Dental composite restorations and neuropsychological development in children: treatment level analysis from a randomized clinical trial.
BACKGROUND
Resin-based dental restorations may intra-orally release their components and bisphenol A. Gestational bisphenol A exposure has been associated with poorer executive functioning in children.


OBJECTIVE
To examine whether exposure to resin-based composite restorations is associated with neuropsychological development in children.


METHODS
Secondary analysis of treatment level data from the New England Children's Amalgam Trial, a 2-group randomized safety trial conducted from 1997 to 2006. Children (N=534) aged 6-10 y with ≥2 posterior tooth caries were randomized to treatment with amalgam or resin-based composites (bisphenol-A-diglycidyl-dimethacrylate-composite for permanent teeth; urethane dimethacrylate-based polyacid-modified compomer for primary teeth). Neuropsychological function at 4- and 5-year follow-up (N=444) was measured by a battery of tests of executive function, intelligence, memory, visual-spatial skills, verbal fluency, and problem-solving. Multivariable generalized linear regression models were used to examine the association between composite exposure levels and changes in neuropsychological test scores from baseline to follow-up. For comparison, data on children randomized to amalgam treatment were similarly analyzed.


RESULTS
With greater exposure to either dental composite material, results were generally consistent in the direction of slightly poorer changes in tests of intelligence, achievement or memory, but there were no statistically significant associations. For the four primary measures of executive function, scores were slightly worse with greater total composite exposure, but statistically significant only for the test of Letter Fluency (10-surface-years β=-0.8, SE=0.4, P=0.035), and the subtest of color naming (β=-1.5, SE=0.5, P=0.004) in the Stroop Color-Word Interference Test. Multivariate analysis of variance confirmed that the negative associations between composite level and executive function were not statistically significant (MANOVA, P=0.18). Results for greater amalgam exposure were mostly nonsignificant in the opposite direction of slightly improved scores over follow-up.


CONCLUSIONS
Dental composite restorations had statistically insignificant associations of small magnitude with impairments in neuropsychological test change scores over 4- or 5-years of follow-up in this trial.
New England Research Institutes, Watertown, MA 02472, USA. nmaserejian@neriscience.com
Nancy N
NN
Maserejian
Felicia L
FL
Trachtenberg
Russ
R
Hauser
Sonja
S
McKinlay
Peter
P
Shrader
David C
DC
Bellinger
D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002657:Child Development / Q000187:drug effects* / Q000502:physiology*; D003071:Cognition / Q000187:drug effects / Q000502:physiology*; D003723:Dental Amalgam / Q000009:adverse effects* / Q000737:chemistry; D003793:Dental Restoration, Permanent / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008568:Memory / Q000187:drug effects / Q000502:physiology; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D013997:Time Factors; D014706:Verbal Learning / Q000187:drug effects / Q000502:physiology
D003723:Dental Amalgam