Let's back up a minute

Oct. 1, 2002
In the article, "Back Up Before You Go Forward" (August 2002 Dental Economics), the author does a fairly good job of covering the basics of data storage. Having used all of the items mentioned (CD-RW, DLT, online backups, RAID systems, etc), I'm surprised at the lack of coverage of simple hard drives.

In the article, "Back Up Before You Go Forward" (August 2002 Dental Economics), the author does a fairly good job of covering the basics of data storage. Having used all of the items mentioned (CD-RW, DLT, online backups, RAID systems, etc), I'm surprised at the lack of coverage of simple hard drives.

The one big thing I don't like about DLT (tape backup) systems is that when — not if — a computer crashes, you have to replace the hard drive, reinstall all of the software (assuming you can find the software to run your backup system), and rebuild the information from the tape.

Having done this several times myself, I know that this is a time-intensive process that most dentists are not up on. I've found that computer crashes are like toothaches; they never happen at a good time. A simple and cost-effective media is an external hard drive. My office is completely paperless (X-rays, charts, images, you name it) and runs into the double-digit gigabytes for storage space. A backup tape will run for at least two hours each night. If something happened to that tape, I'm out the previous day's data (assuming a rotating stock of tapes).

Using an external hard drive with a USB 2.0 connection, I can back up my entire database in less than five minutes. It's done while I'm checking the day sheet, putting a few things away, etc. The backup then goes home with me or an employee each night. In the event of a computer crash, I can plug the hard drive into any of my office computers, and simply by redirecting my practice-management software's pointer to the database to this external hard drive, I'm up and running in about five minutes.

The cost of hard drives continues to plummet, while the capacity shoots up. A mere five years ago data storage in these amounts was somewhat expensive. Now it's down to less than 50 cents per gigabyte! In my mind, you can't beat that!

Benjamin Young, DDS
Sandy, Utah

A Pepsi, a Bud, or orange juice?

Dr. Daniel R. Sweet's Viewpoint in the August 2002 issue of Dental Economics was more entertaining than factual, in my opinion. It still fell short in that regard, though. When a writer calls the reader "chum!" and in his concluding remarks focuses on "the real issue" of "how to do the new procedure quickly and efficiently," I can't help but put him with the growing group of doctors using composite fillings as a profit center.

Nowhere did Dr. Sweet mention patient autonomy and informed consent in choosing composites vs. amalgams. He did not mention gold and porcelain restorations, both of which are superior. In his advocating composites over amalgams, he did not mention that composites have toxic properties. It's just one reason the FDA, in a strictly worded document in late 1998, advised the dental manufacturing community to share the components of these resins (www.fda.gov/cdrh/ ode/642.pdf). In it, they cited several known ingredients used, like urethane dimethacrylate, which may be even less safe than entombed mercury.

In Spahl, Budzikiewicz, and Gieurtsen's study "Determination of leachable components from four commercial dental composites by gas and liquid chromatography/mass spectrometry" [J. Dent. 26(2), 137-145 (1998)], they were able to identify cytotoxic chemicals that leach from composites over time. They wrote, "The extractable quantities of composite resin components should be minimized, either by reducing the mobility of leachable substances within the set material or by applying less-water-soluble components. Furthermore, all ingredients of a dental composite should be declared by the manufacturers, in order to identify those substances in a product which may cause adverse side effects in patients and dental personnel." This may have been the study that prompted the FDA to act.

As doctors of the healing arts, it is our duty to provide optimal care for our patients, whether or not it is "quick and efficient." While I have never treated myself (when working with amalgam in my patients) to Dr. Sweet's "luxury of sloppiness," I did do the deep distal restorations on maxillary second molars of "uncooperative patients," as he mentioned. Because of my attention to detail, I am aware of their continued serviceability, now 10-plus years since.

The goal is to use our armamentarium of dental materials intelligently, scientifically, and humanely. While composites do have a place in dentistry (and, admittedly, more were placed last year than amalgams), they are no panacea for restorative care. After all, in America, the per capita consumption of canned soft drinks is 53 gallons. For beer, it is 31 gallons. Is that a reason to choose a Pepsi over a Bud? What's wrong with more-expensive orange juice?

Richard W. Waters, DMD
Athens, Ga.

