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Journal of Dental Research Nov 2012Resin-based composite dental restoration materials may release bisphenol-A, an endocrine-disrupting chemical. Using secondary analysis of a randomized clinical safety... (Comparative Study)
Comparative Study Randomized Controlled Trial
Resin-based composite dental restoration materials may release bisphenol-A, an endocrine-disrupting chemical. Using secondary analysis of a randomized clinical safety trial of amalgam vs. composites, we tested the hypothesis that dental restoration materials affect children's growth. Children (N = 218 boys, N = 256 girls) aged 6 to 10 yrs at baseline with ≥ 2 decayed posterior teeth were randomized to amalgam or composites (bisphenol-A-diglycidyl-dimethacrylate composite for permanent teeth, urethane-dimethacrylate compomer for primary teeth) for treatment of posterior caries throughout follow-up. Primary outcomes for this analysis were 5-year changes in BMI-for-age z-scores, body fat percentage (BF%), and height velocity; exploratory analyses (n = 113) examined age at menarche. Results showed no significant differences between treatment assignment and changes in physical development in boys [(composites vs. amalgam) BF%, 4.9 vs. 5.7, p = 0.49; (BMI-z-score) 0.13 vs. 0.25, p = 0.36] or girls (8.8 vs. 7.7, p = 0.95; 0.36 vs. 0.21, p = 0.49). Children with more treatment on primary teeth had greater increases in BF% regardless of material type. Girls assigned to composites had lower risk of menarche during follow-up (hazard ratio = 0.57, 95% CI 0.35-0.95). Overall, there were no significant differences in physical development over 5 years in children treated with composites or amalgam. Additional studies examining these restoration materials in relation to age at menarche are warranted (clinicaltrials.gov number NCT00065988).
Topics: Adipose Tissue; Analysis of Variance; Benzhydryl Compounds; Body Height; Body Mass Index; Child; Child Development; Composite Resins; Dental Amalgam; Dental Restoration, Permanent; Estrogens, Non-Steroidal; Female; Humans; Linear Models; Male; Menarche; Methacrylates; Phenols; Polyurethanes; Sex Factors
PubMed: 22972857
DOI: 10.1177/0022034512458691 -
International Dental Journal Dec 2023Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use... (Review)
Review
Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use is declining, mainly driven by its poor aesthetics and by the development of tooth-coloured adhesive materials. Furthermore, the Minamata Convention agreed on a phase-down on the use of dental amalgam. This concise review is based on a FDI Policy Statement which provides guidance on the selection of direct restorative materials as alternatives to amalgam. The Policy Statement was informed by current literature, identified mainly from PubMed and the internet. Ultimately, dental, oral, and patient factors should be considered when choosing the best material for each individual case. Dental factors include the dentition, tooth type, and cavity class and extension; oral aspects comprise caries risk profiles and related risk factors; and patient-related aspects include systemic risks/medical conditions such as allergies towards certain materials as well as compliance. Special protective measures (eg, a no-touch technique, blue light protection) are required when handling resin-based materials, and copious water spray is recommended when adjusting or removing restorative materials. Cost and reimbursement policies may need to be considered when amalgam alternatives are used, and the material recommendation requires the informed consent of the patient. There is no single material which can replace amalgam in all applications; different materials are needed for different situations. The policy statement recommends using a patient-centred rather than purely a material-centred approach. Further research is needed to improve overall material properties, the clinical performance, the impact on the environment, and cost-effectiveness of all alternative materials.
PubMed: 38071154
DOI: 10.1016/j.identj.2023.11.004 -
Current Opinion in Pediatrics Apr 2008To summarize recent evidence regarding associations of early life exposure to mercury from maternal fish consumption during pregnancy, thimerosal in vaccines and dental... (Review)
Review
PURPOSE OF REVIEW
To summarize recent evidence regarding associations of early life exposure to mercury from maternal fish consumption during pregnancy, thimerosal in vaccines and dental amalgam with child neurodevelopment.
