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Clinical Oral Investigations Feb 2020The objectives of this cross-sectional survey were to determine the prevalence of secondary caries (SC) in general population, to identify patient- and material-related...
OBJECTIVES
The objectives of this cross-sectional survey were to determine the prevalence of secondary caries (SC) in general population, to identify patient- and material-related factors which may affect the prevalence, and to describe some clinical characteristics of SC lesions.
MATERIALS AND METHODS
A total of 4036 restorations in 450 patients, who visited the university dental clinic for a regular (half) yearly checkup, were examined clinically (and radiographically) for the presence of SC. Clinical characteristics of the detected SC lesions (size, activity, and location) and the planned treatment were recorded. In addition, patients' caries-risk status was assessed according to the modified "cariogram" model.
RESULTS
In total, 146 restorations were diagnosed with SC, which gives an overall prevalence of 3.6%. Restorative material, restoration class, patient's caries risk, and smoking habits were shown to be important factors, as SC prevalence was significantly higher with composites, class II restorations, high-caries-risk patients, and smokers. Restorations' gingival margins were most frequently affected by SC. The largest number of restorations with SC (72%) was scheduled for the replacement.
CONCLUSIONS
Prevalence of SC was higher with composite than with amalgam restorations, irrespective of the patient's caries-risk status. Gingival margins of class II, including MOD restorations, seem to be the place of less resistance to SC development. Management of SC seems to place a considerable burden on the health care workforce and expenditure.
CLINICAL RELEVANCE
Secondary caries (SC) is considered to be the main cause of dental restoration failure and one of the biggest clinical challenges related to dental composites. Nevertheless, its prevalence in daily practice is still not clear, which impedes an accurate estimation of its impact on health care costs.
Topics: Composite Resins; Cross-Sectional Studies; Dental Amalgam; Dental Caries; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Prevalence
PubMed: 31123872
DOI: 10.1007/s00784-019-02894-0 -
Bundesgesundheitsblatt,... Jul 2021Dental amalgam has been successfully used for the restoration of carious lesions for more than 180 years. It is clinically characterized by high longevity and low... (Review)
Review
Dental amalgam has been successfully used for the restoration of carious lesions for more than 180 years. It is clinically characterized by high longevity and low technique sensitivity. For decades, dental amalgam has been discussed in the public, especially due to its roughly 50% mercury content. Since the Minamata Convention was published in 2013 with the primary goal of reducing the anthropogenic mercury release into the environment, the previously muted amalgam discussion has received fresh impetus. Another considerable disadvantage of amalgam is its silver/greyish color, which simply no longer matches patients' esthetic demands.The present paper describes the basic problems with amalgam against the background of multiple biological, clinical, and health policy factors. Possible consequences of the Minamata Convention concerning legal regulations as well as the use of dental biomaterials and therefore also relating to the future national healthcare system are discussed. Finally, possible amalgam alternatives and the urgent need for biomedical research towards restorative dentistry are presented, embedded into the crucial question of whether we are actually conducting the correct debate.
Topics: Dental Amalgam; Germany; Health Policy; Humans; Mercury
PubMed: 34143251
DOI: 10.1007/s00103-021-03355-4 -
Dental Update 2016
Topics: Composite Resins; Dental Amalgam; Dental Materials; Dental Restoration, Permanent; Health Policy; Humans; International Cooperation; Mercury; United Kingdom
PubMed: 27024897
DOI: 10.12968/denu.2016.43.1.5 -
Journal of the American Dental... May 2023Amalgam has been used for more than 150 years as a safe and reliable restorative material. The authors described the occurrence of amalgam and nonamalgam restorations in...
BACKGROUND
Amalgam has been used for more than 150 years as a safe and reliable restorative material. The authors described the occurrence of amalgam and nonamalgam restorations in the United States in primary and permanent teeth across age groups and according to sociodemographic characteristics.
