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A multidisciplinary study of patients with signs or symptoms attributed to dental restorative materials
Umeå University, Faculty of Medicine, Department of Odontology.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anxiety for adverse health effects attributed to dental restorative materials especially dentalamalgam, have been discussed extensively off and on the last 30 years. The possible health effect ofamalgam and health effect of replacements of amalgam, have been extensively studied but theresults are inconclusive and the etiology of the reactions are not entirely elucidated. Furthermore,the question of psychological influence on symptoms attributed to dental restorative materials hasbeen raised and need further examination.

The aims of this thesis were to describe the change in health over time for patient with symptomsattributed to their dental materials and to determine whether replacement of their dentalrestorative materials had any impact on their perceived health. Furthermore, to determine anddescribe the personality, self-image, level of psychological symptoms and stress among thesepatients and compare the results with those of healthy controls. Finally, to evaluate regression ofLichenoid Contact Reactions and Oral lichen Planus after replacement of the dental materials.

A questionnaire was mailed to 614 patients that had been referred to the School of Dentistry, Umeå,Sweden with symptoms attributed to dental materials. Among these patients a subgroup with orallichen also underwent a clinical examination at follow-up.

The result showed that patients with complex symptoms had a more unfavorable long-termprognosis concerning persistent complaints than those with local symptoms only. The oralsymptoms had decreased between baseline and follow-up and the general symptoms had increased.The increase in general symptoms was contradictory since many patients experienced healthimprovement after removal of their dental restorative materials. Concerning personality thepatients was characterized mainly by high persistence and by high fatigability and asthenia as wellas psychosocially learned high self-acceptance. Regarding self-image, both patients with LocalSymptoms Only and patients with Multi Symptoms, scored significantly higher on "spontaneous"and "positive self-image" than the reference group. The Multi symptoms group scored significantlyhigher on psychological symptoms compared to the reference group. However, the Local symptomsgroup did not differ from the references. The remission of oral lesions was after an exchange ofdental materials was seen to a greater extent in patients with Lichenoid Contact Reaction than inpatients with Oral Lichen Planus. Regarding psychological parameters, there were no significantdifferences between the groups.

In conclusion symptoms related to dental restorative materials seem to be multi-factorial wheredental, medical, social, and psychological factors may be involved. Patient with complex symptomshave a more unfavorable prognosis than patient with local symptoms only. Patient with symptomsself-related to their dental materials may feel improvement in general health after an exchange ofdental materials. The group of patients seems to represent personalities that could be vulnerable inthe demanding modern society, and the various mental and somatic symptoms can be interpretedas attributed to dental fillings. Patients with Local Symptoms or Multi Symptoms are equalconcerning self-image, they are impulsive with an elevated positive self-image, that can result indifficulties in setting limits. Thus in combination with high demands may result in mental stress.The Multi Symptoms group was more psychologically stressed than the group with Local SymptomsOnly and the references. Therefore, before an exchange of dental materials is commenced inpatients with oral lichenoid lesions, a correct diagnosis is needed.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2016. , 73 p.
Series
Umeå University odontological dissertations, ISSN 0345-7532 ; 135
Keyword [en]
Dental restorative materials, environmental intolerance, oral lichen, personality, self-image, psychological symptoms
National Category
Biomaterials Science
Research subject
Odontology
Identifiers
URN: urn:nbn:se:umu:diva-114096ISBN: 978-91-7601-403-5 (print)OAI: oai:DiVA.org:umu-114096DiVA: diva2:893647
Public defence
2016-02-05, Sal D 9 tr, Tandläkarhögskolan, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-01-15 Created: 2016-01-13 Last updated: 2016-01-20Bibliographically approved
List of papers
1. Changes in health over time in patients with symptoms allegedly caused by dental restorative materials
Open this publication in new window or tab >>Changes in health over time in patients with symptoms allegedly caused by dental restorative materials
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2005 (English)In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 33, no 6, 427-437 p.Article in journal (Refereed) Published
Abstract [en]

Abstract –  Objectives:  In Sweden, many patients with symptoms allegedly caused by their dental materials have exchanged their restorations, but the effects of the exchange have been insufficiently investigated. Therefore, the aim of the study was to describe the change in health over time for these patients and the hypothesis was that the patients could be divided based on their symptoms and that the ability to recover differs between these groups. Furthermore, we also examined if other factors such as replacement of dental restorative materials and follow-up time had any impact on the perceived health status.

Methods:  A questionnaire was sent to 614 patients who had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental restorative materials. The response rate was 55%.

Results:  The risk of having any further complaints was higher for patients with complex symptoms (P = 0.03) and these patients had exchanged their restorations to a significantly larger extent than the others (P = 0.03). The remaining complaints was more frequent among men (P = 0.02). Exchange of dental restorative materials had no significant impact on the ability to recover completely. However, the patients who had exchanged their restorations completely perceived a significantly larger alleviation of their symptoms than the others (P < 0.01), although the frequency of most of the symptoms had increased.

Conclusions:  Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with localized symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. The reason for this improvement, however, is unclear. Further analyses regarding other possible explanations than the ‘odontological/medical’ are needed.