RECENT FINDINGS
Recent publications have built upon previous evidence demonstrating mild detrimental neurocognitive effects from prenatal methylmercury exposure from maternal fish consumption during pregnancy. New studies examining the effects of prenatal fish consumption as well as methylmercury suggest there are benefits from prenatal fish consumption, but also that consumption of fish high in mercury should be avoided. Future studies incorporating information on both the methylmercury and the docosahexaenoic acid contained within fish will help to refine recommendations to optimize outcomes for mothers and children. Additional recent studies have supported the safety of vaccines containing thimerosal and of dental amalgam for repair of dental caries in children.
SUMMARY
Exposure to mercury may harm child development. Interventions intended to reduce exposure to low levels of mercury in early life must, however, be carefully evaluated in consideration of the potential attendant harm from resultant behavior changes, such as reduced docosahexaenoic acid exposure from lower seafood intake, reduced uptake of childhood vaccinations and suboptimal dental care.
Topics: Animals; Child; Child Development; Dental Amalgam; Docosahexaenoic Acids; Female; Fishes; Humans; Intelligence; Mercury Poisoning, Nervous System; Methylmercury Compounds; Nutrition Policy; Pregnancy; Prenatal Exposure Delayed Effects; Preservatives, Pharmaceutical; Seafood; Thimerosal; United States; United States Environmental Protection Agency; United States Food and Drug Administration; Vaccines; Water Pollutants, Chemical
PubMed: 18332715
DOI: 10.1097/MOP.0b013e3282f5614c -
Eastern Mediterranean Health Journal =... Jan 2022Amalgam has been the gold standard for restorations in posterior teeth. Mercury, a major component of dental amalgam, is considered an environmental pollutant. The...
BACKGROUND
Amalgam has been the gold standard for restorations in posterior teeth. Mercury, a major component of dental amalgam, is considered an environmental pollutant. The Minamata Convention on mercury recomends a reduction in the use of mercury-containing products. Since Pakistan is a signatory to the Convention, the same amalgam phase-out limitations are implemented in Pakistan.
AIMS
To identify and assess the use of amalgam and its waste management by dentists in Pakistan post-Minamata Convention guidelines.
METHODS
A cross-sectional study was conducted in Lahore among 520 general dental practitioners in 2019.
RESULTS
The sample size for the study was calculated as 500; the questionnaire was distributed among 550 dentists. Dental amalgam was used by only 41.6% of the dentists in their practice; 55.0% perceived it to be a health risk. Most of the dentists (76.3%) were unaware of the proper disposal protocols for dental amalgam and 76.5% were unaware of any guidelines regarding amalgam use and disposal.
CONCLUSION
Although there is a gap in knowledge among the dentists regarding amalgam disposal, dentists in Pakistan are reducing their use of dental amalgam in accordance with the guidelines of the Minamata Convention.
Topics: Cross-Sectional Studies; Dental Amalgam; Dentists; Humans; Pakistan; Professional Role; Surveys and Questionnaires
PubMed: 35165880
DOI: 10.26719/emhj.21.068 -
British Dental Journal Sep 2023Aim This study aimed to explore disparities in experience of UK dental foundation trainees in amalgam use at dental school compared to their first year in dental...
Aim This study aimed to explore disparities in experience of UK dental foundation trainees in amalgam use at dental school compared to their first year in dental practice.Methods A modified version of the 'survey of Yorkshire dentists' targeted the dental foundation trainees. A mixed-method of quantitative and thematic content analysis was undertaken for the close-ended and free-text responses, respectively.Results Only 35% of participants described their confidence level as 'satisfactory' in placing dental amalgam before starting their dental foundation training and 51% scored the level of teaching between 'very poor' and 'satisfactory'. In total, 63% of respondents were in favour of receiving additional support in placing amalgam restorations during their undergraduate training. Participants indicated that the consequences of amalgam phase-out are increased appointment times and decreased quality of care due to patient and health service unaffordability of amalgam alternatives.Conclusion These findings raise concerns regarding newly qualified undergraduates' confidence, experience and skill in placing amalgams. This suggests the need to increase undergraduate education and training to improve undergraduates' skills and confidence in amalgam procedures to reduce the gap between the dental schools and real-world practice.
