[Harmful effects of dental materials on the dental pulp].
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Fluoride-releasing dental materials are generally believed to reduce or prevent secondary caries. The evidence for this is largely anecdotal and centers on clinical experience with silicate cements and, more recently, with glass-ionomer cements. Unfortunately, corroborating evidence from controlled clinical trials is inadequate to establish precisely how effective these materials are or under what conditions they might be effective. Even less is known about the clinical effectiveness of newer materials that, often, release less fluoride. In vitro model systems have been used to study the effects of dental materials on de/remineralization of surrounding tooth structure. Fluoride-releasing materials have been shown in these models to reduce demineralization of both enamel and dentin compared with a material that does not release fluoride. This is useful from a mechanistic standpoint, but without clinical "standards" to guide model results, it is not possible to define an acceptable level of fluoride release or the length of time such release is required. A limited number of in situ model studies has been conducted, and some fluoride dose-response information has been obtained. These models are closer to the real situation and perhaps provide the best means to define required levels of fluoride release from materials in the absence of adequate clinical information.
Although dental and allied dental educators increasingly use computer-based instruction (CBI), few studies have reported on its effectiveness. A study was designed to compare the effectiveness of CBI study guides with that of printed study guides in a dental materials course taught using Keller's Personalized System of Instruction (PSI). To evaluate the effectiveness of CBI versus printed study guides, student performance on unit mastery tests was assessed by means of chi-square analyses. Overall, it was found that students using CBI study guides did not pass significantly more unit tests than those using printed study guides. It was found, however, that high-aptitude students using CBI study guides performed significantly better than high-aptitude students using printed study guides. Students gave high ratings to both printed and CBI study guides.
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Testing of the biologic effects of dental materials has lagged far behind the characterization of their mechanical and physical properties. Various biologic-type tests, whether in vitro or in vivo, have often produced conflicting or confusing data. The objective of this article was to bring together the results of various investigations to form guidelines for the safest use of dental materials. Since many interactions between dental materials and living tissue have not been definitively established, a conservative approach was taken. The clinician who heeds the data summarized for the dental materials presented here will have the greatest probability of obtaining a benign chemical response of soft and hard tissues.
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OBJECTIVES: The extent to which substances released from dental materials cause adverse health effects and whether removal of dental materials results in improvement of health is a matter of dispute. The aim of the study was to investigate changes in the intensity of subjective symptoms after replacement of dental materials in patients referred for adverse reactions related to dental materials, and to compare the profiles of symptoms with those found in the general population. METHODS: Information was obtained from 142 patients referred to the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. At the time of examination, all patients completed a questionnaire regarding a range of subjective symptoms. A follow-up questionnaire was sent to all patients 1 to 2 years later. Similar questionnaires were sent to a reference group of 800 persons drawn from the general population. RESULTS: The follow-up questionnaires were completed and returned by 84 patients, and 441 persons in the reference group. The patient group presented higher symptom indices than the reference group (P<0.001). Generally, there was some decrease in the intensity of different symptoms in patients who had replaced dental materials. The decrease was evident regarding intraoral symptoms (P=0.022) and total symptom index (P=0.041). The group of patients who had replaced materials still had significantly higher symptom indices than those of the reference group. Patients who had not replaced dental materials did not present any reduction in symptom indices. CONCLUSION: The pattern of symptoms was similar for the groups investigated. At the group level, the intensity of local and some general subjective symptoms was reduced after replacement of the materials, but not to the level found in the general population.
Patients undergoing dental treatment can be exposed to a wide range of potential allergens, but adverse events seem infrequent. Patients with symptoms or signs of stomatitis, burning, tingling, cheilitis, oral lichenoid lesions, lip and facial swelling may relate their problems to dental treatment or to the use of dental products. Investigation for immediate type or delayed type hypersensitivity is indicated using patch testing, prick testing and blood tests for allergen-specific IgE. The main allergic reactions found in patients include contact allergy to metals, cosmetics, food additives, flavours and acrylates, and immediate type allergy to latex. Adverse reactions following the administration of local anaesthetics are seen in about 0.5% of cases, but immediate type allergy to these agents is rare. In dental staff, occupationally related problems are common and usually take the form of hand or facial dermatitis or respiratory disease. The most common allergic reactions in dental staff are immediate type allergy to latex, and contact allergy to rubber additives, fragrances, acrylates and formaldehyde. Occupational irritant problems causing hand dermatitis are probably more common in dental personnel than is dermatitis caused by contact allergy. Patch testing and tests for immediate type allergy are useful investigative methods in the investigation of patients who present with oral or facial symptoms possibly related to dental treatments and are also beneficial in dental personnel who present with hand or facial dermatitis or respiratory symptoms.
As a follow-up to previous surveys regarding materials used by dentists a total of 1500 questionnaires were distributed to general dental practitioners in private practice. A response rate of 11.8% was achieved. The most popular products used during 1999 were identified. Changes in the choices of materials were observed when compared to previous surveys. This may be attributed to the development of various new products.
Dental materials which are supposed to contact the oral, mucous membranes during their intended dental use may affect our patients health in different ways. Their local and systemic toxicity, and their allergenic and tumorigenic potential are reviewed and methods of biocompatibility testing discussed. Special emphasis is placed on impression materials, denture base resins and dental alloys.