Trends In the Use of Amalgam & Other Restorative Materials

A critical factor in the formulation of national policy as it relates to the use of health care products is the extent and frequency of use. Dental amalgam and alternative restorative materials are no different. The 1993 USPHS report on amalgam indicated that "[I]n 1990, over 200 million restorative procedures were provided in the United States; of these, dental amalgam accounted for roughly 96 million, a 38 percent reduction since 1979. This trend is expected to continue."

This 4-year old prediction appears to be holding true. Although comprehensive data on amalgam usage and reliance on other substitute materials is not readily available, limited survey and anecdotal information tends to support the thesis that amalgam use continued to decline. One source of information is a quarterly survey performed by the American Dental Association of 1250 member dentists, divided into two groups: "all dentists" (i.e., general practitioners and specialists combined) and "general practitioners." (Source: American Dental Association, Survey Center, 4th Quarter 1990 through 3rd Quarter 1995 - Quarterly Survey of Dental Practice.

One area of inquiry among the 22 dental procedures about which clinical practice information is solicited is restorations of posterior teeth, which are more routinely treated with dental amalgam. Data from this survey show "a slow downward trend from [the] fourth quarter [of] 1990 until [the] third quarter [of] 1995." Since the first quarter [of] 1993, the trend has been essentially stable. In numerical terms, the data show the following:

Another indicator of a continuing downward trend in the use of dental amalgam and other restorative materials is an article published in the February 1997 edition of the Journal of the American Dental Association. Based on a survey of 750,000 residents of Michigan covered by dental insurance, the article by Dr. Stephen Ecklund, et. al. reported "… profound improvements in oral health. These improvements are evident in all age groups, and the effect of the caries decline in children that began about 20 years ago has moved well into the adult population. As those born since about 1950 continue to age and represent an ever-increasing pro-portion of the population, the overall need for restorative care of all types will continue to diminish."

These trends are consonant with anecdotal information shared at dental professional meetings which Working Group members have attended. Of special note are comments made by pediatric dentists indicating a move away from amalgam in favor of resin (plastic), tooth-colored materials that are bonded to the tooth, may release fluoride and are mercury free. Moreover, a greater number of dental practitioners are relying on dental sealants as a preventative measure to thwart the onset of dental caries. Indeed, data from the USPHS National Health and Nutrition Examination Survey (NHANES) study bears out this information. A paper prepared by the NIDR and entitled "The Prevalence of Dental Sealants In the U.S. Population: Findings From NHANES III, 1988-91" reported the following:

The rising use of sealants, combined with community fluoridation, an ever-growing selection of fluoride-containing dental products, improved oral hygiene practices on the part of the general public and greater access to dental care are the major reasons why amalgam use is declining. It is planned for trends in dental restorative procedures to continue to be monitored using the NHANES IV survey, which will begin in 1998 and include queries on dental caries rates, types of restorative materials used and the tooth surfaces that are treated with amalgam and its alternatives.

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