Topics: Humans; Dental Amalgam; Schools, Dental; Students; Dental Care
PubMed: 37684467
DOI: 10.1038/s41415-023-6228-4 -
BMC Research Notes Nov 2016Studies investigating the attitudes of Saudi dentists to the use of amalgam for restorations are relatively rare. Considering the goals set forth by the Minamata...
BACKGROUND
Studies investigating the attitudes of Saudi dentists to the use of amalgam for restorations are relatively rare. Considering the goals set forth by the Minamata Convention on Mercury, it appears prudent to investigate the attitudes of experienced dentists and fresh dental graduates to the use of amalgam. The aim of this study was to assess the attitudes of Saudi dentists and interns working in Riyadh, Saudi Arabia to the use of amalgam. Using a convenience sampling methodology, a total of 400 Saudi dentists and interns were contacted to request their participation in this cross-sectional questionnaire-based study. The questionnaire consisted of socio-demographic and practice characteristics such as gender, type of practice, as well as their service sector and questions related to the use of dental amalgam. The data obtained was analyzed using Chi square tests to compare differences in distribution between groups. P values of less than 0.05 were considered statistically significant.
RESULTS
The overall response rate was 84% (336 of 400 potential participants). The majority of the participants (80.7%) did not use dental amalgam for restorations in their clinical practice frequently. A significantly higher number of participants working in private sector did not use amalgam frequently (P = 0.004), agreed on replacing good amalgam restoration with composite resin (P < 0.000) and on stopping the use of amalgam as a final restoration (P = 0.017) compared to participants working in public sector. A significantly higher number of interns did not use amalgam in their clinical practice frequently (P < 0.000), agreed on replacing good amalgam restoration with composite resin (P = 0.002) and on stopping the use of amalgam as a final restoration (P < 0.000) compared to dentists.
CONCLUSIONS
Within the limitations of this study, dental amalgam seems to be less frequently used among the surveyed Saudi dentists and interns working in Riyadh. Fresh dental graduates used amalgam less frequently compared to experienced dentists. Furthermore, private dental practitioners showed a propensity to replace existing well-placed amalgam restorations with resin composite which reinforces their market-oriented attitude reported in earlier studies.
Topics: Adult; Attitude of Health Personnel; Composite Resins; Cross-Sectional Studies; Dental Amalgam; Dental Caries; Dental Restoration, Permanent; Dentists; Female; Humans; Internship and Residency; Male; Middle Aged; Private Practice; Public Sector; Saudi Arabia; Sex Factors; Surveys and Questionnaires; Workforce
PubMed: 27855718
DOI: 10.1186/s13104-016-2294-x -
Central European Journal of Public... Mar 2020Mercury dental amalgam restorations are an important source of chronic exposure to mercury in the whole population and special attention should be paid not only to...
OBJECTIVE
Mercury dental amalgam restorations are an important source of chronic exposure to mercury in the whole population and special attention should be paid not only to occupational exposure to mercury during the preparation and administration of amalgam. The authors' report is an up-to-date contribution to the health risk assessment of mercury use in dentistry, namely occupational exposure to mercury in dentists working with dental amalgam and exposure to mercury in persons treated with amalgam dental restorations.
METHODS
Determination of total mercury in samples of biological material (urine, hair) was performed during 2017 and 2018 in 50 persons by the AAS method using the mercury vapour generation technique at 254.6 nm.
RESULTS
Current dental exposures based on the most recent findings do not exceed acceptable risk levels and are below the biological limit of mercury in urine valid for occupationally exposed persons (100 μg.g of creatinine), namely median value was 1.48 (min. < limit of detection (LOD), max. 17.14) μg.g of creatinine (40 persons), total mercury content in hair of dental personnel expressed as median value was 0.340 (min. 0.060, max.1.628) μg.g. In controls (10 persons) was total mercury content in urine expressed as median value 0.36 (min. < LOD, max. 2.74) μg.g of creatinine, in hair was median value 0.224 (min. 0.059, max. 0.453) μg.g.
