Prevalence and Need for Replacement of Amalgam and Composite Restorations in Dutch Adults H.J.P. KROEZE, A.J.M. PLASSCHAERT, M.A.
van
't HOF', and G.J. TRUIN
Department of Cariology and Endodontology and 'Department ofMedical Statistics, Research Program in Dental Health Care and Epidemiology, TRIKON: Institute for Dental Clinical Research, University of Nijmegen, P. O. Box 9101, 6500 HB Nijmegen, The Netherlands
In 1986, the first nationwide epidemiological survey of adult oral health and attitudes to oral health care was carried out in The Netherlands. One of the aims of this study was to evaluate the prevalence and the quality (in terms of need for replacement) of amalgam and composite restorations in the Dutch adult population. A group of 600 dentate individuals, 20-44 years of age, was examined. Stratified cluster sampling included as factors age, gender, socioeconomic status, and area of residence. Two additional parameters were studied: frequency of visiting a dentist and type of health insurance. Oral examinations consisted of direct (mirror and explorer) and indirect (color slides and bite-wing radiographs) observations with use of well-defined criteria. On average, 13.4 restorations per individual were present, of which 23.3% were classified as unsatisfactory. A great difference in prevalence and quality data was found among several types of restorations. Test results (ANOVA) for effects of age, gender, socioeconomic status, area of residence, frequency of visiting a dentist, and insurance on the prevalence of unsatisfactoryy restorations resulted nearly always in significant effects of only age and frequency of visits to a dentist. There was a tendency (p0.05); and no significant interactions (p>0.05). Due to the small number of unsatisfactory class V palatal and class V pit restorations, no analysis was carried out for these types of restorations. A distinction was made between class II restorations including (class IIR) and excluding (class II) the use of radiographic bite-wing assessment for evaluation of possible effects of the availability of bite-wing radiographs. Although no significant age effects for class I and class III/ IV restorations were found, we decided to present the results on quality data in relation to age for all types of restorations in order to continue the same pattern of presentation (Fig. 2). Visit effects were found for class II and class III/IV restorations (Fig. 2). There was an obvious area effect in the quality of class III/IV restorations and an obvious gender effect for the quality of class II restorations. It was found that women had a higher percentage of unsatisfactory class II restorations than men. A higher percentage of unsatisfactory class III/IV restorations was found in the western area of The Netherlands than in the other areas. However, since these effects occurred for one type of restoration only, these effects have not been presented in Fig. 2. The results in Fig. 2 suggest the following trends concerning individuals frequently visiting a dentist: The percentages of unsatisfactory class I, class II, class IIR, and class V buccal restorations were higher in group IV (35-44 years). In all age groups, the class IIR restorations were assessed as unsatisfactory more often than were the other types of restorations. Percentages of unsatisfactory class I, class IIR, and class V buccal restorations did not differ in individuals infrequently visiting a dentist, as compared with regular visitors. However,
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Vol. 69 No. 6
REPLACEMENT OF AMALGAM AND COMPOSITE RESTORATIONS
1273
TABLE 3 RELATIVE CONTRIBUTION (IN %) OF CHARACTERISTICS USED IN DEFINING UNSATISFACTORY RESTORATIONS IN 600 DUTCH ADULTS 20-44 YEARS OLD Class I Class IIR Class III/IV Class V Total N = 204 Characteristic' N = 1279 N = 255 N = 141 N = 1879 Restoration 22.5 21.0 7.5 1.4 17.9 fracture 1.4 Tooth 2.5 * * 1.8 fracture Marginal 56.8 10.7 51.8 90.1 27.2 caries Marginal 25.0 10.5 12.5 7.1 12.0 breakdown Anatomical 3.4 10.7 * * 7.6 form Approximal * 7.4 * * 5.0 contact * Approximal 43.0 28.2 1.4 33.2 ledges Cerv. appr. * 23.0 * * 15.6 marg. caries * Subjective * 28.6 28.02 4.6 esthetic problem 'Each restoration could be assessed as unsatisfactory for more than one characteristic. With respect to class III/IV restorations, this applies only for the last characteristic (subjective esthetic problem) in relation to the other four characteristics. 2Only restorations in buccal surfaces of canines and incisors (N = 50). RRadiographic assessment included. *Characteristic not used for quality assessment.
