Abstract
Systematic review conclusion. Bisphenol A (BPA) is released after placement of some dental pit-and-fissure sealants in the oral cavity.Critical summary assessment. Limited evidence suggests that BPA is detected in saliva after sealant placement; however, the authors of this systematic review failed to address any harmful effects on health related to the BPA release.Evidence quality rating.Clinical question. In patients receiving dental sealants, what are the short-term and long-term releases of bisphenol A (BPA) in human saliva, blood serum and urine after treatment?Review methods. The review authors searched four electronic databases for published literature, as well as four other databases for trials and registers for unpublished literature irrespective of language or date of publication. They hand searched the references of all eligible studies for additional studies. They considered for inclusion prospective studies, including randomized controlled trials and observational or survey studies, and they excluded in vitro studies. They did not perform a risk-of-bias assessment on the included studies. They included patients of any age who had dental pit-and-fissure sealants. The authors did not restrict their analysis according to timing of sealant placement. Exclusion criteria included use of resin-based composites other than sealants and studies in which investigators assessed monomers other than BPA. The first two authors performed data extraction independently and in duplicate, resolving disagreements by means of discussion or involving a third author. The authors used customized data collection forms to record the information.Main results. The authors included eight studies (six interventional and two observational), with a total of 748 participants, in which investigators examined in vivo BPA release in human salivary, blood and urinary samples. Six studies were prospective clinical studies in which researchers assessed in vivo release of BPA in human tissues, and two were survey studies. For one study, the review authors were able to retrieve only the abstract. Some studies did not include means and standard deviations. The intervals at which analysis of the BPA content was performed varied substantially, and hence the authors could not perform a meta-analysis of the prospective studies. The authors were able to perform quantitative analysis for only two of the eight studies, and the results showed a statistically significant trend toward BPA release. Only one study involved a comparison group with control patients who did not have sealants. For the rest of the studies, the comparison group was the same patients before sealant placement. BPA levels in saliva ranged from traces below the method's detection limit to 30 micrograms per milliliter. In urine, it ranged from 0.17 to 45.4 milligrams per gram. BPA was not traced in blood samples at any point. There was evidence of BPA release one hour after sealant placement compared with the amount traced before sealant placement.Conclusions. There is limited evidence that suggests that BPA is found in saliva one hour after sealant placement compared with the level before placement.COMMENTARYImportance and contextResin-based dental sealants have demonstrated effectiveness in caries prevention and are used extensively in dental practices as well as in school-based dental programs. Some of these sealants are based on BPA, which is used as a precursor of the BPA-glycidyl methacrylate or BPA-dimethacrylate oligomers during their production. Although BPA is not used by itself in resin-based composites, it is likely to be present as an impurity resulting from the synthesis process. The release of uncured monomers after polymerization has been postulated to cause adverse effects on health.2Van Landuyt KL Nawrot T Geebelen B et al.How much do resin-based dental materials release? A meta-analytical approach.Dent Mater. 2011; 27: 723-747Abstract Full Text Full Text PDF PubMed Scopus (289) Google Scholar BPA has shown potential estrogenicity in a substantial number of studies and is described as an endocrine disruptor chemical, owing to its ability to bind to and activate the human estrogen receptor.1Fleisch AF Sheffield PE Chinn C Edelstein BL Landrigan PJ Bisphenol A and related compounds in dental materials.Pediatrics. 2010; 126: 760-768Crossref PubMed Scopus (180) Google Scholar, 3Mohsen NM Craig RG Hanks CT Cytotoxicity of urethane dimethacrylate composites before and after aging and leaching.J Biomed Mater Res. 1998; 39: 252-260Crossref PubMed Scopus (35) Google Scholar, 4Vandenberg LN Hauser R Marcus M Olea N Welshons WV Human exposure to bisphenol A (BPA).Reprod Toxicol. 