CONCLUSIONS
Authors support opinion that amalgam fillings in the oral cavity are a permanent source of mercury for the body itself.
Topics: Dental Amalgam; Environmental Exposure; Hair; Humans; Mercury; Occupational Exposure; Risk Assessment
PubMed: 32228815
DOI: 10.21101/cejph.a5965 -
Journal of Dental Research Jul 2014Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is... (Comparative Study)
Comparative Study
OBJECTIVE
Nearly all state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children; yet, little is known about how treatment outcomes compare with children visiting dentists. This study compared the association between the provider of preventive services (PCP, dentist, or both) with Medicaid-enrolled children before their third birthday and subsequent dental caries-related treatment (CRT) and CRT payment.
METHODS
We conducted a retrospective study of young children enrolled in North Carolina Medicaid during 2000 to 2006. The annual number of CRT and CRT payments per child between the ages of 3 and 5 yr were estimated with a zero-inflated negative binomial regression and a hurdle model, respectively. Models were adjusted for relevant child- and county-level characteristics and used propensity score weighting to address observed confounding.
RESULTS
We examined 41,453 children with > 1 preventive oral health visit from a PCP, dentist, or both before their third birthday. Unadjusted annual mean CRT and payments were lowest among children who had only PCP visits (CRT = 0.87, payment = $172) and higher among children with only dentist visits (CRT = 1.48, payment = $234) and both PCP and dentist visits (CRT = 1.52, payment = $273). Adjusted results indicated that children who had dentist visits (with or without PCP visits) had significantly more CRT and higher CRT payments per year during the ages of 3 and 4 yr than children who had only PCP visits. However, these differences attenuated each year after age 3 yr.
CONCLUSIONS
Because of children's increased opportunity to receive multiple visits in medical offices during well-child visits, preventive oral health services provided by PCPs may lead to a greater reduction in CRT than dentist visits alone. This study supports guidelines and reimbursement policies that allow preventive dental visits based on individual needs.
Topics: Child, Preschool; Composite Resins; Crowns; Dental Amalgam; Dental Care for Children; Dental Caries; Dental Materials; Dental Restoration, Permanent; Female; Health Care Costs; Humans; Male; Medicaid; Preventive Dentistry; Primary Health Care; Pulpectomy; Pulpotomy; Retrospective Studies; Stainless Steel; Tooth Extraction; Treatment Outcome; United States
PubMed: 24891593
DOI: 10.1177/0022034514536731 -
The Cochrane Database of Systematic... Oct 2016Childhood caries (tooth decay) consists of a form of tooth decay that affects the milk teeth (also known as baby or primary teeth) of children. This may range from tooth... (Review)
Review
BACKGROUND
Childhood caries (tooth decay) consists of a form of tooth decay that affects the milk teeth (also known as baby or primary teeth) of children. This may range from tooth decay in a single tooth to rampant caries affecting all the teeth in the mouth. Primary teeth in young children are vital to their development and every effort should be made to retain these teeth for as long as is possible. Dental fillings or restorations have been used as an intervention to repair these damaged teeth. Oral health professionals need to make astute decisions about the type of restorative (filling) material they choose to best manage their patients with childhood caries. This decision is by no means an easy one as remarkable advances in dental restorative materials over the last 10 years has seen the introduction of a multitude of different filling materials claiming to provide the best performance in terms of durability, aesthetics, symptom relief, etc when placed in the mouth. This review sought to compare the different types of dental materials against each other for the same outcomes.
OBJECTIVES
The objective of this review was to compare the outcomes (including pain relief, survival and aesthetics) for restorative materials used to treat caries in the primary dentition in children. Additionally, the restoration of teeth was compared with extraction and no treatment.
