass spectrometry (GC–MS).

Materials and Methods:

Orthodontic light-cured composite discs were incubated at 37°C in brain heart infusion (BHI) (control group) and in a culture of S. mutans with BHI (test group). Incubation solutions were collected every 48 h in each group and replaced with fresh solutions. These incubation solutions were accumulated and grouped. The assessment of degradation products from composites was done at 1 and 30 days. Detected BPA was then quantified. The limit of quantification was 0.01 μg/mL.

Results:

Degradation products were present at day 30. For the test group, BPA was detected in Blugloo at day 1 (0.38 μg/mL) and triethylene glycol dimethacrylate (TEGDMA) was detected in Grengloo and Transbond LR at day 1.

Conclusion:

S. mutans can hydrolyze long-term orthodontic composites. Monomers such as BPA and TEGDMA may be present in degradation products. It is possible to separate and identify leaching compounds by GC–MS technique.

Once Resin Composites and Dental Sealants Release Bisphenol-A, How Might This Affect Our Clinical Management?-A Systematic Review

(1) Background: Bisphenol A (BPA) based dental resins are commonly used in preventive and reparative dentistry. Since some monomers may remain unpolymerized in the application of dental resin, they dissolve in the saliva. (2) Methods: The literature search was carried out in Pubmed, Cochrane and Embase databases. Randomized controlled trials, cohort studies and case-control studies that evaluated BPA levels in human urine, saliva and/or blood were included. (3) Results: The initial search had 5111 results. A total of 20 studies were included in the systematic review. Most studies showed an increase of the levels of bisphenol A 1 h after treatments with composite resins and dental sealants. One week after treatments the levels were decreased. (4) Conclusions: Some clinical precautions should be taken to decrease the release of BPA, namely the use of rubber dam, the immediate polishing of all resins used, or the use of glycerin gel to avoid non-polymerization of the last resin layer, and mouthwash after treatment. Another preventive measure in addition to the above-mentioned is the use of the smallest possible number of restorations or sealants, a maximum of four per appointment. These measures are even more important in children, adolescents and pregnant women.

Bisphenol A in dental materials - existence, leakage and biological effects

OBJECTIVE

Recently, questions have been raised concerning the potential endocrine disrupting effects of bisphenol A (BPA). This substance is a constituent in many different products which we frequently come into contact with, such as food containers and receipts. Resin-based dental filling materials are another source of exposure, although according to previous studies the amount and potential risks are not clear. Thus, the aims of the present study were (1) to identify if direct dental filling materials are liable to leak BPA and (2) to investigate if this leakage could lead to any adverse effects on health.

MATERIALS AND METHODS

A literature search was made with PubMed as the primary source, subsequently complemented with reference tracking.

RESULTS

A total of 26 articles were included, 24 of which were used for the first aim (leakage) and 2 for the second aim (health risks). The majority of studies, including all in vivo studies, showed leakage of BPA from dental materials in various amounts and during different time intervals. The findings showed a contradiction in results regarding the connection between dental materials and adverse health effects.

CONCLUSIONS

There is leakage of BPA from some dental materials, but critical levels are not evident. Bis-DMA contents might convert to BPA in the oral cavity. There is a contradiction between in vitro and in vivo studies concerning BPA leakage and finally, there is a lack of studies investigating the association between BPA exposure and its adverse effects on human health.

A novel high sensitivity UPLC-MS/MS method for the evaluation of bisphenol A leaching from dental materials

There is a growing necessity to acquire more profound knowledge on the quantity of eluates from resin-based dental materials, especially with regard to bisphenol A (BPA). The aim of the present study was to develop a highly sensitive method to characterize the short-term release of BPA in saliva with ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), using an extraction step and additional derivatization of BPA with pyridine-3-sulfonyl chloride. Light-cured resin-based composites were incubated at 37 °C in 1 mL artificial saliva, which was refreshed daily for one week. The final protocol allows accurate quantification of very low levels of BPA in samples of artificial saliva (i.e. 1.10 pmol BPA/mL or 250 pg/mL). The daily BPA-release from dental composites, ranging from 1.10 to 7.46 pmol BPA/mL, was characterized over a period of 7 days. The highest total amount of BPA was released from Solitaire 2 (24.72 ± 2.86 pmol), followed by G-ænial Posterior (15.51 ± 0.88 pmol) and Filtek Supreme XTE (12.00 ± 1.31 pmol). In contrast, only trace amounts of BPA were released from Ceram.x Universal. This UPLC-MS/MS method might be used for clinical research focusing on the evaluation of the clinical relevance of BPA release from dental materials.