2007; 24: 139-177Crossref PubMed Scopus (2017) Google Scholar BPA is classified as a reproductive toxic substance of category 3, a significant risk factor for human fertility.5Diamanti-Kandarakis E Bourguignon JP Giudice LC et al.Endocrine-disrupting chemicals: an Endocrine Society scientific statement.Endocr Rev. 2009; 30: 293-342Crossref PubMed Scopus (2905) Google Scholar The relevant literature is limited mostly to in vitro studies about BPA release from restorations and sealants; hence, the authors of this systematic review aimed to assess the short-term and long-term release of BPA in human tissues after treatment with dental sealants.Strengths and weaknesses of the systematic reviewThe authors conducted a comprehensive search of the literature in multiple databases, including unpublished as well as non–English-language literature. There were two independent data extractors, with a consensus procedure in place in case of disagreements. The authors adhered to an a priori design for study selection. They did not adhere to their exclusion criteria; they were to exclude studies of resin-based composite. However, investigators in one included survey study examined BPA release after placement of resin-based composite restorations. Although the authors claimed to assess the scientific quality of the included studies, they failed to do so in detail. They identified the shortcomings from the methodological heterogeneity when formulating the conclusion. A meta-analysis was not achievable owing to heterogeneity. They included in the systematic review survey studies, which lend little value to the outcome being studied. The review authors failed to provide the data in a tabular form and in similar units.Strengths and weaknesses of the evidenceThe BPA measurement method was common across five studies and different across three studies. The type of sealant or product name was not disclosed in three of the eight included studies. Investigators in only three of the eight studies reported the limits of BPA detection. The analysis of the methodology of the included studies revealed certain omissions as well as substantial differences in terms of the sample size, the amount of dental material used, the time points of outcome assessment, the BPA measurement method and the reporting units, thus giving them limited interpretability. Investigators in some studies did not provide means and standard deviations. The evaluated outcomes were surrogate measures versus patient-oriented outcomes, which failed to clarify whether the resultant BPA release had any effect on patients’ health.Implications for dental practiceThere is strong evidence indicating the benefits of dental sealants in preventing dental caries in children. On the basis of limited evidence, BPA is detected after placement of some pit-and-fissure sealants in the oral cavity. Evidence from the systematic review suggests that BPA is detected one hour after sealant placement in comparison with the amount traced before restoration. Currently, there are no standards for BPA levels’ causing harmful effects on health. Ideally, the exact composition of the sealant on the market should be publicized so that dentists and patients can make informed product choices that are based on the best current evidence. A major challenge for future research is to specify a causal link between BPA detected from sealants or restorations and negative health effects under the dynamic process of biocompatibility and metabolism. ▪ Systematic review conclusion. Bisphenol A (BPA) is released after placement of some dental pit-and-fissure sealants in the oral cavity.Critical summary assessment. Limited evidence suggests that BPA is detected in saliva after sealant placement; however, the authors of this systematic review failed to address any harmful effects on health related to the BPA release.Evidence quality rating. Systematic review conclusion. Bisphenol A (BPA) is released after placement of some dental pit-and-fissure sealants in the oral cavity.Critical summary assessment. Limited evidence suggests that BPA is detected in saliva after sealant placement; however, the authors of this systematic review failed to address any harmful effects on health related to the BPA release.Evidence quality rating. Systematic review conclusion. Bisphenol A (BPA) is released after placement of some dental pit-and-fissure sealants in the oral cavity. Critical summary assessment. Limited evidence suggests that BPA is detected in saliva after sealant placement; however, the authors of this systematic review failed to address any harmful effects on health related to the BPA release. Evidence quality rating. Clinical question. In patients receiving dental sealants, what are the short-term and long-term releases of bisphenol A (BPA) in human saliva, blood serum and urine after treatment? Review methods. The review authors searched four electronic databases for published literature, as well as four other databases for trials and registers for unpublished literature irrespective of language or date of publication. They hand searched the references of all eligible studies for additional studies. They considered for inclusion prospective studies, including randomized controlled trials and observational or survey studies, and they excluded in vitro studies. They did not perform a risk-of-bias assessment on the included studies. They included patients of any age who had dental pit-and-fissure sealants. The authors did not restrict their analysis according to timing of sealant placement. Exclusion criteria included use of resin-based composites other than sealants and studies in which investigators assessed monomers other than BPA. The first two authors performed data extraction independently and in duplicate, resolving disagreements by means of discussion or involving a third author. The authors used customized data collection forms to record the information. Main results. The authors included eight studies (six