SEARCH METHODS
Electronic searches of the following databases were undertaken: the Cochrane Oral Health Group's Trials Register (up to January 2009); CENTRAL (The Cochrane Library 2009, Issue1); MEDLINE (1966 to January 2009); EMBASE (1996 to January 2009); SIGLE (1976 to 2004); and conference proceedings on early childhood caries, restorative materials for paediatric dentistry, and material sciences conferences for dental materials used for children's dentistry (1990 to 2008). The searches attempted to identify all relevant studies irrespective of language.Additionally, the reference lists from articles of eligible papers were searched, handsearching of key journals was undertaken, and personal communication with authors and manufacturers of dental materials was initiated to increase the pool of suitable trials (both published and unpublished) for inclusion into this review.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-randomised controlled trials with a minimum period of 6 months follow up were included. Both parallel group and split-mouth study designs were considered. The unit of randomisation could be the individual, group (school, school class, etc), tooth or tooth pair. Included studies had a drop-out rate of less than 30%. The eligible trials consisted of young children (children less than 12 years) with tooth decay involving at least one tooth in the primary dentition which was symptomatic or symptom free at the start of the study.
DATA COLLECTION AND ANALYSIS
Data were independently extracted, in duplicate, by two review authors. Disagreements were resolved by consultation with a third review author. Authors were contacted for missing or unclear information regarding randomisation, allocation sequence, presentation of data, etc. A quality assessment of included trials was undertaken. The Cochrane Collaboration statistical guidelines were followed for data analysis.
MAIN RESULTS
Only three studies were included in this review. The Fuks 1999 study assessed the clinical performance of aesthetic crowns versus conventional stainless steel crowns in 11 children who had at least two mandibular primary molars that required a crown restoration. The outcomes assessed at 6 months included gingival health (odds ratio (OR) 0.3; 95% confidence interval (CI) 0.01 to 8.32), restoration failure (OR 3.29; 95% CI 0.12 to 89.81), occlusion, proximal contact and marginal integrity. The odds ratios for occlusion, proximal contact and marginal integrity could not be estimated as no events were recorded at the 6-month evaluation. The Donly 1999 split-mouth study compared a resin-modified glass ionomer (Vitremer) with amalgam over a 36-month period. Forty pairs of Class II restorations were placed in 40 patients (21 males; 19 females; mean age 8 years +/- 1.17; age range 6 to 9 years). Although the study period was 3 years (36 months), only the 6- and 12-month results are reported due to the loss to follow up of patients being greater than 30% for the 24- and 36-month data. Marks 1999a recruited 30 patients (age range 4 to 9 years; mean age 6.7 years, standard deviation 2.3) with one pair of primary molars that required a Class II restoration. The materials tested were Dyract (compomer) and Tytin (amalgam). Loss to follow up at 24 and 36 months was 20% and 43% respectively. This meant that only the 24-month data were useable. For all of the outcomes compared in all three studies, there were no significant differences in clinical performance between the materials tested.No studies were found that compared restorations versus extractions or no treatment as an intervention in children with childhood caries.
AUTHORS' CONCLUSIONS
It was disappointing that only three trials that compared three different types of materials were suitable for inclusion into this review. There were no significant differences found in all three trials for all of the outcomes assessed. Well designed, randomised controlled trials comparing the different types of filling materials for similar outcomes are urgently needed in dentistry. There was insufficient evidence from the three included trials to make any recommendations about which filling material to use.
Topics: Child; Child, Preschool; Compomers; Composite Resins; Crowns; Dental Alloys; Dental Amalgam; Dental Caries; Dental Materials; Dental Restoration, Permanent; Glass Ionomer Cements; Humans; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 27748505
DOI: 10.1002/14651858.CD004483.pub3 -
Dental Materials : Official Publication... Jan 2023Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation...
OBJECTIVES
Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging.
METHODS
Three direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of 'one dental restoration' of each restorative system under investigation: 1.14 g of dental amalgam; 0.25 g of RBC (plus the adhesive = 0.10 g); and 0.54 g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials.
RESULTS
Dental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging.
SIGNIFICANCE
Less intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.
Topics: Animals; Dental Restoration, Permanent; Dental Amalgam; Dental Materials; Glass Ionomer Cements; Life Cycle Stages; Composite Resins
PubMed: 36428112
DOI: 10.1016/j.dental.2022.11.007