In the article, "Don't Take My Adhesives Away," in May 2001 Dental Economics, we were led to believe that all that really matters in today's dentistry is to place something that is cheap, quick, and good-looking.
Being retired, I could not find my text on dental materials, so I am at a disadvantage when it comes to things like coefficient of expansion, crushing strength, absorbability, longevity, durability, and dependability. I do know that man has yet to create a filling material that will provide the benefits of gold inlays. Let me count the ways: greater strength in chewing, better protection for thin edges, better and longer-lasting tooth form, and less wear against both the adjoining tooth and the opposing tooth. The cost of maintenance is practically nothing compared to any adhesive, even amalgam.
The main reason for this letter was suggested by an endodontist. When my wife went in to have a root canal, this dentist noticed her many inlays and crowns that had been in place for 40 years. He had to admit the fact that gold was hard to beat. At the same time, he told me something that needs to be investigated: In his practice, the majority of cases that require root canal fillings result from the placement of adhesives.
Is it possible that present-day plastics and adhesives really do more harm than good? Obviously, the majority of practitioners today would reject this concept. After all, the main parts of their bank accounts are in place because of this "new age" approach to dentistry.
Instead of being so concerned about the efficiency of the curing light, may I suggest that dentists return to the "good, old days," when it was more important to place a filling that would last and provide the service that the patient requires, despite the time involved? How many schools teach students how to place a good Class III gold foil? It is not a travesty of justice or judgment to show gold in the human mouth. Unfortunately, Hollywood has taken over, and aesthetics are most important.
Admittedly, my kind of thinking is outdated today. Still, there is no doubt that well-placed amalgam fillings have saved more teeth during the last generation than anything else. Some time ago, this dentist submitted an article titled, "Are gold and silver obsolete?" It was never printed, because the thoughts contained therein would not be accepted by the majority of dentists who are hooked on adhesives today.
Dr. R.G. Willie
Another side to the story
As the dental consultant to Holland America Line Westours Inc., I would like to respond to Dr. William B. Dragan's letter in the April 2001 issue of Dental Economics, where he "complains" that the nurse on duty would not allow him and his friend (both licensed dentists) into the locked dental clinic aboard the MS Ryndam. I am sympathetic to Dr. Dragan's point of view. I'm sure he is qualified to reseat his own crown, and the dental materials required are insignificant in cost.
However, there is another side to the story. Holland America Line dental clinics are staffed by dentists whose credentials have been evaluated by the Marine Medical Department in Seattle prior to receiving a contract to sail as the ship's dentist. Unfortunately, in this situation, no Holland America dentist was assigned to this cruise.
On the surface, the nurse on duty appeared to be unsympathetic to Dr. Dragan's problem, but she was following Holland America's Policy and Procedures, which require her to inform all passengers that the hospital and dental office are for staff use only. This rule is necessary because passengers who are physicians or dentists frequently ask, "Can we just use the doctor's office for a minute?" And this raises liability concerns.
Dr. Dragan and his friend were aboard as passengers, not as registered dentists with the cruise line. Should the unthinkable happen ... a wave rock the ship just as the dentist-friend is ready to cement the crown and it ends up in Dr. Dragan's trachea ... who would be blamed?
Dr. Dragan was understandably upset that Holland America's "Staff Only" policy applied to all passengers, but he unfairly took it out on the duty nurse. He apparently failed to see that the clinic hours and emergency number are posted in numerous locations — the clinic door, the daily program, and his cabin. The infirmary is routinely closed from 12 p.m. to 2 p.m. for lunch, but the medical staff is always on call for emergencies. Our infirmaries saw more than 1,510 dental patients last year and more than 35,000 passengers and 45,000 crew members.
I am sympathetic to Dr. Dragan's plight, and I will take steps to avoid a similar situation in the future. But his obvious belligerence and the spiteful characterization of "Nurse Ratched" seems a little over the top.
A.K. Solhaug, DDS
Dental Consultant, Marine Medical Services
Holland America Line Westours Inc.
Editor's Note: Rules and policies always seem to win over customer service!
