Restoration survival effects of treatment on dental health in patients attending three selected dental practices

Does dental restorative treatment equate to the re-establishment of the patient's original state of dental health? Are restorative materials an adequate substitute for natural tooth material? Do such materials cure dental caries? For many years the answer to these questions was believed to be yes, but now these traditionally-accepted concepts are being questioned. The challenging of these concepts gathered momentum when the results of a 1978 survey of the General Dental Service (GDS) of the Scottish National Health Service were published. These results indicated that the amount of treatment received and restoration survival varied with the frequency of examinations and how often the patients changed dentists. The present study was designed to compare the Scottish NHS and other study findings with those obtained from privately-treated adult patients from a different population. The findings: were analysed by examining restoration survivals and changes in the dental health status of·100 patients and comparing the results to those reported elsewhere in the literature, primarily Dawson (1989) and Mahmood (1991). This study was a retrospective document survey, with the population group being drawn from the patient lists of three busy Adelaide private dental practices during 1992. The patients all had continuous treatment records ranging between I 0 to 46 years. The survival characteristics of the various restorative materials studied indicated that the mean survival rates of restorations generally reported in the literature may not be representative of many patients who regularly attend private dental practices. For comparison, the results obtained from the present study indicate impressive survival rates of: Amalgams 22. 5 ± 1. 1 years median survival Composite Resins 16.7 ± 1.4 years median survival Crowns 15.41 ± 1.0 year 75% survival Castings 13.8 ± 4.7 years median survival Glass-Ionomers 11.25 ± 0.6 years 75% survival These results are at the higher end of restoration survival when compared to those reported in the literature. As expected, the survivals of replacement restorations were generally inferior to the original restorations, with many such restorations being replaced two or three times over the study period. Overall, restoration survivals were independent of the dental practice, the dentist and the experience of the practitioner, and regardless of whether or not the restorations were replaced by the same dentist who originally placed them. However, there were some significant differences in restoration survivals by patient age cohorts, material type and distribution by class of cavity preparation, tooth site and arch location. The general dental health of the patients within this study, using both DMF and T-Health indices, demonstrated a gradual decline over the treatment period. While the age of the patient had some significant effect upon the rate of change of dental health, this effect could be explained by the 'saturation' of potential restoration sites in the patient's mouth with time. There was also some significant effect upon the rate of change in dental health related to the practices and the number of changes of dentists: However, the frequency with which the patients attended dentists, or whether or not they changed practitioners, did not have any significant effect upon the rates of changes in their dental health.Thesis (MDS) -- University of Adelaide, Dept. of Dentistry, 199