On composite resin materials. Degradation, erosion and possible adverse effects in dentists.

PURPOSE The aims of this thesis were: 1. To study the effect of water and pH on composite resin materials in vitro by assessing sorption, solubility, monomers eluted and flexural properties. 2. To study adverse effects on the skin in dentists possibly caused by acrylic resin-based materials. MATERIALS AND METHODS Proprietary composite resin materials were used for the in vitro experiments. The tests were performed according to the ISO 4049 (1988) with the exception of McIlvaine's solution used in Study II and the storage times. The analysis of eluted monomers was performed using HPLC. The flexural properties were tested in a three-point bending equipment. The secant modulus and deflection at break were calculated for description of the viscoelastic behaviour of the material tested. To study the adverse effects on skin in dentists, a questionnaire was sent to 3500 randomly selected Swedish dentists. A response rate of 88% was achieved and the data were statistically analysed and compared with the results of two studies on skin symptoms among the general Swedish population. Dentists living in the three main cities in Sweden who had experienced hand eczema during the last 12 months were invited to a clinical examination in which a patch test was included. RESULTS A wide range in sorption and solubility over the test period was found, with low sorption values observed for materials containing hydrophobic matrix monomers. A maximum concentration of monomers eluted was found after 7 days of storage, and TEGDMA was the main monomer released. pH affected the sorption and solubility behaviour for two of the three materials tested. The flexural strength and modulus of the composite resin material were lowered after water storage and the secant modulus and deflection at break could describe the viscoelastic behaviour. The prevalence of dry skin and hand eczema was high in dentists compared to two age-matched general population samples investigated using identical questions. The most important predictor for adult hand eczema was found to be childhood eczema. At the clinical examination, irritant contact dermatitis was the predominant diagnosis. Seven per cent reported skin symptoms when working with acrylic resin-based material but the true prevalence of hand eczema caused by acrylates was below 1%. Contact allergy was diagnosed, however, in 50% of the dentists, mainly due to other allergens such as nickel, perfumes or rubber chemicals. CONCLUSIONS The matrix composition was shown to be important for the sorption and solubility behaviour of the composite resin materials tested and a maximum release of monomers occurred after 7 days of storage. pH affected the water sorption and solubility behaviour. Calculation of the secant modulus and the deflection at break allowed the plasticising effect of water on composite resin material to be observed. The prevalence of hand eczema was high among dentists, with irritant contact dermatitis as the predominant diagnosis. Childhood eczema was the most important predictor for adult hand eczema. The prevalence of hand eczema owing to acrylates was below 1%.