Resin-based dental sealants as a source of human exposure to bisphenol analogues, bisphenol A diglycidyl ether, and its derivatives

Although studies have examined leaching of bisphenol A (BPA) from dental sealants into saliva, occurrence of BPA, bisphenol A diglycidyl ether (BADGE), and their derivatives in dental sealants themselves has not been investigated. In this study, concentrations of eight bisphenol analogues (BPs), BADGE and its derivatives (BADGEs), including BADGE‧H₂O, BADGE‧HCl, BADGE‧2H₂O, BADGE‧2HCl, and BADGE‧H₂O‧HCl, were determined in 70 dental sealants collected from the U.S. market. Of the 70 dental sealants analyzed, 65 contained at least one of the target chemicals measured. BADGE‧2H₂O was the most abundant compound, found at concentrations of up to 1780µg/g. The geometric mean (GM) concentration of total BADGEs was 47.8µg/g, which was two to three orders of magnitude higher than that of total BPs (GM: 539ng/g). BPA was found in 46% of the sealants and BADGEs was found in 87% of the sealants analyzed. Majority of the dental sealants analyzed in this study were manufactured in the United States and Korea; no significant differences were observed in the concentrations of BPs and BADGEs between the two countries. An exposure assessment was made based on the concentrations of BPs and BADGEs measured in sealants and their application rates in dentistry. The worst-case exposure scenario with the highest measured concentration of total BPs and BADGEs and application on 8 teeth at 8mg each yielded an estimated daily intake (EDI) of 1670 and 5850ng/kg·bw/day for adults and children, respectively. Although the EDI is below the specific migration limit set by the European Food Safety Authority, dental sealants are a source of exposure to BPs and BADGEs, especially in children.

Cellular Responses in Human Dental Pulp Stem Cells Treated with Three Endodontic Materials

Human dental pulp stem cells (HDPSCs) are of special relevance in future regenerative dental therapies. Characterizing cytotoxicity and genotoxicity produced by endodontic materials is required to evaluate the potential for regeneration of injured tissues in future strategies combining regenerative and root canal therapies. This study explores the cytotoxicity and genotoxicity mediated by oxidative stress of three endodontic materials that are widely used on HDPSCs: a mineral trioxide aggregate (MTA-Angelus white), an epoxy resin sealant (AH-Plus cement), and an MTA-based cement sealer (MTA-Fillapex). Cell viability and cell death rate were assessed by flow cytometry. Oxidative stress was measured by OxyBlot. Levels of antioxidant enzymes were evaluated by Western blot. Genotoxicity was studied by quantifying the expression levels of DNA damage sensors such as ATM and RAD53 genes and DNA damage repair sensors such as RAD51 and PARP-1. Results indicate that AH-Plus increased apoptosis, oxidative stress, and genotoxicity markers in HDPSCs. MTA-Fillapex was the most cytotoxic oxidative stress inductor and genotoxic material for HDPSCs at longer times in preincubated cell culture medium, and MTA-Angelus was less cytotoxic and genotoxic than AH-Plus and MTA-Fillapex at all times assayed.

Bisphenol A release from orthodontic adhesives measured in vitro and in vivo with gas chromatography

INTRODUCTION

The objectives of this study were to quantify in vitro the Bisphenol A (BPA) release from 5 orthodontic composites and to assess in vivo the BPA level in patients' saliva and urine after bracket bonding with an orthodontic adhesive system.

METHODS

For the in-vitro portion of this study, 5 orthodontic composites were evaluated: Eagle Spectrum (American Orthodontics, Sheboygan, Wis), Enlight (Ormco, Orange, Calif), Light Bond (Reliance Orthodontic Products, Itasca, Ill), Mono Lok II (Rocky Mountain Orthodontics, Denver, Colo), and Transbond XT (3M Unitek, Monrovia, Calif). Simulating intraoral conditions, the specimens were immersed in a water/ethanol solution, and the BPA (ng.g^-1) liberation was measured after 30 minutes, 24 hours, 1 day, 1 week, and 1 month by the gas chromatography system coupled with mass spectrometry. Twenty patients indicated for fixed orthodontic treatment participated in the in-vivo study. Saliva samples were collected before bracket bonding and then 30 minutes, 24 hours, 1 day, 1 week, and 1 month after bonding the brackets. Urine samples were collected before bonding and then at 1 day, 1 week, and 1 month after bonding. The results were analyzed statistically using analysis of variance and Tukey posttest, with a significance level of 5%.

