Polymer-based Dental Filling Materials Placed During Pregnancy and Risk to the Foetus

Trine Lise Lundekvam Berge; Gunvor Bentung Lygre; Stein Atle Lie; Lars Björkman

Disclosures

BMC Oral Health. 2018;18(144) 

In This Article

Discussion

The aim of the present study was to investigate whether the placement of polymer-based dental fillings during pregnancy was associated with outcomes including stillbirth, preterm delivery, malformations, and low or high birth weight. No evidence of an increased risk of adverse birth outcomes after placement of white fillings during pregnancy was found. Gender-specific analyses showed generally similar results for girls and boys analysed together.

The main strengths of the present study are the overall large sample size and the large number of participants who had white fillings placed. These large numbers enabled us to study even rare birth outcomes. Furthermore, the prospective design of the study reduced the risk for recall bias. Additionally, the information on health-related and lifestyle data that was derived from both the MBRN and the MoBa questionnaires enabled us to control for some potential confounding factors.

To the best of our knowledge, the present study is the first to investigate potential associations between polymer-based fillings placed during pregnancy and birth outcomes. Michalowicz et al. found no significant associations between adverse pregnancy outcomes and periodontal treatment, the use of anaesthetic during nonsurgical periodontal treatment, treatment including temporary and permanent restorations, endodontic therapy, and extractions.[35] These results are in agreement with our findings. However, in the study of Michalowicz et al., the type of restorative material was not specified. Thus, the results are not directly comparable.

A limitation of the MoBa study is the low response rate, with a possible self-selection of the healthiest women. The MoBa has an underrepresentation of young mothers (< 25 years). The participants have a higher level of education and are more likely to be non-smokers than the general population of pregnant women in Norway.[36]

However, self-selection to the cohort is not a validity problem in studies of associations between exposure and outcomes.[36]

The MoBa study is based on questionnaires filled in by the participating women. To achieve reliable answers from all participants in this large cohort, an effort was made to make the questions as easy and achievable as possible. Thus, information about dental treatment is sparse. Detailed information about the type and manufacturer of the polymer-based filling material and size and number of fillings placed, would be of interest. However, to obtain accurate information about this, access to dental records would be needed. In large epidemiological studies, like the MoBa study, access to updated dental records would be unfeasible. Accordingly, reliable knowledge about the number and size of possible pre-existing composite restorations is lacking. Since leakage of BPA from existing polymer-based restorative materials is very low compared with other sources,[37] this information would most likely be of minor importance.

The participants were asked if they had received "white fillings" during pregnancy. In Norway, white fillings would practically be the same as polymer-based restorative fillings or so called polymer-based or resin-based composites. However, the term "white fillings" may include materials like resin-modified cements, compomers and water-based glass ionomer cements (GIC). In the period of this study, the vast majority of Norwegian dentists used polymer-based filling materials when restoring cavities in adults. Kopperud et al. described management of occlusal caries in adults by Norwegian dentists in 2009 and stated that polymer-based composite was the preferred restorative material (91.9%).[38] In the same study the use of other filling materials was reported to be less than 4%. This is in accordance with another study examining treatment concept for approximal caries in Norway.[39] In 2009 polymer-based filling material was preferred by 94.9% of the responding dentists. Preference for other filling materials was: 1.1% compomer, 1.1% GIC, 0.5% resin-modified GIC and 1.8% a combination of resin composite and GIC.[39] In 1997, 2 years before recruitment started in MoBa, Norwegian data showed that approximately 70% of the tooth-coloured fillings placed in adults were polymer-based.[40]

The participants answered questions regarding dental treatment during the first 30 weeks of pregnancy but were not asked to specify in which week of pregnancy they visited the dentist. Hence, a limitation is that we could not study if treatment with polymer-based filling materials could be a factor of importance at specific time windows during pregnancy. The severity of the effects of prenatal exposure to toxic agents appears to be influenced by the degree and timing of the exposure during gestation.[41] Some teratogens cause damage only during specific days or weeks early in pregnancy, when a particular part of the body is formed.[41] A well-known example is the thalidomide-tragedy in the late 1950s and the early 1960s, where the medication taken during days 20–36 after fertilization resulted in serious malformations of the foetus.[42,43]

Some women with the need for dental treatment do not seek or do not receive dental care during pregnancy.[44] This may, in part, be due to their concerns about the potential risk to the foetus, as well as dentists and other health care providers' attitudes and beliefs about the safety of dental treatment during pregnancy.[44]

The findings from the present study, including more than 90,000 pregnancies, are reassuring. However, taken the limitations of a prospective cohort study into account, these findings could be corroborated in case control studies. Thus, access to dental records and thereby accurate and detailed information regarding dental treatment could be possible to obtain.

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