Choice Between Composite and Amalgam Restorations According to Dentists and Patients Perception

Aims : The aim of the current study was to evaluate dentists and patients choices of type of restorative materials applied in fillings and their knowledge about the mercury content in amalgam restorations. Matrials and Methods: a cross sectional descriptive study based on two types of questionnaire, one for the dentists(119) and the other specific for the patients (500) were distributed to determine the knowledge and awareness, preference of amalgam and composite restorations. Results: showed that the awareness of the dentists about the amalgam controversy came from different sources, half of the dentists sample stated amalgam restorations were safe, were as 21% of the sample stated it unsafe. Placement of the selected restoration(either type) was influenced by different factors, recall appointments of patients complaining from several complaint was mostly from composite, 67.6 % of patients didn’t have any knowledge about harmful effect of mercury release from amalgam with the majority of the patients stating that they preferred composite or a tooth colored restoration. Conclusion: within the limitations of this study awareness of safety of dental amalgam among the dentists was low, with a large agreement that postoperative complications were mainly due to composite restorations. For the patients, the majority of them did not know anything about issues related to the mercury content of the amalgam and the majority of them favored the placement of composite restoration similar to the color of their teeth.


INTRODUCTION
Worldwide and for more than 150 years, amalgam has been known for more than being a dental restorative material, it has proved to be a valuable and dependable filling materials which is relatively cheap and tolerant to the oral environment with minimum problems for millions of patients around the world ( Alternatives to amalgam are composite restorations that have been improved in their formulations in order to withstand and tolerate excessive stress and wear in addition to glass ionomer restorations and compomer (9,10,11).
The aim of the current study was to assess the source of awareness of dental personnel's working in Mosul city to the use of dental              approximately 50% mercury (14) . The current cross sectional study aimed at evaluating dentists and patients perception and preferences to the major types of restorations known in dentistry and that are mostly used.

Dentists and Patients Choice Between Amalgam and Composite Restorations
Looking at the demographic variables of the cluster sample of dentists that participated in this survey showed that male dentists were slightly larger than female dentists, with the majority having served for more than 5 years and were mostly general dental practitioners. The information on the internet is usually updated, which helps in updating the recent knowledge and motivate dentists to undertake research activity on any particular field (16) .When the dentists were asked about the safety of the amalgam restorations 50.4% of the sample replied that it is safe, this is much more than that reported in a previous study that reported a 10.82% of the dentists opinion that amalgam is safe (13) , according to the ADA opinion about amalgam is that it is the safest and most affordable and durable dental materials for specific treatment needs (17) , this includes the option to use dental amalgam, which the scientific community has extensively reviewed and affirmed to be a safe and effective restorative material, the results of two independent clinical trials designed to examine the effects of mercury release from amalgam on the central and peripheral nervous systems and kidney function noted that "there were no statistically significant differences in adverse neuropsychological or renal effects observed over the 5-year period in children whose caries was restored using dental amalgam or composite materials" (18,19) and although some people express concern about mercury vapor released from dental amalgam the quantity released is well below the limits set by the US Environmental Protection Agency and the World Health Organization (20) .Yet a large proportion of dentists 28.6 % were uncertain about the safety of amalgam restorations, this figure is more than that reported in another study (12) .
When the dentist were asked when to replace amalgam restorations, the majority 42.9 % stated when there is a defective restoration, while 38.6% stated that they would replace amalgam according to their judgment for esthetic purposes, and only 18.5% agreed to replace amalgam according to patients wishes.
The current study showed that that the majority of dentists agreed that the recall appointments For the patient sample, the largest proportion of the sample was in the age group equal to or less than 30 years and the primary aim of applying restorations was primary caries, with females attending for treatment more than males which is attributed to the reason the youth and females utilize dental services more than males (27) and are more considerable about their appearance.

CONCLUSIONS
Within the limitation of this study (limited number of dentists and patients) awareness about the safety of amalgam restorations among the dentists was low, with most of the dentist agreed that amalgam is easy to use, has lower cost as compared to composite and produces less postoperative problems. Patients knowledge about the mercury content in amalgam was very low, with the majority of the sample requesting a composite or tooth like restoration. Amalgam is still popular among patients and dentists in Mosul.