title: Do adverse effects of dental materials exist? What are the consequences, and how can they be diagnosed and treated?
abstract: OBJECTIVE
  All dental biomaterials release substances into the oral environment to a varying degree. Various preclinical biocompatibility test systems have been introduced, aiming at an evaluation of the potential risks of dental materials. Potential pathogenic effects of released substances from dental materials have been demonstrated. For the biocompatibility of a biomaterial, it is not only important that minimal diffusable substances are released when it is in body contact--the material must also fulfill the function for which it has been designed. This is also very much dependent on the material properties and its handling properties. The aim of this review was to generate an overview of the present status concerning adverse reactions among patients and personnel.
  
  
  METHODS
  A systematic review was performed using a defined search strategy in order to evaluate all MEDLINE-literature published between 1996 and 2006.
  
  
  RESULTS
  The compilation of the literature available has revealed that the majority of studies have been carried out on patients compared with personnel. Adverse reactions towards dental materials do occur, but the prevalence and incidence are difficult to obtain. The results were essentially based on cohort studies. Clinical trials, especially randomized-controlled trials, are in the minority of all studies investigated, with the exception of composite and bonding studies, where clinical trials, but not randomized-controlled trials, represent the majority of studies. Patients and personnel were treated separately in the manuscript. Amalgam studies show the lowest degree of verified material-related diagnosis. Even if objective symptoms related to adverse reactions with polymer resin-based materials have been reported, postoperative sensitivity dominates reports concerning composites/bondings. Verified occupational effects among dental personnel show a low frequency of allergy/toxic reactions. Irritative hand eczema seemed to be more common than in the general population.
  
  
  CONCLUSIONS
  Patient- and personnel-related studies are of variable quality and can be improved. There is a need for a better description of the content of materials. A registry for adverse effects of dental materials would be useful to detect the occurrence of low-incidence events.
authors.affiliation: Bernhard Gottlieb University Clinic of Dentistry, Central Research Unit, Medical University of Vienna, Vienna, Austria. andreas.schedle@meduniwien.ac.at
authors.forename: Andreas
authors.initials: A
authors.lastname: Schedle
authors.forename: Ulf
authors.initials: U
authors.lastname: Ortengren
authors.forename: Nicole
authors.initials: N
authors.lastname: Eidler
authors.forename: Michael
authors.initials: M
authors.lastname: Gabauer
authors.forename: Arne
authors.initials: A
authors.lastname: Hensten
mesh_terms: D001672:Biocompatible Materials / Q000009:adverse effects*; D003764:Dental Materials / Q000009:adverse effects*; D003813:Dentistry; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology; D009059:Mouth Diseases / Q000209:etiology; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology; D000078329:Workforce
chemical_list: D001672:Biocompatible Materials; D003764:Dental Materials