Abstract
Little has been published on the chemical exposures and risks of dental restorative materials other than from dental amalgam and composite resins. Here we provide the first exposure and risk assessment for gold (Au) alloy and ceramic restorative materials. Based on the 2001–2004 US National Health and Nutrition Examination Survey (NHANES), we assessed the exposure of US adults to the components of Au alloy and ceramic dental restorations owing to dental material wear. Silver (Ag) is the most problematic component of Au alloy restorations, owing to a combination of toxicity and proportional composition. It was estimated that adults could possess an average of four tooth surfaces restored with Au alloy before exceeding, on average, the reference exposure level (REL) for Ag. Lithium (Li) is the most problematic component of dental ceramics. It was estimated that adults could possess an average of 15 tooth surfaces restored with ceramics before exceeding the REL for Li. Relative risks of chemical exposures from dental materials decrease in the following order: Amalgam>Au alloys>ceramics>composite resins.
Similar content being viewed by others
References
Beazoglou T, Eklund S, Heffley D, Meiers J, Brown LJ, Bailit H . Economic impact of regulating the use of amalgam restorations. Public Health Rep 2007; 122: 657–663.
USFDA (US Food and Drug Administration) White Paper: FDA Update/Review of Potential Adverse Health Risks Associated with Exposure to Mercury in Dental Amalgam. National Center for Toxicological Research, USFDA: Washington, DC. 2009.
Richardson GM . Mercury exposure and risks from dental amalgam in Canada: the Canadian Health Measures Survey 2007–2009. Hum Ecol Risk Assess 2014; 20: 433–447.
Richardson GM, Wilson R, Allard D, Purtill C, Douma S, Gravière J . Mercury exposure and risks from dental amalgam in the US population, post-2000. Sci Total Environ 2011; 409: 4257–4268.
Richardson GM . Inhalation of mercury-contaminated particulate matter by dentists: an overlooked occupational risk. Hum Ecol Risk Assess 2003; 9: 1519–1531.
Richardson GM, Evidence that bisphenol-a exposure is not associated with composite resin dental fillings. E-Letter, PediatricsOnline at http://pediatrics.aappublications.org/content/130/2/e328/reply. Published August 21 2012.
Richardson GM . Assessment of adult exposure and risks from components and degradation products of composite resin dental materials. Hum Ecol Risk Assess 1997; 3: 683–697.
Richardson GM, Clark KE, Williams DR . Preliminary estimates of adult exposure to bisphenol-a from dental materials, food and ambient air. In: Henshel DS, Black MC, Harrass MC (eds). Environmental Toxicology and Risk Assessment: Standardization of Biomarkers for Endocrine Disruption and Environmental Assessment: Eighth Volume. American Society for Testing and Materials: West Conshohocken, PA. 1999 pp 286–301.
Joskow R, Barr DB, Barr JR, Calafat AM, Needham LL, Rubin C . Exposure to bisphenol A from bis-glycidyl dimethacrylate-based dental sealants. J Am Dent Assoc 2006; 137: 353–362.
Zimmerman-Downs JM, Shuman D, Stull SC, Ratzlaff RE . Bisphenol A blood and saliva levels prior to and after dental sealant placement in adults. J Dent Hyg 2010; 184: 145–150.
Nicolae A, An Analysis of the Relationship between Urinary Mercury Levels and the Number of Dental Amalgam Restoration Surfaces in a Representative Group of the Canadian Population. Report prepared in association with the program on Dental Public Health, University of Toronto, Toronto, ON, Canada. Dated Summer/Fall 2010.
Vidnes-Kopperud S, Tveit AB, Gaarden T, Sandvik L, Espelid I . Factors influencing dentists’ choice of amalgam and tooth-colored restorative materials for Class II preparations in younger patients. Acta Odontol Scand 2009; 67: 74–79.
Tran LA, Messer LB . Clinicians’ choices of restorative materials for children. Austral Dent J 2003; 48: 221–232.
Peretz B, Ram D . Restorative material for children's teeth: preferences of parents and children. ASDC J Dent Child 2002; 69: 233.
Elshahawy W, Ajlouni R, James W, Abdellatif H, Watanabe I . Elemental ion release from fixed restorative materials into patient saliva. J Oral Rehabil 2013; 40: 381–385.
Ahlgren C, Molin M, Lundh T, Nilner K . Levels of gold in plasma after dental gold inlay insertion. Acta Odontol Scand 2007; 65: 331–334.
ADA (American Dental Association). Practical science: direct and indirect restorative materials. J Am Dent Assoc 2003; 134: 463–472.
Donaldson JA . The use of gold in dentistry: an historical overview, part 1. Gold Bull 1980; 13: 117–124.
Donaldson JA . The use of gold in dentistry: an historical overview, part 2. Gold Bull 1980; 13: 160–165.