RESULTS

All composites evaluated in vitro released small amounts of BPA. Enlight composite showed the greatest release, at 1 month. Regarding the in-vivo study, the mean BPA level in saliva increased significantly only at 30 minutes after bonding in comparison with measurements recorded before bonding.

CONCLUSIONS

All orthodontic composites released BPA in vitro. Enlight and Light Bond had, respectively, the highest and lowest BPA releases in vitro. The in-vivo experiment showed that bracket bonding with the Transbond XT orthodontic adhesive system resulted in increased BPA levels in saliva and urine. The levels were significant but still lower than the reference dose for daily ingestion.

Salivary bisphenol A levels and their association with composite resin restoration

Composite resin has been increasingly used in an effort to remove minimal amount of tooth structure and are used for restoring not just carious cavities but also cervical abrasion. To synthesize composite resin, bisphenol A (BPA) is used. The aim of the study was to measure the changes in salivary BPA level related with composite resin restoration. ELISA was used to examine the BPA levels in the saliva collected from 30 volunteers whose teeth were filled with composite resin. Salivary samples were collected immediately before filling and 5 min and 7 d after filling. Wilcoxon signed-ranks test and linear regression were performed to test the significant differences of the changes in BPA levels in saliva. Before a new composite resin filling, there was no significant difference between with and without existing filling of composite resin and BPA level in the saliva was not correlated to the number of filled surfaces with composite resin. However, BPA level in the saliva increased to average 3.64 μg/L from average 0.15 μg/L after filling 5 min. BPA level increased in proportion with the number of filled surfaces. BPA level decreased to average 0.59 after filling 7 d. However it was higher than the BPA level before a new composite resin filling. Considering 50 μg/kg/day as the Tolerable Daily Intake of BPA suggested by European Food Safety Authority, the amount of BPA eluted in saliva after the composite resin filling is considered a safe level that is not a hazard to health at all.

Dental composite materials and renal function in children

OBJECTIVE

To examine whether greater exposure to resin-based composite materials, which may intra-orally release bisphenol A (BPA), is associated with worse renal function outcomes in children.

DESIGN

Prospective multi-centre study.

SETTING

Community health dental clinics in Boston and Maine from 1997-2005.Subjects and methods Five hundred and thirty-four New England Children's Amalgam Trial participants aged six to ten years were randomised to treatment with amalgam or resin-based composite restorations over five years of follow-up.

INTERVENTIONS

Restorations were placed according to treatment arm, and sealants placed per standard of care. Cumulative composite exposure was calculated using surface-years (each treated surface weighted by number years present).

MAIN OUTCOME MEASURES

Urinary excretion of albumin, gamma-glutamyl transpeptidase (gamma-GT), and N-acetyl-β-D-glucosaminidase (NAG) were available for 417 children.

RESULTS

Analysis of covariance showed no association between exposure to dental composites, polyacid-modified compomer, or flowable composite dental sealants and preventative resin restorations with levels of renal function. There was no association between composite materials and thresholds indicating renal damage in logistic regression models.

CONCLUSIONS

This study found no harmful associations between dental composite materials and renal function in children. Therefore, concerns about renal function need not be a consideration in the choice of dental restoration material or placement of preventative dental sealants.

Dental sealants and restorations and urinary bisphenol A concentrations in children in the 2003-2004 National Health and Nutrition Examination Survey

BACKGROUND

Resin-based dental sealants and composites contain bisphenol A-glycidyl methacrylate, a bisphenol A (BPA) derivative. The authors hypothesized that a greater number of sealants or restorations would be associated with higher urinary BPA concentrations.

METHODS

The authors examined urinary BPA measurements (in nanograms per milliliter) and oral examination data for 1,001 children aged 6 to 19 years from data sets of the 2003-2004 National Health and Nutrition Examination Survey (NHANES). They categorized children according to number of occlusal sealants and number of restorations, with four categories in each of the two groups. They estimated associations by using unadjusted and adjusted tobit regression models.