interventional and two observational), with a total of 748 participants, in which investigators examined in vivo BPA release in human salivary, blood and urinary samples. Six studies were prospective clinical studies in which researchers assessed in vivo release of BPA in human tissues, and two were survey studies. For one study, the review authors were able to retrieve only the abstract. Some studies did not include means and standard deviations. The intervals at which analysis of the BPA content was performed varied substantially, and hence the authors could not perform a meta-analysis of the prospective studies. The authors were able to perform quantitative analysis for only two of the eight studies, and the results showed a statistically significant trend toward BPA release. Only one study involved a comparison group with control patients who did not have sealants. For the rest of the studies, the comparison group was the same patients before sealant placement. BPA levels in saliva ranged from traces below the method's detection limit to 30 micrograms per milliliter. In urine, it ranged from 0.17 to 45.4 milligrams per gram. BPA was not traced in blood samples at any point. There was evidence of BPA release one hour after sealant placement compared with the amount traced before sealant placement. Conclusions. There is limited evidence that suggests that BPA is found in saliva one hour after sealant placement compared with the level before placement. COMMENTARYImportance and contextResin-based dental sealants have demonstrated effectiveness in caries prevention and are used extensively in dental practices as well as in school-based dental programs. Some of these sealants are based on BPA, which is used as a precursor of the BPA-glycidyl methacrylate or BPA-dimethacrylate oligomers during their production. Although BPA is not used by itself in resin-based composites, it is likely to be present as an impurity resulting from the synthesis process. The release of uncured monomers after polymerization has been postulated to cause adverse effects on health.2Van Landuyt KL Nawrot T Geebelen B et al.How much do resin-based dental materials release? A meta-analytical approach.Dent Mater. 2011; 27: 723-747Abstract Full Text Full Text PDF PubMed Scopus (289) Google Scholar BPA has shown potential estrogenicity in a substantial number of studies and is described as an endocrine disruptor chemical, owing to its ability to bind to and activate the human estrogen receptor.1Fleisch AF Sheffield PE Chinn C Edelstein BL Landrigan PJ Bisphenol A and related compounds in dental materials.Pediatrics. 2010; 126: 760-768Crossref PubMed Scopus (180) Google Scholar, 3Mohsen NM Craig RG Hanks CT Cytotoxicity of urethane dimethacrylate composites before and after aging and leaching.J Biomed Mater Res. 1998; 39: 252-260Crossref PubMed Scopus (35) Google Scholar, 4Vandenberg LN Hauser R Marcus M Olea N Welshons WV Human exposure to bisphenol A (BPA).Reprod Toxicol. 2007; 24: 139-177Crossref PubMed Scopus (2017) Google Scholar BPA is classified as a reproductive toxic substance of category 3, a significant risk factor for human fertility.5Diamanti-Kandarakis E Bourguignon JP Giudice LC et al.Endocrine-disrupting chemicals: an Endocrine Society scientific statement.Endocr Rev. 2009; 30: 293-342Crossref PubMed Scopus (2905) Google Scholar The relevant literature is limited mostly to in vitro studies about BPA release from restorations and sealants; hence, the authors of this systematic review aimed to assess the short-term and long-term release of BPA in human tissues after treatment with dental sealants.Strengths and weaknesses of the systematic reviewThe authors conducted a comprehensive search of the literature in multiple databases, including unpublished as well as non–English-language literature. There were two independent data extractors, with a consensus procedure in place in case of disagreements. The authors adhered to an a priori design for study selection. They did not adhere to their exclusion criteria; they were to exclude studies of resin-based composite. However, investigators in one included survey study examined BPA release after placement of resin-based composite restorations. Although the authors claimed to assess the scientific quality of the included studies, they failed to do so in detail. They identified the shortcomings from the methodological heterogeneity when formulating the conclusion. A meta-analysis was not achievable owing to heterogeneity. They included in the systematic review survey studies, which lend little value to the outcome being studied. The review authors failed to provide the data in a tabular form and in similar units.Strengths and weaknesses of the evidenceThe BPA measurement method was common across five studies and different across three studies. The type of sealant or product name was not disclosed in three of the eight included studies. Investigators in only three of the eight studies reported the limits of BPA detection. The analysis of the methodology of the included studies revealed certain omissions as well as substantial differences in terms of the sample size, the amount of dental material used, the time points of outcome assessment, the BPA measurement method and the reporting units, thus giving them limited interpretability. Investigators in