Christensen G J . Longevity versus esthetics: the great restorative debate. J Am Dent Assoc 2007; 138: 1013–1015.
Knosp H, Holliday RJ, Corti CW . Gold in dentistry: alloys, uses and performance. Gold Bull 2003; 36: 93–101.
ADA (American Dental Association). Grills, ‘grillz’ and fronts. J Am Dent Assoc 2006; 137: 1192.
Leinfelder KF . An evaluation of casting alloys used for restorative procedures. J Am Dent Assoc 1997; 128: 37–45.
Chu S, Ahmad I . A historical perspective of synthetic ceramic and traditional feldspathic porcelain. Pract Proced Aesthet Dent 2005; 17: 593–598.
Jones DW . A brief overview of dental ceramics. J Can Dent Assoc 1998; 64: 648–650.
Kukiattrakoon B, Hengtrakool C, Kedjarune-Leggat U . The effect of acidic agents on surface ion leaching and surface characteristics of dental porcelains. J Prosthet Dent 2010; 103: 148–162.
Christensen GJ . The coming demise of the cast gold restoration? J Am Dent Assoc 1996; 127: 1233–1236.
Mormann WH . The evolution of the CEREC system. J Am Dent Assoc 2006; 137: 7S–13S.
Eley BM . The future of dental amalgam: a review of the literature. Part 7: possible alternative materials to amalgam for the restoration of posterior teeth. Br Dent J 1997; 183: 11–14.
USEPA (US Environmental Protection Agency) Risk Assessment Guidance for Superfund: Volume III - Part A, Process for Conducting Probabilistic Risk Assessment Report EPA 540-R-02-002. Office of Emergency and Remedial Response, USEPA: Washington, DC. 2001.
NCHS (National Center for Health Statistics) Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES). Centers for Disease Control and Prevention: Hyattsville, Maryland. 2005.
Al-Hiyasat AS, Saunders WP, Sharkey SW, Smith GM, Gilmour WH . Investigation of human enamel wear against four dental ceramics and gold. J Dent 1998; 26: 487–495.
Yip KH-K, Smales RJ, Kaidonis JA . Differential wear of teeth and restorative materials: clinical implications. Int J Prosthodon 2004; 17: 350–356.
Willems G, Lambrechts P, Braem M, Vanherle G, Classification and wear of dental composites. Proc. Int. Symp. on State-of-the-art on Direct Posterior Filling Materials and Dentin Bonding, Paris 1993.
Kraus B S, Jordan R E, Abrams L . Dental Anatomy and Occlusion. Williams and Wilkins, Co: Baltimore, MD, 1978.
Haj-Ali R, Walker M P, Williams K . Survey of general dentists regarding posterior restorations, selection criteria, and associated clinical problems. Gen Dent 2005; 53: 369–375.
Albertini T F, Kingman A, Brown J . Prevalence and distribution of dental restorative materials in US air force veterans. J Public Health Dent 1997; 57: 5–10.
Kean WF, Kean IRL . Clinical pharmacology of gold. Inflammopharmacology 2008; 16: 112–125.
Eisler R . Mammalian sensitivity to elemental gold (Au0. Biol Trace Elem Res 2004; 100: 1–17.
Benemann J, Lehmann N, Bromen K, Marr A, Seiwert M, Schulz C, Jockel K-H . Assessing contamination paths of the German adult population with gold and platinum. The German Environmental Survey 1998 (GerES III). Int J Hyg Environ Health 2005; 208: 499–508.
Schierl R . Urinary platinum levels associated with dental gold alloys. Arch Environ Health 2001; 56: 283–286.
Drasch G,; Muss C, Roider G . Gold and palladium burden from dental restoration materials. J Trace Elem Med Biol 2000; 14: 71–75.
Schrauzer GN . Lithium: occurrence, dietary intakes, nutritional essentiality. J Am Coll Nutr 2002; 21: 14–21.
Shiotsuki I, Terao T, Ogami H, Ishii N, Yoshimura R, Nakamura J . Drinking spring water and lithium absorption: a preliminary study. Ger J Psychiatry 2008; 11: 103–106.
Milleding P, Haraldsson C, Karlsson S . Ion leaching from dental ceramics during static in vitro corrosion testing. J Biomed Mater Res 2002; 61: 541–550.
Garhammer P, Hiller KA, Reitinger T, Schmalz G . Metal content of saliva of patients with and without metal restorations. Clin Oral Investig 2004; 8: 238–242.
CADTH (Canadian Agency for Drugs and Technologies in Health) Composite Resin and Amalgam Dental Filling Materials: A Review of Safety, Clinical Effectiveness and Cost-effectiveness. CADTH: Ottawa, Canada. 2012.
