Research sparks media controversy over fillings
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- Published: Wednesday, 28 October 2015 07:49
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An article published in the Journal of Dentistry has been turned into a sensational story by some sections of the press. The research aimed to assess risk factors for caries development on the approximal surfaces in contact with newly placed Class II composite restorations. It concluded that clinicians should be aware of a notable risk of caries development on the adjacent tooth surface, especially when placing approximal restorations in high caries risk patients,
The abstract of the article can be found at:
http://www.jodjournal.com/article/S0300-5712(15)30038-5/abstract
The research found that both patient- and dentist related variables are risk factors for caries development on approximal surfaces in contact with newly placed Class II composite restorations. It advised that all clinicians should be aware of a notable risk of caries development on the adjacent tooth surface, especially when placing approximal restorations in high caries risk patients, and should consider greater use of preventive strategies or non-operative treatment that should be evaluated and repeated at every recall.
The results of came from examining 750 surfaces, either sound or with caries confined to enamel, in contact with newly placed Class II composite restorations, placed by PDS dentists in Norway, which were evaluated by clinicians, using standardized clinical and radiographic criteria.
After the observation period (mean 4.9 year, SD 0.67), 38.8% of the initially sound contact surfaces (n?=?417) remained sound, 34.0% developed caries confined to enamel and 27.2% developed caries into dentine. Of surfaces with caries confined to enamel present at baseline (n?=?333), 57.3% remained in enamel, while 42.7% progressed into dentine. Risk factors for dentine caries development were assessed by logistic regression analyses. The risk of developing caries on surfaces that were initially sound at baseline was higher in patients with poor or medium oral hygiene (OR 1.53; CI 1.10–3.68), higher DMFT at baseline (OR 1.12; Cl 1.04–1.20). Maxillary teeth (OR 2.01; Cl 1.14–3.56) and surfaces on the right side of the mouth (OR 1.65; Cl 1.01–2.72) were also risk factors. For surfaces with enamel caries present at baseline, the risk of dentine caries was higher in patients with higher DMFT (OR 1.06; CI 1.00–1.13). In both analyses the treating dentists had a significant impact on the caries development.
Simen Kopperud, of the Nordic Institute of Dental Materials in Oslo, Norway, who led the study, said: “The most important message is that if restoration takes place in one place the problem of decay is not solved. “It is highly possible that the intervention by the dentist causes a problem in adjacent teeth. Fillings are not an ideal solution but at the moment it’s the best solution we have.”
Professor Damien Walmsley, from Birmingham University, added: “Once a dentist treats a diseased tooth, they may accidentally damage another tooth. Dentists need to keep up to date with the latest techniques to ensure they don’t damage other teeth when they do a filling.” He said the new minimal intervention techniques were now being taught to established dentists across the country. The training sessions, some Government-funded, aim to show them how to cause the least trauma to patients’ teeth.
Image is "Filling" by Kauzio - Own work. Licensed under Public Domain via Commons
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