some studies did not provide means and standard deviations. The evaluated outcomes were surrogate measures versus patient-oriented outcomes, which failed to clarify whether the resultant BPA release had any effect on patients’ health.Implications for dental practiceThere is strong evidence indicating the benefits of dental sealants in preventing dental caries in children. On the basis of limited evidence, BPA is detected after placement of some pit-and-fissure sealants in the oral cavity. Evidence from the systematic review suggests that BPA is detected one hour after sealant placement in comparison with the amount traced before restoration. Currently, there are no standards for BPA levels’ causing harmful effects on health. Ideally, the exact composition of the sealant on the market should be publicized so that dentists and patients can make informed product choices that are based on the best current evidence. A major challenge for future research is to specify a causal link between BPA detected from sealants or restorations and negative health effects under the dynamic process of biocompatibility and metabolism. ▪ Importance and contextResin-based dental sealants have demonstrated effectiveness in caries prevention and are used extensively in dental practices as well as in school-based dental programs. Some of these sealants are based on BPA, which is used as a precursor of the BPA-glycidyl methacrylate or BPA-dimethacrylate oligomers during their production. Although BPA is not used by itself in resin-based composites, it is likely to be present as an impurity resulting from the synthesis process. The release of uncured monomers after polymerization has been postulated to cause adverse effects on health.2Van Landuyt KL Nawrot T Geebelen B et al.How much do resin-based dental materials release? A meta-analytical approach.Dent Mater. 2011; 27: 723-747Abstract Full Text Full Text PDF PubMed Scopus (289) Google Scholar BPA has shown potential estrogenicity in a substantial number of studies and is described as an endocrine disruptor chemical, owing to its ability to bind to and activate the human estrogen receptor.1Fleisch AF Sheffield PE Chinn C Edelstein BL Landrigan PJ Bisphenol A and related compounds in dental materials.Pediatrics. 2010; 126: 760-768Crossref PubMed Scopus (180) Google Scholar, 3Mohsen NM Craig RG Hanks CT Cytotoxicity of urethane dimethacrylate composites before and after aging and leaching.J Biomed Mater Res. 1998; 39: 252-260Crossref PubMed Scopus (35) Google Scholar, 4Vandenberg LN Hauser R Marcus M Olea N Welshons WV Human exposure to bisphenol A (BPA).Reprod Toxicol. 2007; 24: 139-177Crossref PubMed Scopus (2017) Google Scholar BPA is classified as a reproductive toxic substance of category 3, a significant risk factor for human fertility.5Diamanti-Kandarakis E Bourguignon JP Giudice LC et al.Endocrine-disrupting chemicals: an Endocrine Society scientific statement.Endocr Rev. 2009; 30: 293-342Crossref PubMed Scopus (2905) Google Scholar The relevant literature is limited mostly to in vitro studies about BPA release from restorations and sealants; hence, the authors of this systematic review aimed to assess the short-term and long-term release of BPA in human tissues after treatment with dental sealants.Strengths and weaknesses of the systematic reviewThe authors conducted a comprehensive search of the literature in multiple databases, including unpublished as well as non–English-language literature. There were two independent data extractors, with a consensus procedure in place in case of disagreements. The authors adhered to an a priori design for study selection. They did not adhere to their exclusion criteria; they were to exclude studies of resin-based composite. However, investigators in one included survey study examined BPA release after placement of resin-based composite restorations. Although the authors claimed to assess the scientific quality of the included studies, they failed to do so in detail. They identified the shortcomings from the methodological heterogeneity when formulating the conclusion. A meta-analysis was not achievable owing to heterogeneity. They included in the systematic review survey studies, which lend little value to the outcome being studied. The review authors failed to provide the data in a tabular form and in similar units.Strengths and weaknesses of the evidenceThe BPA measurement method was common across five studies and different across three studies. The type of sealant or product name was not disclosed in three of the eight included studies. Investigators in only three of the eight studies reported the limits of BPA detection. The analysis of the methodology of the included studies revealed certain omissions as well as substantial differences in terms of the sample size, the amount of dental material used, the time points of outcome assessment, the BPA measurement method and the reporting units, thus giving them limited interpretability. Investigators in some studies did not provide means and standard deviations. The evaluated outcomes were surrogate measures versus patient-oriented outcomes, which failed to clarify whether the resultant BPA release had any effect on patients’ health.Implications for dental practiceThere is strong evidence indicating the benefits of dental sealants in preventing