Improvements in mechanical properties and a shift of focus towards esthetic dentistry led to the application of dental resins in various areas of dentistry. However, dental resins are not inert in the oral environment and may release monomers and other substances such as Bisphenol-A (BPA) due to incomplete polymerization and intraoral degradation. Current research shows that various monomers present cytotoxic, genotoxic, proinflammatory, and even mutagenic effects. Of these eluting substances, the elution of BPA in the oral environment is of particular interest due to its role as an endocrine disruptor. For this reason, the release of residual monomers and especially BPA from dental resins has been a cause for public concern. The assessment of patient exposure and potential health risks of dental monomers require a reliable experimental and analytical setup. However, the heterogeneous study design applied in current research hinders biocompatibility testing by impeding comparative analysis of different studies and transfer to the clinical situation. Therefore, this review aims to provide information on each step of a robust experimental and analytical in vitro setup that allows the collection of clinically relevant data and future meta-analytical evaluations.

• biocompatibility
• bisphenol A
• elution
• leaching
• materials testing
• monomer
• resin based dental materials

Amalgam was banned as a dental restorative material in Norway in 2008 due to environmental considerations. An electronic questionnaire was sent to all dentists in the member register of the Norwegian Dental Association (NTF) one year later, to evaluate dentists’ satisfaction with alternative restorative materials and to explore dentists’ treatment choices of fractured amalgam restorations. Replies were obtained from 61.3%. Composite was the preferred restorative material among 99.1% of the dentists. Secondary caries was the most commonly reported cause of failure (72.7%), followed by restoration fractures (25.1%). Longevity of Class II restorations was estimated to be ≥10 years by 45.8% of the dentists, but 71.2% expected even better longevity if the restoration was made with amalgam. Repair using composite was suggested by 24.9% of the dentists in an amalgam restoration with a fractured cusp. Repair was more often proposed among young dentists (p < 0.01), employees in the Public Dental Service (PDS) (p < 0.01) and dentists working in counties with low dentist density (p = 0.03). There was a tendency towards choosing minimally invasive treatment among dentists who also avoided operative treatment of early approximal lesions (p < 0.01). Norwegian dentists showed positive attitudes towards composite as a restorative material. Most dentists chose minimally- or medium invasive approaches when restoring fractured amalgam restorations.

• amalgam
• composite resin
• dentistry
• minimal intervention dentistry
• minimally invasive dentistry
• operative treatment

• Adult
• Attitude of Health Personnel
• Composite Resins
• Dental Amalgam
• Dental Care
• Dental Caries/therapy
• Dental Restoration Failure
• Dental Restoration, Permanent/statistics & numerical data
• Dentists/statistics & numerical data
• Female
• Humans
• Male
• Middle Aged
• Norway
• Practice Patterns, Dentists'/statistics & numerical data

• Amalgam
• decision-making
• dentist
• direct restoration
• resin composite

• Adult
• Body Burden
• Dental Amalgam/analysis
• Dental Debonding/instrumentation
• Dental High-Speed Equipment
• Dental Restoration, Permanent/instrumentation
• Dental Waste/analysis
• Female
• Hazardous Waste/analysis
• Humans
• Male
• Mercury/analysis
• Mercury/urine
• Water/analysis
• Young Adult

Dental amalgam is a source of elemental and inorganic mercury. The safety of dental amalgam in individuals remains a controversial issue. Urinary mercury concentrations are used to assess chronic exposure to elemental mercury. At present, there are no indications of mercury-associated adverse effects at levels below 5 μg Hg/g creatinine (Cr) or 7 μg Hg/L (urine). The purpose of the present study is to determine the overall urinary mercury level in the Canadian general population in relation to the number of dental amalgam surfaces.

Data come from the 2007/09 Canadian Health Measures Survey, which measured urinary mercury concentrations in a nationally representative sample of 5,418 Canadians aged 6–79 years. Urinary mercury concentrations were stratified by sex, age, and number of dental amalgam surfaces.