METHODS
The authors used clinical examination data from the National Health and Nutrition Examination Survey 2015-2018 for participants 2 years and older (n = 17,040). The authors estimated the prevalence and mean number of amalgam and nonamalgam restorations in primary and permanent teeth according to age groups (2-5 years, 6-11 years, 12-15 years, 16-19 years, 20-39 years, 40-59 years, 60-79 years, and ≥ 80 years), race and ethnicity, federal poverty guideline, education, and pregnancy status.
RESULTS
The prevalence of amalgam restorations ranged from 4% through 69%. Overall, amalgam restorations were more prevalent in children and adolescents from racial and ethnic minority groups and families at lower poverty levels and with lower education. The mean number of teeth with nonamalgam restorations was higher than those with amalgam restorations in primary teeth of children aged 6 through 11 years, permanent teeth of those 12 through 15 years and 20 through 39 years, and women aged 20 through 49 years, regardless of pregnancy status. The mean number of amalgam restorations was higher than that for nonamalgam restorations in older age groups.
CONCLUSIONS
Nonamalgam restorations were the most common in the primary teeth of children older than 5 years and in the permanent teeth of adults younger than 40 years. Amalgam restorations were more common in older adults. Amalgam and nonamalgam restorations were equally common in children younger than 5 years.
PRACTICAL IMPLICATIONS
The study findings suggest a shift from amalgam to alternative restorative materials in the United States.
Topics: Child; Adolescent; Humans; Female; United States; Pregnancy; Child, Preschool; Aged; Dental Restoration, Permanent; Prevalence; Ethnicity; Nutrition Surveys; Minority Groups; Dental Materials; Dental Amalgam; Composite Resins
PubMed: 37105669
DOI: 10.1016/j.adaj.2023.02.016 -
The Journal of Clinical Pediatric... 2015The science of dental materials and restorative care in children and adolescent is constantly evolving, and the ongoing search for ideal restorative materials has led to... (Review)
Review
BACKGROUND
The science of dental materials and restorative care in children and adolescent is constantly evolving, and the ongoing search for ideal restorative materials has led to plethora of research.
AIM
To provide an evidence base to assist dental practitioners choose appropriate restorative care for children and adolescents.
STUDY DESIGN
This evidence-based review appraises this literature, primarily between the years 1995-2013, for efficacy of dental amalgam, composites, glass ionomer cements, compomers, preformed metal crowns and anterior esthetic restorations. The assessment of evidence for each dental material was based on a strong evidence, evidence in favor, expert opinion, and evidence against by consensus of the authors.
RESULTS
There is varying level of evidence for the use of restorative materials like amalgam, composites, glass ionomers, resin-modified glass-ionomers, compomers, stainless steel crowns and anterior crowns for both primary and permanent teeth.
CONCLUSIONS
A substantial amount data is available on restorative materials used in pediatric dentistry; however, there exists substantial evidence from systematic reviews and randomized clinical trials and clinicians need to examine and understand the available literature evidence carefully to aid them in clinical decision making.
Topics: Adolescent; Child; Crowns; Dental Materials; Dental Restoration, Permanent; Evidence-Based Dentistry; Humans
PubMed: 26161599
DOI: 10.17796/1053-4628-39.4.303 -
Acta Odontologica Scandinavica Apr 2022Many patients have medically unexplained physical symptoms (MUPS); some of them attribute their health complaints to dental amalgam fillings. The aim of this study was...
OBJECTIVE
Many patients have medically unexplained physical symptoms (MUPS); some of them attribute their health complaints to dental amalgam fillings. The aim of this study was to assess the validity and responsiveness of General Health Complaints index (GHC-index) for measuring the symptom load in MUPS patients compared to the widely used symptom outcome measure, Giessen Subjective Complaints List (GBB-24).
METHODS
Three outcome measures - GHC-index, GBB-24, and Munich Amalgam Scale (MAS) - were administered at baseline and 12 months after removal of all dental amalgam restorations. The validity and responsiveness of these symptom measures were tested against external anchors: bodily distress syndrome (BDS), SF-36 vitality, and visual analogue scale (VAS). We tested both convergent and known group validities. We also examined the predictive validity and responsiveness to changes for each instrument.