dental caries in children. On the basis of limited evidence, BPA is detected after placement of some pit-and-fissure sealants in the oral cavity. Evidence from the systematic review suggests that BPA is detected one hour after sealant placement in comparison with the amount traced before restoration. Currently, there are no standards for BPA levels’ causing harmful effects on health. Ideally, the exact composition of the sealant on the market should be publicized so that dentists and patients can make informed product choices that are based on the best current evidence. A major challenge for future research is to specify a causal link between BPA detected from sealants or restorations and negative health effects under the dynamic process of biocompatibility and metabolism. ▪ Importance and contextResin-based dental sealants have demonstrated effectiveness in caries prevention and are used extensively in dental practices as well as in school-based dental programs. Some of these sealants are based on BPA, which is used as a precursor of the BPA-glycidyl methacrylate or BPA-dimethacrylate oligomers during their production. Although BPA is not used by itself in resin-based composites, it is likely to be present as an impurity resulting from the synthesis process. The release of uncured monomers after polymerization has been postulated to cause adverse effects on health.2Van Landuyt KL Nawrot T Geebelen B et al.How much do resin-based dental materials release? A meta-analytical approach.Dent Mater. 2011; 27: 723-747Abstract Full Text Full Text PDF PubMed Scopus (289) Google Scholar BPA has shown potential estrogenicity in a substantial number of studies and is described as an endocrine disruptor chemical, owing to its ability to bind to and activate the human estrogen receptor.1Fleisch AF Sheffield PE Chinn C Edelstein BL Landrigan PJ Bisphenol A and related compounds in dental materials.Pediatrics. 2010; 126: 760-768Crossref PubMed Scopus (180) Google Scholar, 3Mohsen NM Craig RG Hanks CT Cytotoxicity of urethane dimethacrylate composites before and after aging and leaching.J Biomed Mater Res. 1998; 39: 252-260Crossref PubMed Scopus (35) Google Scholar, 4Vandenberg LN Hauser R Marcus M Olea N Welshons WV Human exposure to bisphenol A (BPA).Reprod Toxicol. 2007; 24: 139-177Crossref PubMed Scopus (2017) Google Scholar BPA is classified as a reproductive toxic substance of category 3, a significant risk factor for human fertility.5Diamanti-Kandarakis E Bourguignon JP Giudice LC et al.Endocrine-disrupting chemicals: an Endocrine Society scientific statement.Endocr Rev. 2009; 30: 293-342Crossref PubMed Scopus (2905) Google Scholar The relevant literature is limited mostly to in vitro studies about BPA release from restorations and sealants; hence, the authors of this systematic review aimed to assess the short-term and long-term release of BPA in human tissues after treatment with dental sealants. Resin-based dental sealants have demonstrated effectiveness in caries prevention and are used extensively in dental practices as well as in school-based dental programs. Some of these sealants are based on BPA, which is used as a precursor of the BPA-glycidyl methacrylate or BPA-dimethacrylate oligomers during their production. Although BPA is not used by itself in resin-based composites, it is likely to be present as an impurity resulting from the synthesis process. The release of uncured monomers after polymerization has been postulated to cause adverse effects on health.2Van Landuyt KL Nawrot T Geebelen B et al.How much do resin-based dental materials release? A meta-analytical approach.Dent Mater. 2011; 27: 723-747Abstract Full Text Full Text PDF PubMed Scopus (289) Google Scholar BPA has shown potential estrogenicity in a substantial number of studies and is described as an endocrine disruptor chemical, owing to its ability to bind to and activate the human estrogen receptor.1Fleisch AF Sheffield PE Chinn C Edelstein BL Landrigan PJ Bisphenol A and related compounds in dental materials.Pediatrics. 2010; 126: 760-768Crossref PubMed Scopus (180) Google Scholar, 3Mohsen NM Craig RG Hanks CT Cytotoxicity of urethane dimethacrylate composites before and after aging and leaching.J Biomed Mater Res. 1998; 39: 252-260Crossref PubMed Scopus (35) Google Scholar, 4Vandenberg LN Hauser R Marcus M Olea N Welshons WV Human exposure to bisphenol A (BPA).Reprod Toxicol. 2007; 24: 139-177Crossref PubMed Scopus (2017) Google Scholar BPA is classified as a reproductive toxic substance of category 3, a significant risk factor for human fertility.5Diamanti-Kandarakis E Bourguignon JP Giudice LC et al.Endocrine-disrupting chemicals: an Endocrine Society scientific statement.Endocr Rev. 2009; 30: 293-342Crossref PubMed Scopus (2905) Google Scholar The relevant literature is limited mostly to in vitro studies about BPA release from restorations and sealants; hence, the authors of this systematic review aimed to assess the short-term and long-term release of BPA in human tissues after treatment with dental sealants. Strengths and weaknesses of the systematic reviewThe authors conducted a comprehensive search of the literature in multiple databases, including unpublished as well as non–English-language literature. There were two independent data extractors, with a consensus procedure in place in case of