ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Xerostomia And Its Effects On Dental Restorative Materials
Clinical Question In a patient with xerostomia which dental restoration amalgam, resin composite, or glass ionomer best combats the occurrence of secondary caries throughout the lifetime of the restoration?
Clinical Bottom Line Glass Ionomer best combats secondary caries due to the fact that it releases fluoride throughout the lifetime of the restoration. Fluoride treatment is essential in a patient with xerostomia. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12636121Haveman/2003 Group of 9 xerostomic patients and placed 111 restorations in these patientsRandomized Split Mouth Design
Key resultsThe glass ionomer preformed better at resisting secondary caries in these patients that didn’t use any fluoride gel. Materials that release fluoride and patients who take a fluoride have a much better chance resisting secondary caries then do the materials and patients who don’t use fluoride regimens. However, there was no difference in marginal integrity between the three materials.
#2) 12216559McComb/2002 45 patients who had all undergone radiation for head and neck cancer and were all xerostomicCase Series
Key resultsIn patients who were very compliant with fluoride treatment (used more than 50% of the time) all three dental restorations (glass ionomer, resin modified glass ionomer, and resin composite) all held up nicely and none had secondary caries. In the patients who were not compliant with the fluoride regimen the glass ionomer and resin modified glass ionomer restorations showed to be 80% more resistant than resin composite restoration without fluoride.
Evidence Search Search ("Xerostomia"[Mesh]) AND "Dental Amalgam"[Mesh]Search ("Xerostomia"[Mesh]) AND "Composite Resins"[Mesh
Comments on
The Evidence
In both articles the patient base started with the same problem and were treated the same way besides the restorations that were placed in each patient. There was adequate completion rate in each article and the compliance was good for each. Each set of patients received adequate follow up. In the Havemen article patients were recalled at 2 years and in the McComb article patient recalls were made at 6,12,18, and 24 months.
Applicability The evidence in these articles shows that fluoride treatment either from glass ionomer or any fluoride regimen is highly recommended for the xerostomic patient in order to prevent the possibility of recurrent caries.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Xerostomia, dental amalgam, composite resin, glass ionomer, recurrent caries
ID# 847
Date of submission: 04/01/2011spacer
E-mail wieck@livemail.uthscsa.edu
Author Blaine Wieck
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Joesph Connor, DDS
Faculty mentor/Co-author e-mail connorj@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Ju Ri Hur, James Dix (San Antonio, Texas) on 10/04/2014
Recent comparative study by De Moor, 2011 (PubMed ID: 19997859) was found. This split mouth study further strengthens the claim of this CAT. 35 patients who had received head and neck radiation and suffered from xerostomia received glass ionomer and conventional composite restorations in areas of class 5 lesions. The article found that glass ionomer’s fluoride releasing abilities made them better restorations to prevent recurrent caries but also found that increased degradation occurs with time compared to conventional resins. They recommend using glass ionomer restorations in areas of low wear and using the sandwich technique in areas of increased wear.
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