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A multidisciplinary risk assessment of dental restorative materials.
Umeå University, Faculty of Medicine, Odontology.
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 [en]
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: urn:nbn:se:umu:diva-1860ISBN: 978-7264-523-6 OAI: oai:DiVA.org:umu-1860DiVA: diva2:142221
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
List of papers
1. Changes in health over time in patients with symptoms allegedly caused by dental restorative materials
Open this publication in new window or tab >>Changes in health over time in patients with symptoms allegedly caused by dental restorative materials
Show others...
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
Keyword
dental materials, follow-up study, long-term prognosis, subgroups
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-3488 (URN)10.1111/j.1600-0528.2005.00240.x (DOI)16262610 (PubMedID)
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved
2. Replacement of restorations in subjects with symptoms associated with dental restorations; a follow-up study
Open this publication in new window or tab >>Replacement of restorations in subjects with symptoms associated with dental restorations; a follow-up study
2008 (English)In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 116, no 4, 362-368 p.Article in journal (Refereed) Published
Keyword
dental restorations • follow-up • perceived health • social factors • adverse effect
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-3489 (URN)18705804 (PubMedID)
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved
3. Risks with dental materials
Open this publication in new window or tab >>Risks with dental materials
2008 (English)In: Dental Materials, ISSN 0109-5641, E-ISSN 1879-0097, Vol. 24, no 7, 940-943 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Dental materials are among the most used substitutes for biological tissue in the human body. The possible health effects of amalgam have been studied extensively and have sometimes been replaced with other less well-examined materials. The aim was to study the hazards of other dental materials than amalgam. METHODS: Toxicological information was collected from the Swedish Dental Materials Register 2003 (DentMr). The material safety data sheets (MSDS) included in the DentMR was examined regarding the given composition of the products, the occurrence of CAS-numbers and risk and safety phrases of the substances. Furthermore, complementary information about risk and safety phrases for substances with missing information in the MSDS was collected by using two easily available databases. RESULTS: There were 482 products that included 377 substances of which 219 could be identified. Only 26% of 219 substances had risk and safety phrases. However, via the Swedish Chemicals Inspectorate Classification Register and the Sigma-Aldrich product register, risk and safety phrases could be found for 37 substances. A literature search indicated that some of the listed substances had possible hazards, e.g. substances with embryotoxic and neurotoxic potential. SIGNIFICANCE: 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 personnel. There is a need for stronger regulation of dental materials, at least substances that the patients will be exposed to for decades.

Keyword
material safety data sheet, dental material, side effect, adverse reaction
National Category
Dentistry
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-3490 (URN)10.1016/j.dental.2007.11.009 (DOI)18164381 (PubMedID)
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved
4. Reactions to resin-based dental materials in patients-type, time to onset, duration, and consequence of the reaction.
Open this publication in new window or tab >>Reactions to resin-based dental materials in patients-type, time to onset, duration, and consequence of the reaction.
2009 (English)In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 61, no 6, 313-319 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of the present study was to determine the types of side-effects occurring and for how long they lasted in a group of patients with side-effects assessed to be caused by resin-based materials. METHODS: A total of 618 reports were received by the Swedish National Register of Side-Effects to Dental Materials, among which 36 were on patients with reactions assessed to be caused by resin-based restorative materials. The group examined consisted of 25 women and 11 men, with a mean age of 47.8 +/- 15.6 years. A follow-up was done through a structured telephone interview. RESULTS: The majority of symptoms were intra-oral or a combination of intra-oral and extra-oral symptoms that appeared within the first 24 hr after treatment. The most common adverse effects reported were skin problems, oral ulcers, and burning mouth. Within less than a week, the reactions had disappeared in 50% of the patients. CONCLUSION: Immediate reactions to resin-based materials were more prevalent than delayed allergic reactions, and the mechanism of the immediate reactions is probably non-allergic in most cases. There is a need for developing provocation tests to verify the association between the reaction and the material, and also to identify the offending component.

Keyword
adverse effects • allergy • dental materials • resin-based materials
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-3491 (URN)10.1111/j.1600-0536.2009.01590.x (DOI)19807750 (PubMedID)
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved

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