RESULTS
All the main outcome measures showed evidence of convergent and known group validities. The GHC-index, GBB-24 and MAS were all able to detect the anticipated differences in BDS and Energy. But the GBB-24 was more efficient in discriminating the BDS compared with the GHC-index (relative efficiency: RE = 0.69; 95% CI: 0.41-0.96) and MAS (RE = 0.59; 95% CI: 0.32-0.86). Each main outcome variable revealed good predictive validity for vitality (standardized coefficient: ≈ 0.71 and ≈ 0.50). Moderate to high sensitivity to change over time was demonstrated, with GHC-index performing better.
CONCLUSION
The GHC-index is a valid and responsive instrument for assessing symptom load in MUPS patients attributing their health complaints to amalgam fillings and undergoing amalgam removal.
Topics: Dental Amalgam; Humans
PubMed: 34651557
DOI: 10.1080/00016357.2021.1989032 -
International Dental Journal Sep 2020There has been considerable controversy concerning the health risks and benefits of using mercury-containing amalgam. This study aimed to evaluate the Turkish dentists'...
OBJECTIVES
There has been considerable controversy concerning the health risks and benefits of using mercury-containing amalgam. This study aimed to evaluate the Turkish dentists' and patients' preference and opinion about amalgam and to assess Internet search trends about amalgam.
METHODS
The study consists of three stages. The first two stages of the study are cross-sectional studies to verify both the patients' perception with amalgam restorations and dentists' attitudes regarding the use of dental amalgam. The third stage of the study evaluated the Internet search trends of Turkish people about mercury and amalgam related concerns between 2004 and 2018.
RESULTS
A total of 320 patients (180 female, 140 male) and 1,211 dentists (533 female, 678 male) participated in this study. Majority of the patients have no idea about the type of dental restorations and effect of dental materials on their health. 188 (58.8%) participants stated that they would not prefer amalgam restoration in their teeth as amalgam is unaesthetic. A total of 24% (291) of the dentists used amalgam routinely; 9.5% (156) of them used amalgam rarely, and 63.1% (764) did not use amalgam at all. The reason for not using amalgam included the patients' desire and unaesthetic properties. According to the Internet search trends, Turkish people do not know as much about amalgam as people in the rest of the world.
CONCLUSION
Awareness about dental amalgam is low among patients studied. Although dentists do not use dental amalgam frequently, they disagree on banning dental amalgam.
PubMed: 32996144
DOI: 10.1111/idj.12610 -
European Oral Research May 2023The popularity of dental amalgam arises from its excellent long-term performance, ease of use, and low cost. However, there is a concern about the potential adverse... (Review)
Review
PURPOSE
The popularity of dental amalgam arises from its excellent long-term performance, ease of use, and low cost. However, there is a concern about the potential adverse health effects arising from exposure to mercury in amalgam. This review article critically discusses the safety of dental amalgam as a restorative material and our preparedness for a mercury-free road ahead.
MATERIALS AND METHODS
A database search was performed on PubMed and Google scholar using the keywords: "mercury-free dentistry", "mercury toxicity", "amalgam substitutes", "amalgam mercury toxicity". Inclusion and exclusion criteria were specified clearly. Relevant literature was also searched in the dental textbooks.
RESULTS
Around 40 articles, highlighting mercury exposure among dental professionals and patients were included. Despite the overwhelming body of scientific evidence demonstrating amalgam to be a safe restorative material, concerns about the toxic effects of mercury persist.
CONCLUSION
The real challenge is to find a suitable amalgam substitute and to follow the mercury hygiene measures closely.
PubMed: 37525858
DOI: 10.26650/eor.20231050091 -
JDR Clinical and Translational Research Jan 2022Amalgam use has recently been phased down, and the potential for a phase-out is being investigated.
INTRODUCTION
Amalgam use has recently been phased down, and the potential for a phase-out is being investigated.
OBJECTIVES
The study aimed to identify knowledge of the phase-down and opinions of a potential phase-out of amalgam by UK primary care clinicians and assess their confidence in using different materials in different situations.
