Dr David Sackett (1996) explains An authoritative definition of evidence based practice as “the conscientious-, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.” In order to accept this concept , Dental professionals are expected to give justifications for their actions.Evidence based practice involves the three components of: Research ,Clinical/professional judgement , and Consent to achieve improved patient outcomes.The usage of clinical and nonclinical Evidence is an important factor when practicing ‘evidence based practice’. With best clinical and nonclinical evidence within evidence – based dentistry , it is used as a guide to aid in decision making. In terms of the importance of evidence-based dentistry, it ensures that patients receive personalised dental care that is current; based on relevant scientific data. Registered dental professionals hold the responsibility to “provide good quality care based on current evidence and authoritative guidance”.
(Standards for the Dental Team, 2013) which supports evidence based-dentistry to be used heavily amongst the dental team.A distal occlusal cavity affects the biting surface and the adjacent mesial tooth surface side. A dental carie (cavity) has formed on these surfaces , which has resulted in demineralization of the supporting of the tooth (the enamel & the dentine). A dental amalgam or a composite filling are the two of many materials that can be used to restore a distal-occlusal cavity; located on a lower left first molar tooth.
The material of Amalgam is produced from a mixture of powdered and liquid metals ( 50% mercury, 60% silver, tin and copper). Mercury is a substantial material that forms a large amount of amalgam. Mercury acts as a ‘binding agent’ to bind the metals in amalgam together because of the chemical properties it has. Due to the composition of the metals in amalgam , it allows the composite to have great durability and strength.
There are several advantages attached to amalgam being used as a dental filling. For instance the restorative material can be referred to as ‘cost effective’. This is generally because amalgam has methods that are primitive compared with other restorative fillings e.g.
composite.Amalgam being used as a restorative material has been used for a considerable amount of time over the years. However , its usage is very debatable in terms of its safety. The mercury contained in amalgam can be released in low level vapours that can be absorbed through the lungs.
If there is a consistent exposure to these mercury vapours it can affect both the brain and the lungs. Furthermore , research has shown that mercury can be a potential risk to pregnant women. Dental professionals will usually advise pregnant women to avoid getting an amalgam filling during their pregnancy period. Due to amalgam being questionable in its safety a few countries have banned it’s usage as a restorative material. For example, according to (David Howard.com.au, 2018) states that the the government of Sweden declared that “amalgam will be totally banned for children and adolescents up to the age of 19 by 1 July 1995 at the latest and for adults by 1997.
“However , the (Ada.org, 2018) has made a statement that “It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance.” Amalgam being used as a filling can also be a disadvantage. For example , the aesthetic disadvantage of amalgam not matching the colour of your teeth. As a result , patients often opt for a composite resin fillings which are tooth coloured.
The silver appearance of amalgam fillings discolour over time. This is because the metal components in amalgam corrode which causes the tooth to darkly discolour. Mercy is the toxic metal contained in amalgam which can potentially damage the health of a patient. The material of a composite filling or in other words a ‘a white filling’ can also be used to restore a distal-occlusal cavity. A composite filling is composed of a tooth-coloured plastic that is mixed with silicon hydroxide (a glass). “They are durable, solid, non-toxic, easy to work with” according to Thomas P.
Connelly, DDS.This means that a composite filling can easily be manipulated into different shapes to aid in restoring a distal-occlusal cavity. The aesthetic appeal is the main advantage of a composite filling. The dentist is able to shade the filling to mimic the tooth shade of the patient’s existing tooth. This then improves the visibility of filling , by shading the filling to mimic the tooth shade of the patient’s existing tooth. There are several other advantages attached to composite fillings that are able to benefit the patient.
For instance , It allows the majority of the tooth structure to be maintained because the removal of the tooth is less required. In terms of supporting the tooths structure , a composite filling is able to chemically bond to the tooth structure, for support and strength. Due to its bonding nature composite fillings can be used to repair an existing composite filling that has been damaged , through bonding.
The newly added composite will bond with the old composite filling to repair it. (Sharecare, 2018)Several disadvantages are attached to having a composite filling, which is less beneficial to the patient. For example , the technique required to perform a ‘white requires more time. This is due to the amount of moisture control needed to keep the tooth dry from saliva , which is needed to complete the procedure. Discolouration may occur from the filling being frequently exposed substances and liquids e.
g. red wine that have high potential of staining. Also at a disadvantage , composite fillings are usually technique sensitive. Which means that patients often experience postoperative tooth sensitivity which is due to the inflammation from the work that has been carried out on the tooth.(Erickson, 2018).Dentists will usually refer two types of filling material a composite and amalgam filling to patient at their filling appointment(to restore their distal-occlusal cavity). As a result , patients usually question ”which one is best for me?”.
Factors such as : the preparation , the aesthetics , the cost , safety and time. Are all taken into account when choosing an appropriate filling for a patient. The difference in appearance is the most obvious difference between both of the restorative materials. Composite fillings are at a cosmetic advantage , because they are modified to mirror the tooths natural shade. Whilst silver fillings have an ‘unpleasant’ silver appearance which can darken over time. Due to the high manipulation skills and expensive material that composite demands the material is more expensive. Amalgam restorations are much more support to composite resin fillings when it comes to longevity. This factor is especially beneficial when it comes to large restorations because they are able to resist the pressure induced from chewing compared with a composite filling.
When it comes to the bonding and preparing of the tooth , composite fillings allow more of the tooth’s structure to be restored. This is means that less drilling of the tooth structure will be required. (Hughes, 2018) Has explained that “Because composite materials contain absolutely no mercury, some experts feel it is a safer option”. Due to amalgams metallic composition , there is a high likelihood of metal sensitivity/allergy issues within the patient. Seeing as composite fillings are metal free dental professionals are more drawn using composite as a restorative material opposed to amalgam. Overall , the decision to opt for an amalgam filling or a composite filling should be decided upon the dental professional and the patient. The dental professional should use great Evidence-based dentistry to justify their action when suggesting a restorative material to the patient.
However , The main factor of this decision should be decided on what material would be best to restore the affected tooth and prevent further damage. It is important that the dental professional e.g. the dentist is knowledgeable in the different restorative tequices. As this will allow them to provide the patient with advice that is accurate and knowledge based.