Amalgam — is its continued use 'criminal?'

The anti-amalgamist rose in the morning to the sound of the alarm clock and turned the light on.

by Michael J. Wahl, DDS

The anti-amalgamist rose in the morning to the sound of the alarm clock and turned the light on. Since it was a bit cool, he turned up the thermostat of his central heating system. Like every other morning, he then walked to the bathroom, where he used the toilet and then took the daily aspirin that his physician had recommended. A voracious reader, he scanned both The New York Times and The Wall Street Journal as he ate breakfast.

Before he left his house, his office staff telephoned to remind him that, after seeing some morning patients, he was to give a lecture that afternoon at a large dental meeting. After driving his automobile to the office, he studied the radiographs of his first patient. He complimented the patient on the fine gold restorations in her mouth, then proceeded to place several posterior resin-composite restorations under a rubber dam while the patient was under nitrous oxide analgesia and local anesthesia.

The morning patients were treated efficiently and without complications. The anti-amalgamist then took the train to a nearby university, where he was to give a lecture on "The Crime of Dental Amalgam." He quoted from an article he had read by Dr. Bill Dickerson, calling it "a crime [that] the most common restoration today is the same one as it was 100 years ago. Where is the progress in our profession? What other industry has not had a significant advancement in the last 100 years?" The audience gave the anti-amalgamist a rousing ovation, convinced that the use of amalgam was "criminal."

It was odd that the anti-amalgamist singled out dental amalgam as criminal because the material is more than 100 years old. He did not mention the alarm clock, the electric light bulb, central heating, the flush toilet, aspirin, The New York Times, The Wall Street Journal, the telephone, automobile, radiographs, gold restorations, the rubber dam, nitrous oxide, local anesthesia, or the train. Each of these items also is over 100 years old, but still in common use. Even the history of resin composite can be traced to the discovery of acrylic acid more than 150 years ago and to the discovery of methacrylate esters and their polymers more than 100 years ago.

The moral of the story? Don't be critical of a material or technique just because it has been around for a long time. Keep in mind that, although it has been in use for more than 100 years, modern amalgam and amalgam techniques bear little resemblance to what was used 100 years ago. In G.V. Black's day, unmeasured components of amalgam were mixed with mortar and pestle and then put into squeeze cloths. Then the amalgam was placed into teeth prepared with sharp-line angles and "extension for prevention." Now, premeasured, self-activated, encapsulated components of high-copper amalgam are mixed in electric triturators and bonded into conservative preparations with rounded-line angles.

Has amalgam been around a long time? Yes — and despite reports of its demise, it will be around for a long time to come. There may be undesirable aspects of any dental material, including amalgam, but longevity is certainly not one of them. On the contrary, as is the case with gold restorations, the rubber dam, and anesthesia, longevity is one of the many positive attributes of this remarkable material for the new millennium — dental amalgam!

Michael J. Wahl, DDS, is the creator of the presentation and home study courses, "Medical Myths of Clinical Dentistry" and "The Lazy Dentist's Guide to Excellence." He is in full-time private general practice in Wilmington, Del. He can be reached at lazydds@aol.com or (302) 655-1228.

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