RESULTS

The lowest quartile of BPA concentrations ranged from 0.3 ng/mL to 1.9 ng/mL, whereas the highest quartile ranged from 7.3 ng/mL to 149 ng/mL. In adjusted analysis, children with seven to 16 sealants had geometric mean BPA concentrations 25 percent higher than those of children with no sealants (95 percent confidence interval [CI], -14 percent to 82 percent; P = .23). In adjusted analysis, children with seven to 42 restorations had geometric mean BPA concentrations 20 percent higher than those of children with no restorations (95 percent CI, -6 percent to 53 percent; P = .13). Neither of these adjusted estimates was statistically significant.

CONCLUSIONS

Though the findings were in the direction hypothesized, the authors did not observe a statistically significant association between a greater number of sealants or restorations and higher urinary BPA concentrations. Additional studies are needed to determine the extent of oral and systemic exposure to BPA from resin-based dental restorative materials over time.

PRACTICAL IMPLICATIONS

Dentists should follow this issue carefully as it develops and as the body of evidence grows. There is insufficient evidence to change practice at this time.

Dental sealants and flowable composite restorations and psychosocial, neuropsychological, and physical development in children

PURPOSE

Dental sealant materials may intraorally release their components, including bisphenol-A (BPA), but long-term health effects are uncertain. The New England Children's Amalgam Trial (NECAT) found that composite restorations were associated with psychosocial, but not neuropsychological or physical, outcomes. The previous analysis did not consider sealants and preventive resin restorations (PRRs), which were routinely placed. The purpose of this analysis was to examine sealant/PRR exposure in association with psychosocial and other health outcomes.

METHODS

NECAT recruited 534 six- to 10-year-olds and provided dental care during a five-year follow-up. Annually, examiners conducted psychosocial and neuropsychological tests and measured body mass index (BMI) and fat percentage (BF%). Associations between surface years (SY) of sealants/PRRs and outcomes were tested using multivariable models.

RESULTS

Cumulative exposure level to sealants and/or PRRs was not associated with psychosocial assessments (eg, total problems: Child Behavior Checklist, 10-SY β=-0.2 ± 0.3, P=.60) or neuropsychological tests (eg, full-scale IQ, 10-SY β=0.1 ± 0.2, P=.60). There were no associations for changes in BMI-for-age z-score (P=.40), BF% (girls 10-SY β=-0.2 ± 0.3; boys 10-SY β=-0.1 ± 0.3), or menarche (10-SY hazard ratio=0.91, 95% confidence interval=0.83-1.01, P=.08).

CONCLUSIONS

This study showed no associations between exposure level of dental sealants or PRRs and behavioral, neuropsychological, or physical development in children over 5-years.

In vivo bisphenol-a release from dental pit and fissure sealants: a systematic review

OBJECTIVE

To search the literature and assess the short- and long-term release of bisphenol-A (BPA) in human tissues after treatment with dental sealants.

DATA

Two review authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion with an arbiter.

SOURCES

Electronic database searches of published and unpublished literature were performed. The following electronic databases with no language and publication date restrictions were searched: MEDLINE (via Ovid and Pubmed), EMBASE (via ovid), Cochrane Trials Register and CENTRAL. The reference lists of all eligible studies were hand-searched.

STUDY SELECTION

In the absence of RCTs, six interventional and two observational studies, examining in vivo BPA release in human salivary, blood and urinary samples, were included. Due to the heterogeneity in methodology and reporting, the main synthesis of the results was qualitative. The quantitative synthesis based on the weighted Z-test could only include two studies. BPA levels identified in saliva ranged from traces below the method's detection limit to 30 μg/ml. In urine, BPA quantities spanned from 0.17 mg/g to 45.4 mg/g. BPA was not traced in any blood sample at any point of time in the relevant studies. The quantitative analysis showed evidence of BPA release one hour after sealant placement compared to the amount traced before restoration (Stouffer's z trend: <0.001).

CONCLUSIONS

The available evidence on this topic derived from studies that represent a moderate level of evidence. Nevertheless, the available evidence supports that BPA is released in saliva after sealant placement.

CLINICAL SIGNIFICANCE

From the qualititative and quantitative synthesis of studies, it is reasonable to conclude that BPA is released after placement of some dental pit and fissure sealants in the oral cavity. The biggest quantities are detected in saliva immediately after or one hour after their placement.