Curriculum Time Compared to Clinical Procedures in Amalgam and Composite Posterior Restorations in U.S. Dental Schools: A Preliminary Study

Abstract

Dental clinicians have an expanding range of biomaterial choices for restoring tooth structure. Scientiic developments in cariology, advances in dental biomaterials, and patients' esthetic concerns have led to a reduction in amalgam restorations and an increase in composite restorations. The aim of this study was to compare teaching time with students' clinical procedures in amalgam and composite posterior restorations in dental schools across the United States. Academic deans in 60 schools were invited to complete a survey that asked for the amount of instructional time for amalgam and composite posterior restorations and the number of clinical restorations performed by their Classes of 2009, 2010, and 2011. Of these 60, 12 returned surveys with complete data, for a 20% response rate. Responses from these schools showed little change in lecture and preclinical laboratory instruction from 2009 to 2011. There was a slight increase in two-surface restorations for both amalgam and composites; however, the total number of reported composite and amalgam restorations remained the same. Of 204,864 restorations reported, 53% were composite, and 47% were amalgam. There were twice as many multisurface large or complex amalgam restorations as composites. One-surface composite restorations exceeded amalgams. Among the participating schools, there was little to no change between curriculum time and clinical procedures. Findings from this preliminary study relect a modest increase in twosurface resin-based restorations placed by dental students from 2009 to 2011 and little change in curricular time devoted to teaching amalgam restorations. The total number of posterior composite restorations placed by students in these schools was slightly higher than amalgams.

Phase down of amalgam

“… 11 A recent study showed that 47% of restorations placed by undergraduates in USA were amalgam. 12 Moreover, 75% of direct restorations placed in molar teeth by general dental practitioners in England and Wales are amalgam. 19 …”

“… 10 , 11 Amalgam is no longer the first choice among instructors, students, or patients. 12 Time spent to teach amalgam will continue to fall, and perhaps it will be on preclinical basis, or cease to exist in the next decade. 7 Even in a post-amalgam era, dentists would still need to adhere to national and international guidelines of mercury hygiene 13 while removing old amalgam fillings or preparing existing restorations to act as the foundation restorations for crowns and fixed partial dentures.…”

Dental educators’ attitudes towards the teaching of dental amalgam

“…A series of studies from 2004 to 2007 from Lynch, McConnell and Wilson identified that curricula of dental schools in the United Kingdom, Ireland and North America were not incorporating modern techniques and therefore a certain “incompetence” existed with graduating dentists inappropriately restoring posterior teeth. Rey et al similarly described the need for an alignment of curricula reflecting the ever‐changing evidence base relating to direct restorative materials.…”

Assessing dental students' professional training satisfaction with operative dentistry teaching and curriculum: A study in Saudi Arabia.

“…The students' attitude towards amalgam restorations and the di culty to convince the patients to undergo treatment with amalgam have been documented. 35,36 This factor may have resulted in a lower level of satisfaction among the level 10 students (p>0.05) ( Table 5). There was no statistical difference in the gender group (p>0.05) ( Table 5).…”