for unsatisfactory class II and class III/IV restorations, the were significantly higher in almost all age groups than in "frequent visit" individuals. Quality data on types of restorations are presented in Fig. 3 for the combined age group of 20-44 years. The contribution of each restoration to the total number of unsatisfactoryy restorations per individual is depicted as well. There was a tendency (p
van
't HOF', and G.J. TRUIN
Department of Cariology and Endodontology and 'Department ofMedical Statistics, Research Program in Dental Health Care and Epidemiology, TRIKON: Institute for Dental Clinical Research, University of Nijmegen, P. O. Box 9101, 6500 HB Nijmegen, The Netherlands
In 1986, the first nationwide epidemiological survey of adult oral health and attitudes to oral health care was carried out in The Netherlands. One of the aims of this study was to evaluate the prevalence and the quality (in terms of need for replacement) of amalgam and composite restorations in the Dutch adult population. A group of 600 dentate individuals, 20-44 years of age, was examined. Stratified cluster sampling included as factors age, gender, socioeconomic status, and area of residence. Two additional parameters were studied: frequency of visiting a dentist and type of health insurance. Oral examinations consisted of direct (mirror and explorer) and indirect (color slides and bite-wing radiographs) observations with use of well-defined criteria. On average, 13.4 restorations per individual were present, of which 23.3% were classified as unsatisfactory. A great difference in prevalence and quality data was found among several types of restorations. Test results (ANOVA) for effects of age, gender, socioeconomic status, area of residence, frequency of visiting a dentist, and insurance on the prevalence of unsatisfactoryy restorations resulted nearly always in significant effects of only age and frequency of visits to a dentist. There was a tendency (p0.05); and no significant interactions (p>0.05). Due to the small number of unsatisfactory class V palatal and class V pit restorations, no analysis was carried out for these types of restorations. A distinction was made between class II restorations including (class IIR) and excluding (class II) the use of radiographic bite-wing assessment for evaluation of possible effects of the availability of bite-wing radiographs. Although no significant age effects for class I and class III/ IV restorations were found, we decided to present the results on quality data in relation to age for all types of restorations in order to continue the same pattern of presentation (Fig. 2). Visit effects were found for class II and class III/IV restorations (Fig. 2). There was an obvious area effect in the quality of class III/IV restorations and an obvious gender effect for the quality of class II restorations. It was found that women had a higher percentage of unsatisfactory class II restorations than men. A higher percentage of unsatisfactory class III/IV restorations was found in the western area of The Netherlands than in the other areas. However, since these effects occurred for one type of restoration only, these effects have not been presented in Fig. 2. The results in Fig. 2 suggest the following trends concerning individuals frequently visiting a dentist: The percentages of unsatisfactory class I, class II, class IIR, and class V buccal restorations were higher in group IV (35-44 years). In all age groups, the class IIR restorations were assessed as unsatisfactory more often than were the other types of restorations. Percentages of unsatisfactory class I, class IIR, and class V buccal restorations did not differ in individuals infrequently visiting a dentist, as compared with regular visitors. However,
Downloaded from jdr.sagepub.com at UNIVERSITE DE MONTREAL on June 13, 2015 For personal use only. No other uses without permission.
Vol. 69 No. 6
REPLACEMENT OF AMALGAM AND COMPOSITE RESTORATIONS
1273
TABLE 3 RELATIVE CONTRIBUTION (IN %) OF CHARACTERISTICS USED IN DEFINING UNSATISFACTORY RESTORATIONS IN 600 DUTCH ADULTS 20-44 YEARS OLD Class I Class IIR Class III/IV Class V Total N = 204 Characteristic' N = 1279 N = 255 N = 141 N = 1879 Restoration 22.5 21.0 7.5 1.4 17.9 fracture 1.4 Tooth 2.5 * * 1.8 fracture Marginal 56.8 10.7 51.8 90.1 27.2 caries Marginal 25.0 10.5 12.5 7.1 12.0 breakdown Anatomical 3.4 10.7 * * 7.6 form Approximal * 7.4 * * 5.0 contact * Approximal 43.0 28.2 1.4 33.2 ledges Cerv. appr. * 23.0 * * 15.6 marg. caries * Subjective * 28.6 28.02 4.6 esthetic problem 'Each restoration could be assessed as unsatisfactory for more than one characteristic. With respect to class III/IV restorations, this applies only for the last characteristic (subjective esthetic problem) in relation to the other four characteristics. 2Only restorations in buccal surfaces of canines and incisors (N = 50). RRadiographic assessment included. *Characteristic not used for quality assessment.
for unsatisfactory class II and class III/IV restorations, the were significantly higher in almost all age groups than in "frequent visit" individuals. Quality data on types of restorations are presented in Fig. 3 for the combined age group of 20-44 years. The contribution of each restoration to the total number of unsatisfactoryy restorations per individual is depicted as well. There was a tendency (p
