Amalgam controversy : current practice, perception, attitudes, and factors associated with clinical decision making among US dentists
Bakhurji, Eman Abduljalil
MetadataShow full item record
Objectives: As part of the United Nations Envirornment Programme (UNEP) effbrts to minimize mercury pollution, a binding agreement on global phase-down of dental analgam use was reached in 2013. While each country may take different approaches to comply with the binding agreement, it is unknown what would be the best strategy for the US. Therefore, the aim of this study is to investigate dentists’perception, attitude and opinions about amalgam, and the relative importance of different patient-related factors on the restorative decision. Methods: A total of 45,557 general dentists and 5,101 pediatric dentists were invited to participate in a pre-tested electronic survey. The survey was sent out using the Qualtrics[TM] software, followed by three reminders. The survey investigated dentists’ perception, attitude and opinions regarding amalgam. It also included hypothetical Clinical scenarios to measure the relative importance of two factors: (type of dental insurance and caries risk) on their restorative preference. Data analysis was conducted using SAS 9.3. Multiple and multinomial logistic regressions were used to investigate the participants’ perception, attitude and opinions about future direction for amalgam. Choice-based conjoint analysis was used to determine the trade-offs affecting the decision-making about amalgam. Results: Of45,557 general dentists and 5,101 pediatric dentists, 1,538 and 850 responses were analyzed. Sixty-two percent of general dentists and 56% of pediatric dentists reported using amalgam. The majority of general dentists (65%) and pediatric dentists (68%) disagreed with banning amalgam, while 53% of general dentists and 60% of pediatric dentists agreed with installing amalgam separators. Multinomial logistic regression showed that respondents’ opinion about banning amalgam and installing amalgam separators varied by their environmental consciousness. Conjoint analysis revealed that caries risk and type of dental insurance affected respondents’ decision about amalgam use, with caries risk more influential for choosing amalgam, than insurance status. Conclusion: The majority of US dentists value amalgam as a useful restorative material, especially for higher caries risk patients. This finding supports the Minamata treaty recommendations for focusing on caries prevention to reduce amalgam use. Policies, including insurance reimbursement, and mitigating mercury pollution while supporting appropriate clinical practice for underserved populations should be implemented.
Dissertation (DScD) --Boston University, Henry M. Goldman School of Dental Medicine, 2015.Includes bibliography: leaves 137-148.
RightsThis work is being made available in OpenBU by permission of its author, and is available for research purposes only. All rights are reserved to the author.