Place, publisher, year, edition, pages
John Wiley & Sons, Inc, 2005
Keyword
dental materials, follow-up study, long-term prognosis, subgroups
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-3488 (URN)10.1111/j.1600-0528.2005.00240.x (DOI)16262610 (PubMedID)
Available from: 2008-09-23 Created: 2008-09-23 Last updated: 2017-12-14Bibliographically approved
2. Psychobiological personality dimensions in two environmental-illness patient groups
Open this publication in new window or tab >>Psychobiological personality dimensions in two environmental-illness patient groups
2005 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 9, no 4, 251-256 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to investigate the psychobiological personality dimensions in two subgroups of patients with environmental illness (EI). Fifty-nine patients, 34 women and 25 men (aged 32-69 years), were referred for symptoms allegedly caused by abnormal sensitivity to either dental fillings (DF; n=26) or electromagnetic fields (EMF; n=33). For the evaluation of personality, the Swedish 238-item version of the Temperament and Character Inventory (TCI) was used. Compared with a control group, the EMF group scored higher on the temperament dimension Persistence. The DF group scored higher on the TCI subscales Harm Avoidance (fatigability and asthenia) and Self-Directedness (self-acceptance). Women scored higher than men did on the Novelty Seeking and Reward Dependence (RD) dimensions in the DF group and on RD in the control group, indicating an inherited gender difference. No differences were found between men and women in the EMF group. Our results indicate that the high level of persistence found in the EMF group and the high level of fatigability and asthenia in combination with high self-acceptance found in the DF group represent vulnerable personalities. No significant differences were found between the two patient groups, indicating that these groups are quite similar regarding personality. This vulnerability can be expressed as various mental and somatic symptoms, which can be interpreted as El symptoms by the affected individual.

Keyword
dental fillings, electromagnetic fields, environmental illness, character, personality, temperament
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-113828 (URN)10.1007/s00784-005-0015-2 (DOI)000234471600006 ()16215748 (PubMedID)
Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2017-12-01Bibliographically approved
3. Psychological symptoms and self-image of patients with complaints attributed to dental restorative materials: Psychological symptoms in patients with environmental intolerance
Open this publication in new window or tab >>Psychological symptoms and self-image of patients with complaints attributed to dental restorative materials: Psychological symptoms in patients with environmental intolerance
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives The aim was to study self-image the level of psychological symptoms in patients with symptoms attributed to their dental restorative materials, one group with local oral symptoms only (LSO) and one group with multi-symptoms (M-S).

Materials and methods A questionnaire was sent to the 257 participants, 189 women and 68 men, containing questions regarding their dental and medical history.The self-image was assessed with the Structural Analysis of Social Behavior (SASB. Psychological symptomssuch as somatization, depression and anxiety were assessedand the Global Severity Index (GSI) was computed by using the Symptom Check List 90 (SCL-90).

Results The SASB showed that the M-S group and the LSO-group scored significantly higher on the “spontaneous” and “positive self-image” than the reference group. In the SCL-90, the M-S group scored significantly higher than the LSO-group and the references on the somatization subscales. On depression, anxiety and the GSI scale, the M-S group scored significantly higher than the reference group.

Conclusions The two subgroups rated significantly higher on the SASB Spontaneous and Positive clusters which indicates that these patients have an excessively positive self-image, are very spontaneous and have an overconfidence in themselves compared to the reference group. In the M-S group  there was a clear tendency to somatization, depression and anxiety and they are more psychologically stressed than the reference group.

Clinical relevance Clinicians should be aware of that illness attributed to dental restorative materials seems to be multi-factorial and patient with multi-symptoms are more psychologically stressed than patient with local-symptoms only.

National Category
Biomaterials Science
Research subject
Odontology
Identifiers
urn:nbn:se:umu:diva-114092 (URN)
Available from: 2016-01-13 Created: 2016-01-13 Last updated: 2016-01-13
4. Regression of oral lichenoid lesions after replacement of dental restorations
Open this publication in new window or tab >>Regression of oral lichenoid lesions after replacement of dental restorations
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2014 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 41, no 5, 381-391 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to determine the prognosis and to evaluate the regression of lichenoid contact reactions (LCR) and oral lichen planus (OLP) after replacement of dental restorative materials suspected as causing the lesions. Forty-four referred patients with oral lesions participated in a follow-up study that was initiated an average of 6years after the first examination at the Department of Odontology, i.e. the baseline examination. The patients underwent odontological clinical examination and answered a questionnaire with questions regarding dental health, medical and psychological health, and treatments undertaken from baseline to follow-up. After exchange of dental materials, regression of oral lesions was significantly higher among patients with LCR than with OLP. As no cases with OLP regressed after an exchange of materials, a proper diagnosis has to be made to avoid unnecessary exchanges of intact restorations on patients with OLP.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keyword
oral lichen; oral lichen planus; oral lichenoid contact reactions; exchange of dental materials
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-88663 (URN)10.1111/joor.12151 (DOI)000334050900008 ()
Available from: 2014-05-19 Created: 2014-05-12 Last updated: 2017-12-05Bibliographically approved

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