The Amalgam Debate: How you scored it!

In three issues (April, May, and June), Dental Economics published a debate between Drs. Joe Steven Jr. and William Dickerson about the trend toward no-amalgam practices. We asked readers to let us know who they agreed with, or if the comments made by both writers represented a "draw."

In three issues (April, May, and June), Dental Economics published a debate between Drs. Joe Steven Jr. and William Dickerson about the trend toward no-amalgam practices. We asked readers to let us know who they agreed with, or if the comments made by both writers represented a "draw."

The percentages below likely reflect the final tally for the May 1999 issue; the range included 401 readers "voting" on the fifth round to 385 votes on the seventh round. At press deadline for the August issue, readers were still responding to the writers` comments in the June issue. We will keep you updated. The results of the first four rounds were printed in the July issue.

Round 5

Steven said too many people interpret "cosmetic dentistry" to mean the same thing as "quality" dentistry. As an example, he referred to eight MODBL pin-retained amalgams in his father-in-law`s mouth. For years, he kept "an eye on them," thinking he would need to replace them with crowns. "Many dentists would have crowned those eight teeth years ago ... Conservative, traditional treatment saved him needless inconveniences and expense." He said that he sees amalgam cusps that he capped with amalgam 15 years ago, and "they`re doing great." Dickerson countered, first, by asking, "Did you remove them (the father-in-law`s restorations after he passed away) to see how much decay was under them?" In regards to capping amalgam cusps with amalgam, he remarked, "I challenge you to show me any scientific literature by a respected clinician that says this is an acceptable treatment." Dickerson asked, "Again, is this the best thing for your patient?" referring back to a question often aimed at cosmetic dentists.

Your vote: Steven: 63 percent; Dickerson: 31 percent; 6 percent said it was draw.

Round 6

Steven pleaded, "Don`t we have any fiscal responsibility in trying to keep the cost of medicine down? He said Americans spend $42 billion annually on dental care. The figure would "double" or "triple" Steven wrote, if patients paid "$300 to $500 or more for an indirect Concept or Empress." Dickerson accused Steven of "perpetuating the guilt that dentists have for adequately charging for their work." He pointed out that "dentists` incomes have not kept pace with inflation in 23 out of the last 25 years." He also emphasized that Americans spend "billions more" on cosmetic surgery, gambling, dog food, tobacco, etc. "Stop making dentists feel guilty about charging a fair price for what they do," he stated.

Your vote: Dickerson: 49 percent; Steven: 43 percent; and 8 percent called it a draw.

Round 7

Steven observed that amalgam is still the material of choice for a subgingival Class V on a molar or a deep gingival box on a Class II. He still agrees with Dr. G.V. Black`s concept of "extension for prevention" and questioned the logic of doubling a margin length with an inlay or onlay. Steven said that a facial amalgam would last "20 years" at "one-tenth" the cost. He then asked the question that riled Dickerson, "How can you tell a single mother of four children that you do not provide this service and still sleep at night?" Dickerson retorted, "How can you sleep at night knowing that you destroyed healthy tooth structure unnecessarily?" He refuted a claim that esthetic restorations have to be "redone" continually. He reminded Steven of the "advances" made with dental materials. "What if, in two years, dentistry discovers a way to restore it even more conservatively. Too bad if it`s already been destroyed by an overzealous preparation."

Your vote: Steven: 53 percent; Dickerson: 36 percent; and 11 percent said it was a draw.

Round 8

Steven said that "amalgam-bashers" claim decay is under "every old amalgam they remove." He asked, "How come I don`t see the same thing in my practice?" In his practice, Steven said he finds "plenty" of recurrent decay under posterior composites. He asked another question, "If every amalgam leaks and gets recurrent decay, shouldn`t we be seeing tons of teeth needing root canals?" He also said the "Dr. Bondos" complain about amalgam fracturing cusps. He noted that "I also see virgin teeth with fractured cusps." Dickerson referred to a study indicating decay under at least 50 percent of amalgam restorations (the restorations examined were "deemed clinically excellent"). He also stated that the scientific literature supports the contention that the expansion properties of amalgam causes fractured cusps. In response to Steven`s claim that it is "overkill" to pursue "more expensive" treatment just to assure that a few teeth "don`t break," Dickerson responded, "Why is placing a tooth-supportive material that prevents the tooth from fracturing overkill?"

Your vote: Steven: 53 percent; Dickerson: 36 percent; and 11 percent said it was a draw.

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