Amalgam or composite in pediatric dentistry: Analysis of private insurance claims data

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

Synergistic enhancement of hydrophobic dental adhesives: autonomous strengthening, polymerization kinetics, and hydrolytic resistance

The leading cause of composite restoration failure is recurrent marginal decay. The margin between the composite and tooth is initially sealed by a low-viscosity adhesive, but chemical, physical, and mechanical stresses work synergistically and simultaneously to degrade the adhesive, destroying the interfacial seal and providing an ideal environment for bacteria to proliferate. Our group has been developing self-strengthening adhesives with improved chemical and mechanical characteristics. This paper reports a self-strengthening adhesive formulation that resists hydrolysis-mediated degradation by providing intrinsic reinforcement of the polymer network through synergistic stimulation of free-radical polymerization, sol-gel reaction, and hydrophobicity. Hydrophobic resin formulation (NE1) was developed using HEMA/BisGMA 28/55w/w and 15 wt% MPS. Control (NC1) contained HEMA/BisGMA 28/55 w/w and 15 wt% MES. The polymerization kinetics, water sorption, leachates, and dynamic mechanical properties of the resin samples were investigated. The NC1 and NE1 samples showed comparable polymerization kinetics, degree of conversion and water sorption. In contrast, NC1 showed significantly higher levels of HEMA and BisGMA leachate, indicating faster degradation in ethanol. At day 3, cumulative HEMA leachate for NC1 was tenfold greater than NE1 (p < 0.05). Dynamic mechanical properties were measured at 37 and 70°C in both dry and wet conditions. Under dry conditions, the storage moduli of NC1 and NE1 were comparable and the glass transition temperature (T g) of NC1 was statistically significant lower (p < 0.001) than NE1. Under wet conditions, the storage modulus of NC1 was lower than NE1 and at 70°C there is a threefold difference in storage modulus. At this temperature and under wet conditions, the storage modulus of NC1 is statistically significantly lower (p < 0.001) than NE1. The results indicated that in the wet environment, NE1 provided lower chain mobility, higher crosslink density, and more hydrogen bonds. The newly formulated methacrylate-based adhesive capitalizes on free-radical polymerization, sol-gel reactions, and hydrophobicity to provide enhanced mechanical properties at elevated temperatures in wet environments and hydrolytic stability under aggressive aging conditions.

Metal mixtures and oral health among children and adolescents in the National Health and Nutrition Examination Survey (NHANES), 2017-2020

INTRODUCTION

Dental caries is the most common non-communicable human disease, yet little is known about the role of environmental metals, despite teeth consisting of a hard matrix of trace elements. We conducted a cross-sectional study of associations between environmental metals and objective assessment of dental caries and subjective assessments of oral health among a representative sample of U.S. children and adolescents.

METHODS

Data were from the 2017-March 2020 pre-pandemic data file of the National Health and Nutrition Examination Survey (NHANES). To account for metal mixtures, we used weighted quantile sum (WQS) regression to estimate the joint impact of multiple trace elements assessed in blood and urine with oral disease outcomes.

RESULTS

The blood metal mixture index was associated with a 32% (95% CI: 1.11, 1.56) increased risk of decayed surfaces while the urine metal mixture index was associated with a 106%, RR (95% CI = 2.06 (1.58, 2.70) increased caries risk. For both blood and urine, Mercury (Hg) had the largest contribution to the mixture index followed by Lead (Pb). The WQS blood metal mixture index was also significantly associated with poorer self-rated oral health, although the magnitude of the association was not as strong as for the objective oral disease measures, RR (95% CI) = 1.04 (1.02, 1.07).

DISCUSSION

Increased exposure to a metal mixture was significantly related to poorer objective and subjective oral health outcomes among U.S. children and adolescents. These are among the first findings showing that metal mixtures are a significant contributor to poor oral health.