Dental composite restorations and psychosocial function in children

Abstract

Background and objective: Resin-based dental materials may intraorally release their chemical components and bisphenol A. The New England Children's Amalgam Trial found that children randomized to amalgam had better psychosocial outcomes than those assigned to composites for posterior tooth restorations. The objective of this study was to examine whether greater exposure to dental composites is associated with psychosocial problems in children.

Methods: Analysis of treatment-level data from the New England Children's Amalgam Trial, a 2-group randomized safety trial comparing amalgam with the treatment plan of bisphenol A-glycidyl methacrylate (bisGMA)-based composite and urethane dimethacrylate-based polyacid-modified composite (compomer), among 534 children aged 6 to 10 years at baseline. Psychosocial function at follow-up (n = 434) was measured by using the self-reported Behavior Assessment System for Children (BASC-SR) and parent-reported Child Behavior Checklist (CBCL).

Results: Children with higher cumulative exposure to bisGMA-based composite had poorer follow-up scores on 3 of 4 BASC-SR global scales: Emotional Symptoms (β = 0.8, SE = 0.3, P = .003), Clinical Maladjustment (β = 0.7, SE = 0.3, P = .02), and Personal Adjustment (β = -0.8, SE = 0.2, P = .002). Associations were stronger with posterior-occlusal (chewing) surfaces, where degradation of composite was more likely. For CBCL change, associations were not statistically significant. At-risk or clinically significant scores were more common among children with greater exposure for CBCL Total Problem Behaviors (16.3% vs 11.2%, P-trend = .01) and numerous BASC-SR syndromes (eg, ≥ 13 vs 0 surface-years, Interpersonal Relations 13.7% vs 4.8%, P-trend = .01). No associations were found with compomer, nor with amalgam exposure levels among children randomized to amalgam.

Conclusions: Greater exposure to bisGMA-based dental composite restorations was associated with impaired psychosocial function in children, whereas no adverse psychosocial outcomes were observed with greater urethane dimethacrylate-based compomer or amalgam treatment levels.

Trial registration: ClinicalTrials.gov NCT00065988.

FIGURE 1

Multivariable-adjusted 5-year select psychosocial function scores and change scores, by cumulative exposure (surface-years) to BisGMA-based dental composite in posterior occlusal surfaces. Higher scores indicate poorer function for all domains except for the BASC-SR Personal Adjustment.

FIGURE 2

Percentage of children with at-risk or clinically significant select psychosocial function scores at end of 5-year follow-up, by cumulative exposure (surface-years) to BisGMA-based dental composite in posterior occlusal surfaces. P values are from multivariate logistic regression models adjusted for the factors listed in Table 3 footnotes. For CBCL, at-risk T-scores: 60–63, clinically significant ≥64. For BASC-SR Depression and Interpersonal Relations, at-risk: 60–69, clinically significant ≥70. BASC Anxiety at-risk: 60–64, clinically significant ≥65.