The overall mean urinary mercury concentration varied between 0.12 μg Hg/L and 0.31 μg Hg/L or 0.13 μg Hg/g Cr and 0.40 μg Hg/g Cr. In general, females showed slightly higher mean urinary mercury levels than men. The overall 95^th percentile was 2.95 μg Hg/L, the 99^th percentile was 7.34E μg Hg/L, and the 99.9^th percentile was 17.45 μg Hg/L. Expressed as μg Hg/g Cr, the overall 95^th percentile was 2.57 μg Hg/g Cr, the 99^th percentile was 5.65 μg Hg/g Cr, and the 99.9^th percentiles was 12.14 μg Hg/g Cr. Overall, 98.2% of participants had urinary mercury levels below 7 μg Hg/L and 97.7% had urinary mercury levels below 5 μg Hg/g Cr. All data are estimates for the Canadian population. The estimates followed by the letter “E” should be interpreted with caution due to high sampling variability (coefficient of variation 16.6%-33.3%).

The mean urinary mercury concentrations in the general Canadian population are significantly lower than the values considered to pose any risks for health.

• Composites
• Curing lamps
• Curing time
• Degree of conversion
• Depth of cure
• LED
• Residual monomers
• Restorative materials
• Wear

Dental materials’ choice of patients has considerably changed. Whereas cast gold and amalgam have been the predominant biomaterials for decades, today tooth-colored materials like resin-based composites and ceramics are more and more successful. However, are we going to replace a good but biologically questionable material (amalgam) with an equal material (resin composite) being more esthetic but also biologically questionable For amalgam, long-term clinical studies reported some significant hints that in single cases amalgam may be a health hazard for patients, finally Norway banned amalgam completely. The main advantage of a resin-based composite over amalgam is its tooth-like appearance and more or less absence of extensive preparation rules. For many years it was believed that resin-based composites may cause pulpal injury. However, pulpal injury associated with the use of resin-based composites is not correlated with their cytotoxic properties. Nevertheless, resin-based composites and other dental materials require rigorous safety evaluation and continuous monitoring to prevent adverse events similar like with amalgam. Because of non-biocompatible pulp responses to resin-based composites and amalgam, they should not be placed in direct contact with the dental pulp. The less dentin remaining in the floor of preparations between resin-based composites or other dental materials is more likely to cause pulpitis. Percentage of patients and dental practitioners who display allergic reactions is between 0.7% and 2%. The release of cytotoxic monomers from resin-based materials is highest after polymerization and much lower after 1 wk. Substances released from resin-based composites have been shown to be toxic in cytotoxicity tests. Nevertheless, in vitro cytotoxicity assays have shown that amalgam has greater toxic effects than resin-based composites, sometime 100-700-fold higher. Altogether, the risk of side-effects is low, but not zero, especially for dental personnel.

• Exposures
• Restoratives
• Amalgam
• Resin-based composites
• Adhesives

Objective. The purpose of this review paper is to review the literature regarding the toxicology of mercury from dental amalgam and evaluate current statements on dental amalgam. Materials and Methods. Two key-words “dental amalgam” and “toxicity” were used to search publications on dental amalgam biocompatibility published in peer-reviewed journals written in English. Manual search was also conducted. The most recent declarations and statements were evaluated using information available on the internet. Case reports were excluded from the study. Results. The literature show that mercury released from dental amalgam restorations does not contribute to systemic disease or systemic toxicological effects. No significant effects on the immune system have been demonstrated with the amounts of mercury released from dental amalgam restorations. Only very rarely have there been reported allergic reactions to mercury from amalgam restorations. No evidence supports a relationship between mercury released from dental amalgam and neurological diseases. Almost all of the declarations accessed by the internet stated by official organizations concluded that current data are not sufficient to relate various complaints and mercury release from dental amalgam. Conclusions. Available scientific data do not justify the discontinuation of amalgam use from dental practice or replacement with alternative restorative dental materials.