May 6, 2009 So far, there is a not a clear winner among the types of fillings used to repair childhood cavities, according to a new review.
In fact, there are so few useful studies on the topic that there is not enough evidence “to make any recommendations about which filling material to use,” said Veerasamy Yengopal, who led the review.
Yengopal, an oral health expert at South Africa’s University of Witswatersrand, said it was “disappointing” that there have been few comparisons of dental fillings for children, given “remarkable advances in dental restorative materials over the last 10 years.”
“Oral health professionals need to make astute decisions about the type of restorative material they choose to best manage their patients,” Yengopal said, since the type of material used in the fillings could affect how long the filling lasts, how well it looks in the child’s mouth and whether it causes any pain.
Joel Berg, D.D.S., chair of pediatric dentistry at the University of Washington and a spokesperson for the American Academy of Pediatric Dentists, said high-level studies of dental fillings could be hard to come by, since filling manufacturers change their products from year to year.
“Manufacturers replace their products so frequently; by the time that outcome and controlled data can be collected on a product, it might not be on the market any longer,” said Berg.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Healthy primary dentition or “baby” teeth serve many purposes before they are lost, the Cochrane reviewers noted. Baby teeth act as placeholders and spacers for the primary dentition, and they help children chew nutritious foods such as raw vegetables and fruit. Children with untreated cavities might experience teasing about their appearance or bad breath, and they could have trouble speaking if teeth decay and fall out prematurely, according to Yengopal and colleagues.
The three studies examined by the reviewers included 81 children between the ages of 4 and 9 years old. In each study, the children had at least one cavity on each side of their mouth filled with a different material, so that researchers could compare different fillings for one person. The materials included a metal-mercury amalgam, a resin-modified glass composite filling and a filling that combines a plastic-ceramic material with elements of the glass filling.
The researchers found no significant differences among the materials, whether in terms of how well the materials lasted or whether the children were free from tooth pain at the end of the studies.
“This lack of useful evidence from a consumer point of view means that we cannot make any recommendations about which filling material was best to use to achieve a particular outcome,” Yengopal said.
None of the studies in the review compared the usefulness of fillings to pulling the teeth or “watchful waiting” of the cavities. Nevertheless, if a child has cavities, “many of these will go beyond the tooth,” to infect the gums and face, said Berg. “Treating a caries lesion can get rid of the disease before it can progress and become dangerous over time.”
The authors said that measures to prevent caries, such as sealants, were beyond the scope of the review.
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- Yengopal et al. Dental fillings for the treatment of caries in the primary dentition. Cochrane Database of Systematic Reviews Reviews, 2009; DOI: 10.1002/14651858.CD004483.pub2
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