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Changes in health over time in patients with symptoms allegedly caused by dental restorative materials
Umeå University, Faculty of Medicine, Department of Odontology.
Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science.
Umeå University, Faculty of Medicine, Department of Odontology.
Umeå University, Faculty of Social Sciences, Department of Psychology.
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2005 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 33, no 6, 427-437 p.Article in journal (Refereed) Published
Abstract [en]

Abstract –  Objectives:  In Sweden, many patients with symptoms allegedly caused by their dental materials have exchanged their restorations, but the effects of the exchange have been insufficiently investigated. Therefore, the aim of the study was to describe the change in health over time for these patients and the hypothesis was that the patients could be divided based on their symptoms and that the ability to recover differs between these groups. Furthermore, we also examined if other factors such as replacement of dental restorative materials and follow-up time had any impact on the perceived health status.

Methods:  A questionnaire was sent to 614 patients who had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental restorative materials. The response rate was 55%.

Results:  The risk of having any further complaints was higher for patients with complex symptoms (P = 0.03) and these patients had exchanged their restorations to a significantly larger extent than the others (P = 0.03). The remaining complaints was more frequent among men (P = 0.02). Exchange of dental restorative materials had no significant impact on the ability to recover completely. However, the patients who had exchanged their restorations completely perceived a significantly larger alleviation of their symptoms than the others (P < 0.01), although the frequency of most of the symptoms had increased.

Conclusions:  Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with localized symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. The reason for this improvement, however, is unclear. Further analyses regarding other possible explanations than the ‘odontological/medical’ are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, Inc , 2005. Vol. 33, no 6, 427-437 p.
Keyword [en]
dental materials, follow-up study, long-term prognosis, subgroups
National Category
Dentistry
Identifiers
URN: urn:nbn:se:umu:diva-3488DOI: 10.1111/j.1600-0528.2005.00240.xPubMedID: 16262610OAI: oai:DiVA.org:umu-3488DiVA: diva2:142217
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved
In thesis
1. A multidisciplinary risk assessment of dental restorative materials.
Open this publication in new window or tab >>A multidisciplinary risk assessment of dental restorative materials.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Amalgam has been used as a dental restorative material for centuries, but its potential health effects and biopersistance has lead to a decreased use especially in the Nordic countries. New materials have been introduced, partly to replace the mercury containing amalgam and partly because of esthetical reasons. The possible health effects of amalgam have been studied extensively and the material has been replaced with other less well-examined materials during the last few decades. The prevalence of side effects of dental materials is considered to be low in relation to the vast number of dental treatments undertaken. With the introduction of new and more complex materials, side effects related to dental treatment may increase. Epidemiological data suggest that the side effects of dental resins that have almost completely replaced amalgam fillings in Scandinavia, possess a risk for adverse reactions; however, the causal relation has not been fully established. Therefore, the type and extent of side effects caused by resin-based materials are of great interest.

The aims of the study were:

- to describe the change in health over time for patients with problems related to their dental materials. The hypothesis was that the patients could be divided into subgroups based on their symptoms and that the ability to recover differs between these groups [Paper I]. Furthermore, to determine whether factors such as the replacement of dental restorative materials and follow-up time had any impact on the perceived health.

- to assess the long-term development of symptoms and their social consequences among patients referred for diagnosis and treatment of symptoms related to dental materials [Paper II]

- to investigate the possible risks with dental restorative materials other than amalgam [Paper III].

- to describe side effects assessed to be caused by resin-based materials that occurred in a group of patients as well as treatment and long-term consequences of the reactions [Paper IV].

A questionnaire was sent to 614 patients [Paper I and II] that had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental materials. The questionnaire contained questions on, among others; civil status, present health, medical and dental treatment and other measures and precautions taken because of psychosocial problems related to current employment situation, feelings, self-image and coping behavior. Moreover, information was collected [Paper III] from the Swedish Dental Materials Register 2003 (DentMr), a compilation of MSDS for 487 materials, and information from the user guide of the materials. The Material Safety Data Sheets (MSDS) included in the DentMR were examined regarding the given composition of the products, the occurrence of CAS-numbers and the risk- and safety phrases of the substances. Information was collected [Paper IV] on 36 patients with reactions to resin-based restorative materials from the Swedish National Register of Side-Effects of Dental Materials.

Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with local symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. However, the reason for this improvement was unclear. Replacement of dental restorative materials had no significant impact on the ability to recover completely. Our results also indicate a relationship between patients’ self-related health and social consequences in daily life. Those with remaining complex symptoms had more often stopped working or had decreased their work hours because of their symptoms The information about hazards with dental materials seems insufficiently described in MSDS and there might be materials with side effects unknown to both patients and dental professionals. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. The patients were very heterogeneous; a few with only local symptom free reactions while other had more complex symptoms. The latter group would gain from a multidisciplinary approach, i.e. dental, medical, as well as social and psychological factors have to be considered when developing care management programs for this group of patients. Furthermore, there is a need for stronger regulations of dental materials, such as those applied to pharmaceutical drugs. Finally, it was found that the majority of symptoms suspected to be caused by resin-based materials were local or a combination of local and extra-oral symptoms that appeared within the first 24 hours after treatment. The most frequent adverse effect reported was skin problems/dermatitis. It appears as though immediate reactions to resin based materials are not uncommon and more prevalent than allergic reactions. Still, we have had, difficulties in verifying associations between the dental restorative materials and adverse reactions and also to identify the offending component.

Place, publisher, year, edition, pages
Umeå: Tandteknikerprogrammet, 2008. 44 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 106
Keyword
Dental materials, adverse reactions, Social factors, self-reported health, material safety data sheet, resin-based dental materials, allergy, follow-up study, subgroups, long term prognosis, perceived health
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-1860 (URN)978-7264-523-6 (ISBN)
Public defence
2008-10-10, Sal B, 2A, Tandläkarhögskolan, 9 tr, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2009-12-10Bibliographically approved
2. A multidisciplinary study of patients with signs or symptoms attributed to dental restorative materials
Open this publication in new window or tab >>A multidisciplinary study of patients with signs or symptoms attributed to dental restorative materials
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anxiety for adverse health effects attributed to dental restorative materials especially dentalamalgam, have been discussed extensively off and on the last 30 years. The possible health effect ofamalgam and health effect of replacements of amalgam, have been extensively studied but theresults are inconclusive and the etiology of the reactions are not entirely elucidated. Furthermore,the question of psychological influence on symptoms attributed to dental restorative materials hasbeen raised and need further examination.

The aims of this thesis were to describe the change in health over time for patient with symptomsattributed to their dental materials and to determine whether replacement of their dentalrestorative materials had any impact on their perceived health. Furthermore, to determine anddescribe the personality, self-image, level of psychological symptoms and stress among thesepatients and compare the results with those of healthy controls. Finally, to evaluate regression ofLichenoid Contact Reactions and Oral lichen Planus after replacement of the dental materials.

A questionnaire was mailed to 614 patients that had been referred to the School of Dentistry, Umeå,Sweden with symptoms attributed to dental materials. Among these patients a subgroup with orallichen also underwent a clinical examination at follow-up.

The result showed that patients with complex symptoms had a more unfavorable long-termprognosis concerning persistent complaints than those with local symptoms only. The oralsymptoms had decreased between baseline and follow-up and the general symptoms had increased.The increase in general symptoms was contradictory since many patients experienced healthimprovement after removal of their dental restorative materials. Concerning personality thepatients was characterized mainly by high persistence and by high fatigability and asthenia as wellas psychosocially learned high self-acceptance. Regarding self-image, both patients with LocalSymptoms Only and patients with Multi Symptoms, scored significantly higher on "spontaneous"and "positive self-image" than the reference group. The Multi symptoms group scored significantlyhigher on psychological symptoms compared to the reference group. However, the Local symptomsgroup did not differ from the references. The remission of oral lesions was after an exchange ofdental materials was seen to a greater extent in patients with Lichenoid Contact Reaction than inpatients with Oral Lichen Planus. Regarding psychological parameters, there were no significantdifferences between the groups.

In conclusion symptoms related to dental restorative materials seem to be multi-factorial wheredental, medical, social, and psychological factors may be involved. Patient with complex symptomshave a more unfavorable prognosis than patient with local symptoms only. Patient with symptomsself-related to their dental materials may feel improvement in general health after an exchange ofdental materials. The group of patients seems to represent personalities that could be vulnerable inthe demanding modern society, and the various mental and somatic symptoms can be interpretedas attributed to dental fillings. Patients with Local Symptoms or Multi Symptoms are equalconcerning self-image, they are impulsive with an elevated positive self-image, that can result indifficulties in setting limits. Thus in combination with high demands may result in mental stress.The Multi Symptoms group was more psychologically stressed than the group with Local SymptomsOnly and the references. Therefore, before an exchange of dental materials is commenced inpatients with oral lichenoid lesions, a correct diagnosis is needed.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2016. 73 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 135
Keyword
Dental restorative materials, environmental intolerance, oral lichen, personality, self-image, psychological symptoms
National Category
Biomaterials Science
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-114096 (URN)978-91-7601-403-5 (ISBN)
Public defence
2016-02-05, Sal D 9 tr, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-01-15 Created: 2016-01-13 Last updated: 2016-01-20Bibliographically approved

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Berglund, AndersMårell, LenaBergdahl, JanEriksson, NilsStenberg, BerndtWidman, Lars
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