5. Are there any health risks associated with the use of alternative materials?

Alternative materials are used because they are tooth coloured and thus are perceived as being aesthetically superior to alloys, such as amalgam. Alternative materials used in direct restorations are composed from a variety of substances that may undergo chemical reactions within the tooth cavity and the adjacent soft tissues during placement. In many cases, ceramic restorations have to be cemented to the tooth with resin-based composite materials.

There exists little evidence of clinically significant adverse effects from these materials. However, many of the new forms of these alternative materials lack long-term clinical data and as such, need to be monitored for possible risks to patients and dental personnel. As with amalgam, genetic predisposition may play a role for the occurrence of adverse reactions towards constituents of alternative materials. The kinetics may influence the degree of individual susceptibility with regard to internal exposure and consequently toxicity. However, clinical data are missing and more research is warranted.

There are very limited data available concerning exposure of patients and dental personnel to substances that are used in alternative restorative materials. Many of the monomers and other organic solvents used in them are volatile and need to be better identified and quantified.

In particular, the release of bisphenol A (BPA) from some dental filling materials has been considered in an independent evaluation by the SCENIHR and shown to be of negligible risk. Similar extensive risk assessments have not been performed for other compounds released from alternative dental filling materials. Allergies to some of these substances have been reported, both in patients and in dental personnel. Globally, the scientific data on possible adverse effects of alternatives are very limited and further toxicological research on the various components of these alternative dental filling materials is needed.

Therefore, the SCENIHR notes that it is not possible to provide a scientifically sound generic statement on the safety of all these materials.