SCENIHR (Scientific Committee on Emerging and Newly-Identified Health Risks) Scientific opinion on the Safety of Dental Amalgam and Alternative Dental Restoration Materials for Patients and Users. Health and Consumer Protection Directorate-General, European Commission: Brussels. 2008.
Begerow J, Neuendorf J, Turfeld M, Raab W, Dunemann L . Long-term urinary platinum, palladium, and gold excretion of patients after insertion of noble-metal dental alloys. Biomarkers 1999; 4: 27–36.
Lopez-Alias J F, Martinez-Gomis J, Anglada J M, Peraire M . Ion release from dental casting alloys as assessed by a continuous flow system: nutritional and toxicological implications. Dent Mater 2006; 22: 832–837.
Sjogren G, Sletten G, Dahl JE . Cytotoxicity of dental alloys, metals, and ceramics assessed by millipore filter, agar overlay, and MTT tests. J Prosthet Dent 2000; 84: 229–236.
Wataha JC, Lockwood PE . Release of elements from dental casting alloys into cell-culture medium over 10 months. Dent Mater 1998; 14: 158–163.
Elshahawy W, Watanabe I, Koike M . Elemental ion release from four different fixed prosthodontic materials. Dent Mater 2009; 25: 976–981.
Hero H, Jorgensen R, Sorbroden E . A low-gold dental alloy–structure and segregations. J Dent Res 1982; 61: 1292–1298.
Johansson G, Bergman M, Anneroth G, Eskafi M . Human pulpal response to direct filling gold restorations. Scand J Dent Res 1993; 101: 78–83.
Lappalainen R, Yli-Urpo A . Release of elements from some gold-alloys and amalgams in corrosion. Scand J Dent Res 1987; 95: 364–368.
Ogino T, Koizumi H, Furuchi M, Murakami M, Matsumura H, Tanoue N . Effect of a metal priming agent on wear resistance of gold alloy-indirect composite joint. Dent Mater J 2007; 26: 201–208.
Ucar Y, Brantley WA, Johnston WM, Dasgupta T . Mechanical properties, fracture surface characterization, and microstructural analysis of six noble dental casting alloys. J Prosthet Dent 2011; 105: 394–402.
Wataha JC . Alloys for prosthodontic restorations. J Prosthet Dent 2002; 87: 351–363.
Wataha JC, Lockwood PE, Khajotia SS, Turner R . Effect of pH on element release from dental casting alloys. J Prosthet Dent 1998; 80: 691–698.
USEPA (US Environmental Protection Agency). Integrated Risk Information System (IRIS). Online at http://www.epa.gov/iris/. Accessed on 15 December 2013.
Health Canada Federal Contaminated Site Risk Assessment in Canada Part II: Health Canada Toxicological Reference Values (TRVs) and Chemical-Specific Factors, Version 20. Contaminated Sites Division, Health Canada: Ottawa, ON, Canada. 2010.
EMA (European Medicines Agency) Guideline on the specification limits for residues of metal catalysts, Doc. Ref. CPMP/SWP/QWP/4446/00 corr Committee for Human Medicinal Products, EMA: London, UK. 2007.
Moskowitz PD, Bernholc N, DePhillips MP, Viren J . Derived reference doses for three compounds used in the photovoltaics industry: copper indium diselenide, copper gallium diselenide, and cadium telleride Report BNL-62045. Biomedical and Environmental Assessment Group, Analytical Sciences Division, Department of Applied Science, Brookhaven National Laboratory: Long Island, NY, Dated July 6, 1995.
Anusavice KJ . Degradability of dental ceramics. Adv Dent Res 1992; 6: 82–89.
Elmaria A, Goldstein G, Vijayaraghavan T, Legeros RZ, Hittelman EL . An evaluation of wear when enamel is opposed by various ceramic materials and gold. J Prosthet Dent 2006; 96: 345–353.
Jakovac M, Zivko-Babic J, Curkovic L, Aurer A . Measurement of ion elution from dental ceramics. J Europ Ceram Soc 2006; 26: 1695–1700.
Kase HR, Tesk JA, Case ED . Elastic constants of two dental porcelains. J Mater Sci 1985; 20: 524–531.
Roy S, Basu B . Hardness properties and microscopic investigation of crack–crystal interaction in SiO2–MgO–Al2O3–K2O–B2O3–F glass ceramic system. J Mater Sci Mater Med 2010; 21: 109–122.
Santos C, Souza RC, Almeida N, Almeida FA, Silva RRF, Fernandes MHFV . Toughened ZrO2 ceramics sintered with a La2O3-rich glass as additive. J Mater Process Technol 2008; 200: 126–132.
Uo M, Sjoren G, Sundh A, Watari F, Bergman M, Lerner U . Cytotoxicity and bonding property of dental ceramics. Dent Mater 2003; 19: 487–492.