METHODS
An anonymized, prepiloted cross-sectional e-survey was used to assess primary care clinicians' knowledge and opinions of the amalgam phase-down and potential phase-out and their confidence in using amalgam and the alternatives in different situations. In total, 11,902 invitations were distributed through British dentist and therapist associations. Prior hypotheses were tested alongside descriptive statistics.
RESULTS
Response rate was 13% ( = 1,513). Knowledge of the amalgam phase-down was low, with just 3% clinicians correctly identifying all patient groups in whom amalgam use should be avoided in the United Kingdom. Postgraduate education on posterior composite placement was high (88%), but a large majority had personal and patient-centered concerns over the suitability of the alternatives and lacked confidence when placing composite in comparison to amalgam in difficult situations ( < 0.0001). Logistic regressions revealed that the best predictors of high confidence in placing mesio-occluso-distal composites and composites in difficult situations were being a private general dentist or being primarily a composite user.
CONCLUSION
Primary care clinicians have major personal and patient-centered concerns regarding the amalgam phase-down (of which they have limited knowledge) and potential phase-out. Many lack confidence in using the alternative, composite, to restore posterior teeth in difficult situations, whereas confidence in using amalgam in similar situations is high. Effective education of clinicians and understanding patients' needs, alongside policy changes, are required to enable a successful amalgam phase-down and potential phase-out.
KNOWLEDGE TRANSFER STATEMENT
This study shows that UK primary care clinicians are worried about the phase-down of amalgam for themselves and their patients. Many lack confidence in the alternative, composite, when used in difficult situations, which is in stark contrast to amalgam. Knowledge of the phase-down is limited. There is a need for more effective education of clinicians, an understanding of patients' values, and policy changes to ensure the success of the phase-down and potential phase-out of amalgam.
Topics: Composite Resins; Cross-Sectional Studies; Dental Amalgam; Humans; United Kingdom
PubMed: 33300424
DOI: 10.1177/2380084420954766 -
JDR Clinical and Translational Research Jan 2022A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use....
INTRODUCTION
A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use. The current use of amalgam and its alternatives has not been fully investigated in the United Kingdom.
OBJECTIVES
The study aimed to identify direct posterior restorative techniques, material use, and reported postoperative complication incidence experienced by primary care clinicians and differences between clinician groups.
METHODS
A cross-sectional survey was distributed to primary care clinicians through British dentist and therapist associations (11,092 invitations). The questionnaire sought information on current provision of direct posterior restorations and perceived issues with the different materials. Descriptive statistical and hypothesis testing was performed.
RESULTS
Dentists' response rate was 14% and therapists' estimated minimum response rate was 6% (total = 1,513). The most commonly used restorative material was amalgam in molar teeth and composite in premolars. When placing a direct posterior mesio-occluso-distal restoration, clinicians booked on average 45% more time and charged 45% more when placing composite compared to amalgam ( < 0.0001). The reported incidences of food packing and sensitivity following the placement of direct restorations were much higher with composite than amalgam ( < 0.0001). Widely recommended techniques, such as sectional metal matrix use for posterior composites, were associated with reduced food packing ( < 0.0001) but increased time booked ( = 0.002).
CONCLUSION
Amalgam use is currently high in the publicly funded sector of UK primary care. Composite is the most used alternative, but it takes longer to place and is more costly. Composite also has a higher reported incidence of postoperative complications than amalgam, but time-consuming techniques, such as sectional matrix use, can mitigate against food packing, but their use is low. Therefore, major changes in health service structure and funding and posterior composite education are required in the United Kingdom and other countries where amalgam use is prevalent, as the amalgam phase-down continues.
KNOWLEDGE TRANSFER STATEMENT
This study presents data on the current provision of amalgam for posterior tooth restoration and its directly placed alternatives by primary care clinicians in the United Kingdom, where publicly funded health care with copayment provision predominates. The information is important to manage and plan the UK phase-down and proposed phase-out of amalgam and will be of interest to other, primarily developing countries where amalgam provision predominates in understanding some of the challenges faced.
Topics: Composite Resins; Cross-Sectional Studies; Dental Amalgam; Dental Materials; Dental Restoration, Permanent
PubMed: 33300416
DOI: 10.1177/2380084420978653