First-class journal; third-class Viewpoint

Dental Economics is a first-class journal that had a third-class Viewpoint in the August 2002 issue. I was so disappointed to read Dr. Daniel R. Sweet's article, "Rush to Judgment." I have never read such a narrow-minded, ego-driven, and unintelligent dental article. He takes every dentist who does not work within his guidelines and groups them together into a toxic, sloppy group of practitioners. I am a dentist who chooses to place posterior composites instead of amalgams, but I do so because of knowledge and judgment, not because I am a self-proclaimed cosmetic dentist.

Jill DuLac, DDS
Edina, Minn.

"Sweet" talk

Dr. Daniel Sweet's Viewpoint, "Rush to judgment," is well-written and expresses his opinion about the amalgam/composite controversy. Unfortunately, this kind of talk seriously harms dentistry and all dentists. I am referring to the continued focus on the hazards, especially of amalgam (e.g., mercury toxicity).

Dr. Sweet uses terms (such as "toxic mercuric-silver biofilm," "cringe," and "hazardous materials permit") that cater to the emotions, but, in reality, this is a case of the pot calling the kettle black. Certainly all heavy metals are toxic in some concentration (e.g., silver, mercury, and copper), but the ingredients in composites also are toxic in specific concentrations too.

If one would select absolutes, as many dentists like Dr. Sweet seem to have done, we all could tell our patients that we no longer are filling their teeth with toxic mercury, that instead we are filling them with stuff that causes abortion, cancer, and heart attacks. The good news is that these situations (for amalgam or composites) are so rare that they are insignificant ... in fact, theoretical. The bad news is that once the public and politicians get emotionally aroused by this foolish talk, not only will amalgams be banned, but composites too. They all will get swiped with the same nonscientific, we-want-to-be-100-percent-safe brush.

I advise Dr. Sweet and others who have time to debate the amalgam/composite controversy to leave the health issue out of the discussion; it's a wash. Concentrate on the other issues: aesthetics, cost, comfort, durability. That's where this debate should be headed.

E.J. Neiburger, DDS
Vice president, American Association of Forensic Dentists
Waukegan, Ill.

My wife is my greatest asset!

I want to compliment you on your dedication to our profession and the guidance you provide to young dentists like myself. I have been reading your magazine for quite some time. It has definitely assisted me in obtaining my goals, providing great practical information.

In fact, I recently opened my own practice from scratch. So far, we have been doing very well. We strive to provide personalized and comfortable care, and it seems to be paying off, even during these times.

I also contribute our office's success to my wife. She is, indeed, my greatest asset! When I read the article about Dr. Greg Psaltis and his wife, Mary Ellen, "Your most valuable worker" (May 2002 Dental Economics), I could definitely relate.

Marzena and I have been married for six years. We have a four-year-old son and are expecting another in early September. Not only can she chairside-assist (she's an RDA trained in Ontario and California), but now that we have our own office, she overlooks the business and management area as well.

Upon graduation from dental school, I enrolled in the U.S. Navy for an AEGD residency and then two years of general dentistry. Once I completed my military dental career, I returned to Michigan, where I joined a group practice for about two years. During this time, I had the honor of hearing Dr. Bill Dickerson speak. He definitely sparked an interest in me to provide comprehensive cosmetic dentistry to my patients. Soon afterwards, with the encouragement of Marzena, we decided to open our own office.

It has been a year-and-a-half since we opened our practice here in Michigan. We concentrate on restorative and cosmetic dentistry. It has really been great. Already we've been on the local news for our leadership in cosmetics and written up several different times for our dedication to aesthetics and five-star service. Recently, I was honored to receive the Dr. Woody Oakes Scholarship and Award for Excellence in Dentistry. I'm pleased to say that my cosmetic work will be featured on the next CAESY system.

Currently, we are attending more and more continuing-education courses to better ourselves. It's amazing what you can achieve by implementing the information you learn at courses and from trade journals such as yours. I can confidently say that I have learned a lot from your publication! Thanks again for all of your support and the information you provide!

Ara Nazarian, DDS
Troy, Mich.

An ad for ViperSoft in the August issue of Dental Economics listed an incorrect phone number. The correct contact number is 1-877-VIPERGO.

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