Zhang Y, Kim J-W . Graded structures for damage resistant and aesthetic all-ceramic restorations. Dent Mater 2009; 25: 781–790.
UKEGVM (UK Expert Group on Vitamins and Minerals) Safe Upper Levels for Vitamins and Minerals. UKEGVM, Committee on Toxicology, Food Standards Agency: UK. 2003.
USEPA (US Environmental Protection Agency). Regional Screening Level (RSL) Summary Table. USEPA, Region 3. Online at http://www.epa.gov/reg3hwmd/risk/human/rb-concentration_table/Generic_Tables/index.htm. Accessed 15 December 2013.
NVDEP (Nevada Division of Environmental Protection) Technical memorandum: Toxicity Criteria for Titanium and Compounds, and for Tungsten and Compounds. Nevada State Department of Conservation and Natural Resources. 2008.
Hacker CH, Wagner WC, Razzoog ME . An in vitro investigation of the wear of enamel on porcelain and gold in saliva. J Prosthet Dent 1996; 75: 14–17.
Ramp MH, Suzuki S, Cox CF, Lacefield WR, Koth DL . Evaluation of wear: enamel opposing three ceramic materials and a gold alloy. J Prosthet Dent 1997; 77: 523–530.
Graf K, Johnson GH, Mehl A, Rammelsberg P . The influence of dental alloys on three-body wear of human enamel and dentin in an inlay-like situation. Oper Dent 2002; 27: 167–174.
Suzuki S, Nagai E, Taira Y, Minesaki Y . In vitro wear of indirect composite restoratives. J Prosthet Dent 2002; 88: 431–436.
Ohkubo C, Shimura I, Aoki T, Hanatani S, Hosoi T, Hattori M, Oda Y, Okabe T . Wear resistance of experimental Ti-Cu alloys. Biomaterials 2003; 24: 3377–3381.
Alarcon JV, Engelmeier RL, Powers JM, Triolo. PT . Wear testing of composite, gold, porcelain, and enamel opposing a removable cobalt–chromium partial denture alloy. J Prosthodont 2009; 18: 421–426.
Delong R, Douglas WH, Sakaguchi RL, Pintado MR . The wear of dental porcelain in an artificial mouth. Dent Mater 1986; 2: 214–219.
Leinfelder KF, Suzuki S . In vitro wear device for determining posterior composite wear. J Am Dent Assoc 1999; 130: 1347–1353.
Al-Hiyasat AS, Saunders WP, Smith GM . Three-body wear associated with three ceramics and enamel. J Prosthet Dent 1999; 82: 476–481.
Krejci I, Lutz F, Reimer M, Heinzmann JL . Wear of ceramic inlays, their enamel antagonists, and luting cements. J Prosthet Dent 1993; 69: 425–430.
Ramp MH, Ramp LC, Suzuki S . Vertical height loss: an investigation of four restorative materials opposing enamel. J Prosthodont 1999; 8: 252–257.
Richardson GM, Brecher R, Scobie H, Hamblen J, Phillips K, Samuelian J, Smith C . Mercury vapour (Hg0: continuing toxicological uncertainties, and establishing a Canadian reference exposure level. Regul Toxicol Pharmacol 2009; 53: 32–38.
Willhite CC, Ball GL, McLellan CJ . Derivation of a bisphenol A oral reference dose (RfD) and drinking-water equivalent concentration. J Toxicol Environ Health B Crit Rev 2008; 11: 69–146.
USEPA (US Environmental Protection Agency). Integrated Risk Information System (IRIS). Online at http://www.epa.gov/iris/. Accessed 7 January 2015.
Acknowledgements
Funding for this project was provided by the Natural Sciences and Engineering Research Council of Canada, Collaborative Research and Training Experience (CREATE) Grant in Human and Ecological Risk Assessment (HERA), to SDS and GMR. Funding in kind, for time committed by GMR and SRC, was provided, respectively, by Stantec Consulting, and SNC-Lavalin Environment, both of Ottawa, Ontario, Canada.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Richardson, G., Clemow, S., Peters, R. et al. Assessment of exposures and potential risks to the US adult population from wear (attrition and abrasion) of gold and ceramic dental restorations. J Expo Sci Environ Epidemiol 26, 70–77 (2016). https://doi.org/10.1038/jes.2015.17
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jes.2015.17
- Springer Nature America, Inc.
Keywords
This article is cited by
-
A Review on Biocompatibility of Dental Restorative and Reconstruction Materials
Current Oral Health Reports (2024)
-
Assessment of exposures and potential risks to the US adult population from the leaching of elements from gold and ceramic dental restorations
Journal of Exposure Science & Environmental Epidemiology (2016)