Mary Tavares, DMD, MPH

Members of the Tavares group are interested in the public health aspects of dentistry. We have been involved in designing and carrying out a variety of studies to learn about attitudes and concerns regarding dental health among patients from a wide range of backgrounds. We are also conducting a large-scale study to assess the health effects of mercury-containing dental amalgam fillings in children. The results of this study should help to settle a controversy that has continued since the 1970s.

Public Health Issues

The focus of work in the Tavares group is on issues, in both the clinical and policy arenas, that have an impact on dental health of the public. We have explored the area of clinical outcomes research, in particular the satisfaction of patients with their dental procedures. In the early 1990s, with a precipitous rise in the use of dental implants, we designed and tested a patient satisfaction survey directed at implant recipients. This survey continues to be used for research and clinical purposes.

Another project involved learning about the dental health of our nation's newest immigrant populations. As part of the Northeast Regional Minority Oral Health Center based at New York University, we worked with our NYU colleagues to determine the oral health status, needs, and attitudes of six of the largest immigrant populations in the New York area, as well as resident minority populations. In addition to clinical examinations in the community, we developed and tested survey instruments to learn more about health behaviors and attitudes toward dental health. Currently, we are examining the feasibility of including an intervention to prevent childhood obesity in the routine bi-annual dental hygiene appointments. Children in this study are asked to describe their eating and physical activity habits and then, to set goals for improving those habits.

Clinical Trial on the Effects of Dental Amalgams in Children

A major research direction addresses issues of public health through our work in clinical trials. A prospective clinical trial to evaluate the health effects of dental amalgam in children ended in August, 2006 after ten years. The "New England Children's Amalgam Trial", usually referred to as NECAT, was funded by a grant from the National Institute of Dental and Craniofacial Research (NIDCR) to New England Research Institutes (NERI) and The Forsyth Institute. Collaborating investigators included researchers from Children's Hospital in Boston, the University of Rochester School of Medicine and Dentistry, and the University of Maine at Farmington.

Mercury-containing dental amalgam has been at the center of a great deal of controversy over the past two decades. Critics point to known kidney and neurological effects of high levels of mercury, although there is little evidence that such effects can be caused by the low doses resulting from dental fillings. On the other hand, dental amalgam continues to be the most widely used and preferred dental filling material in the U.S. and the rest of the world. It is hoped that this study will assist in resolving this controversy. Five hundred children between the ages of 6 and 10 who never had amalgam fillings but were in need of treatment, were enrolled into the study from sites in Boston, Cambridge, and Farmington, Maine. Subjects were randomly assigned to receive amalgam or composite fillings, and followed every six months for five years with collection of blood, urine, hair samples, and educational/psychological testing.

The primary outcome and endpoints of the trial related to neurobehavioral and renal functioning, since the central nervous system and the kidneys are the primary target organs for mercury toxicity. Primary outcome variables related to general intellectual ability and neuropsychological functioning. The null hypothesis was that the mean change in population IQ between baseline and year 5 would not be different between the two treatment groups. The final results of this trial were published in the Journal of the American Medical Association in April, 2006. The conclusions were that no statistically significant differences in adverse neuropsychological or renal effects were observed in children whose teeth were restored with dental amalgam compared to composite resin. The findings indicated that the health effects of dental amalgam need not be the basis of treatment decisions when choosing a restorative dental material.

Selected Publications

Maserjian NN, Trachtenberg F, Hayes C, Tavares M. 2008. Oral health disparities in children of immigrants: dental caries experience at enrollment and during follow up in the New England Children's Amalgam Trial. J Public Health Dent. 68:(1):
14-21.

Maserejian NN, Tavares MA, Hayes C, Soncini JA, Trachtenberg FL. 2008. Rural and urban disparities in caries prevalence in children with unmet dental needs: the New England Children's Amalgam Trial. J Public Health Dent. 68(1):7-13.

Soncini JA, Maserejian NN, Trachtenberg F, Tavares M, Hayes C. 2007. The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: findings from the New England Children's Amalgam Trial. J. Am Dent Assoc. 138(6):763-72

Bellinger DC, Trachtenberg F, Barregard L, Tavares M, Cernichiari E, Daniel D, McKinlay S. 2006. Neuro-psychological and renal effects of dental amalgam in children. A randomized clinical trial. J. Am. Med. Assoc. 295(15):1775-1 783.

Goodson JM, Tavares M, Sweeney M, Stultz J, Newman M, Smith V, Regan EO, Kent R. 2005. Tooth whitening: Tooth color changes following treatment by peroxide and light. J. Clin. Dent. XVI (3)78–82.

Cruz GD, Shore R, Le Geros RZ, Tavares M. 2004. Effect of acculturation on objective measures of oral health in Haitian immigrants in New York City. J. Dent. Res. 83 (2):180–184.

Tavares M, Stultz J, Newman M, Smith V, Kent R, Carpino E, Goodson JM. 2003. Light augments tooth whitening with peroxide. J. Am. Dent. Assoc. 134 (2):167– 173.

McKinlay SM, Meurer EA, Assmann SF, Bellinger D, Tavares M, Daniel DB, Clarkson T, Cermichiari E. 2003. The Children's Amalgam Trial: Design and methods. Control. Clin. Trials 24:795–814.

Gemmel A, Tavares M, Alperin S, Soncini J, Daniel D, Dunn J, Crawford S, Braveman N, Clarkson TW, McKinley S, Bellinger DC. 2002. Blood lead level and dental caries in school-age children. Environ. Health Perspect. 110(1 0) :A625–630.

Cruz GD, Xue X, Le Geros RZ, Halpert N, Galvin DL, Tavares M. 2001. Dental caries experience, tooth loss, and factors associated with unmet needs of Haitian immigrants in New York City. J. Public Health Dent. 61(4):203–209.

Cruz GD, Galvin DL, Kim M, Le Geros RZ, Barrow SY, Tavares M, Bachiman R. 2001. Self-perceived oral health among three subgroups of Asian-Americans in New York City: A preliminary study. Community Dent. Oral Epidemiol. 29(2):99–106.

Staff

Staff Associate

Jennifer Soncini, D.M.D.

Research Dental Hygienist

Jacyn D. Stultz, R.D.H.

Dental Assistant

Valerie F. Smith