The A to Z of dental materials.
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The problems in patch testing and relevance evaluation as well as the practical consequences are discussed for the most important groups of dental materials (DM). These include metal alloys: amalgam with a low allergy prevalence; palladium salts showing a high correlation with nickel allergy but a low one with metallic palladium or alloys; the widespread allergen nickel is most relevant when dealing with nickel containing DM-alloys that are not corrosionresistant; gold salts with widely differing test results and limited benefit to detect genuine gold intolerance. Among synthetic resins methylmethacrylate is the most important allergen because of the high frequency of exposition. With composite materials and other methacrylates, both cross reactions and active sensitization should be kept in mind. Relevant reactions due to additives are rare; positive benzoylperoxide tests should be interpreted very critically. A number of DM may contain allergens of the etheric oils-colophonium - Perubalsam group. DM should be tested with standardized methods only. As the dental consequences may be expensive, interpretation of such test results demands utmost care and special experience.
Many methodologies are used during the testing of dental materials, although different tests are suitable for different materials and clinical situations. This paper discusses factors relevant to the choice of a dental material, and suggests questions that a practitioner would find helpful to ask a dental sales representative, such as ease of use, effect on the environment and the relevance of fluoride release.
OBJECTIVES: Since all dental materials pose a potential risk to patients and members of the dental team, the post-market monitoring of adverse reactions caused by dental materials should be considered essential. This article reviews the current status of post-market monitoring of adverse reactions to dental materials and highlights some of the issues that arise in trying to establish an evidence base on the characteristics of adverse reactions to dental materials. METHODS: Norway, Sweden and more recently the UK have sought to monitor adverse reactions to dental materials systematically and proactively in an effort to add to the evidence base on the safety of dental materials. Their experiences in undertaking post-market surveillance have been combined in preparing this article. RESULTS: To date the Norwegian, Swedish and the UK projects has received 1268 reports over 11 years, 848 reports over 5.5 years and 1117 reports over 3 years, respectively, relating to adverse reactions seen or experienced by dental personnel and patients. Presently, there are no harmonized criteria for what can be classified as an adverse reaction related to dental materials. Under reporting is a recognised problem and lack of awareness and lack of clarity as to what constitutes an adverse reaction may be contributory factors. A pro-active reporting system takes a considerable time to become established, but can generate a lot of potentially useful information. CONCLUSIONS: There is a need to raise the awareness among dental professionals of the potential for adverse reactions due to dental materials and to develop an internationally accepted system of data gathering that can produce the evidence that reflect the extent, severity and incidence of adverse reactions to dental materials.
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Porcelain repair materials, when properly chosen and used, provide some bond strength in bonding to porcelain. The bond strength is decreased by thermocycling and long-term storage in water. Currently available products are affected differently by these conditions. Surface roughening by rotary instruments and chemical etching by hydrofluoric acid or APF enhances the bond strength. The long-term clinical performance of the porcelain repair materials is not well documented. The council is preparing guidelines to evaluate these materials under the Acceptance Programs of the council. These guidelines will include requiring information on the laboratory and chemical data on these products to demonstrate their safety and efficacy.
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The acrylic content of modern dental materials poses a risk of adverse reactions. Although the quantities of the substances released are normally too small to cause systemic reactions, local reactions may occur resulting in damage to the skin. A study, in which 81 dental workers referred to dermatologists for a variety of adverse reactions were patch tested, showed work-related dermatoses to represent a serious problem for dental staff, sometimes entailing occupational disability and re-schooling. Much of this could be avoided by observing special precautions to prevent direct contact with the sensitising substances in composite materials used in dental surgery. Since the use of dental amalgam has been reduced to about 10 per cent of all fillings in Sweden, the prevalence of adverse local reactions to the acrylic composite materials which are used instead may be expected to increase.