The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics

Abstract

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time ( N = 57) to participate in an internet‐based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3–5‐year‐old patients (β = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off‐site satellite dental clinics (β = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (β = .091, p < .0001) and glass ionomer (β = 103, p < .0001) more frequently and were less likely to use amalgam (β = −.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

Perceptions of dental therapy students regarding the teaching and training with dental amalgam, in a dental school in KwaZulu-Natal, South Africa

“…At the time of the study, the US dental schools did not appear ready to phase out dental amalgam training, and amalgam was still widely used in paediatric predoctoral training to restore both primary and permanent teeth. 25 Teaching with dental amalgam continues at UKZN moreover in SA, and this is in line with many countries.…”

Managing the phase‐down of amalgam amongst Nigerian dental professionals and students: A national survey

“…The Irish Dental Association, British Dental Association (BDA), ADA, Council of European Dentists (CED), WHO and FDI support the amalgam phase‐down outlined by the Minamata Convention. However, compared with its implementation in the United States (where there appears to be greater resistance to adopting this global trend), European countries have shown greater acceptance of the shift to the use of mercury‐free dental restorations 40 . Concerted team efforts and lobbying by these local and international bodies are aimed at revoking the decision to completely ban the use of amalgam in the near future.…”

“…A complete phase‐out of amalgam on environmental grounds is planned, latest by 2030, following a full feasibility study to which the BDA and CED intend to contribute. The FDI is of the view that currently available alternative restorative materials are not economically feasible in many circumstances, particularly in developing countries 40,41 . Based on the environmental health risks associated with the use of amalgam and poor disposal practices of hazardous materials adopted by developing countries, 42,43 there is an urgent need to discontinue the use of amalgam by dentists in the foreseeable future.…”

“…(where there appears to be greater resistance to adopting this global trend), European countries have shown greater acceptance of the shift to the use of mercury-free dental restorations. 40 Concerted team efforts and lobbying by these local and international bodies are aimed at revoking the decision to completely ban the use of amalgam in the near future. They suggest that the treaty recognised the need to focus on disease prevention and improved oral health, thereby reducing the need for dental restorations.…”

“…The FDI is of the view that currently available alternative restorative materials are not economically feasible in many circumstances, particularly in developing countries. 40,41 Based on the environmental health risks associated with the use of amalgam and poor disposal practices of hazardous materials adopted by developing countries, 42,43 there is an urgent need to discontinue the use of amalgam by dentists in the foreseeable future. Adequate training of hospital staff regarding proper biomedical waste disposal is also required because in addition to phase-out of amalgam in dental clinics, it is important to follow specific precautions during removal of old defective amalgam restorations and adopt proper amalgam waste disposal practices to eliminate further mercury pollution of the environment.…”