disagreements. The authors adhered to an a priori design for study selection. They did not adhere to their exclusion criteria; they were to exclude studies of resin-based composite. However, investigators in one included survey study examined BPA release after placement of resin-based composite restorations. Although the authors claimed to assess the scientific quality of the included studies, they failed to do so in detail. They identified the shortcomings from the methodological heterogeneity when formulating the conclusion. A meta-analysis was not achievable owing to heterogeneity. They included in the systematic review survey studies, which lend little value to the outcome being studied. The review authors failed to provide the data in a tabular form and in similar units. The authors conducted a comprehensive search of the literature in multiple databases, including unpublished as well as non–English-language literature. There were two independent data extractors, with a consensus procedure in place in case of disagreements. The authors adhered to an a priori design for study selection. They did not adhere to their exclusion criteria; they were to exclude studies of resin-based composite. However, investigators in one included survey study examined BPA release after placement of resin-based composite restorations. Although the authors claimed to assess the scientific quality of the included studies, they failed to do so in detail. They identified the shortcomings from the methodological heterogeneity when formulating the conclusion. A meta-analysis was not achievable owing to heterogeneity. They included in the systematic review survey studies, which lend little value to the outcome being studied. The review authors failed to provide the data in a tabular form and in similar units. Strengths and weaknesses of the evidenceThe BPA measurement method was common across five studies and different across three studies. The type of sealant or product name was not disclosed in three of the eight included studies. Investigators in only three of the eight studies reported the limits of BPA detection. The analysis of the methodology of the included studies revealed certain omissions as well as substantial differences in terms of the sample size, the amount of dental material used, the time points of outcome assessment, the BPA measurement method and the reporting units, thus giving them limited interpretability. Investigators in some studies did not provide means and standard deviations. The evaluated outcomes were surrogate measures versus patient-oriented outcomes, which failed to clarify whether the resultant BPA release had any effect on patients’ health. The BPA measurement method was common across five studies and different across three studies. The type of sealant or product name was not disclosed in three of the eight included studies. Investigators in only three of the eight studies reported the limits of BPA detection. The analysis of the methodology of the included studies revealed certain omissions as well as substantial differences in terms of the sample size, the amount of dental material used, the time points of outcome assessment, the BPA measurement method and the reporting units, thus giving them limited interpretability. Investigators in some studies did not provide means and standard deviations. The evaluated outcomes were surrogate measures versus patient-oriented outcomes, which failed to clarify whether the resultant BPA release had any effect on patients’ health. Implications for dental practiceThere is strong evidence indicating the benefits of dental sealants in preventing dental caries in children. On the basis of limited evidence, BPA is detected after placement of some pit-and-fissure sealants in the oral cavity. Evidence from the systematic review suggests that BPA is detected one hour after sealant placement in comparison with the amount traced before restoration. Currently, there are no standards for BPA levels’ causing harmful effects on health. Ideally, the exact composition of the sealant on the market should be publicized so that dentists and patients can make informed product choices that are based on the best current evidence. A major challenge for future research is to specify a causal link between BPA detected from sealants or restorations and negative health effects under the dynamic process of biocompatibility and metabolism. ▪ There is strong evidence indicating the benefits of dental sealants in preventing dental caries in children. On the basis of limited evidence, BPA is detected after placement of some pit-and-fissure sealants in the oral cavity. Evidence from the systematic review suggests that BPA is detected one hour after sealant placement in comparison with the amount traced before restoration. Currently, there are no standards for BPA levels’ causing harmful effects on health. Ideally, the exact composition of the sealant on the market should be publicized so that dentists and patients can make informed product choices that are based on the best current evidence. A major challenge for future research is to specify a causal link between BPA detected from sealants or restorations and negative health effects under the dynamic process of biocompatibility and metabolism. ▪
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