Park L. Firebaugh, DDS
Based on the letters I have read over the past year, it is clear that some dentists have strong opinions on both sides of the amalgam debate, but I have to feel that most dentists are in the middle somewhere on this issue. I find that I agree with many points made by both sides, but I don`t feel that I need to choose sides. And I think that I am like many dentists in that I see a broad range of patients with varying needs and desires. I will gladly place composites on posterior teeth if patients ask for something that looks nice or if they want to avoid mercury, but I don`t exclusively limit myself to composites. I find that some patients truly don`t care to pay the higher fee for a composite, even if it looks better and even if they have been educated about other benefits.
And how in the world do dentists who don`t use amalgam restore those ridiculously difficult subgingival, Class V wraparounds on second molars? Dam replacement is impossible, and isolating with cord is not always successful, so contamination is sure to be a problem for composites or glass ionomers. Finishing also can be a chore. Aside from a crown, what can I offer a patient who has many such lesions, poor hygiene, and no money? While it isn`t the perfect solution, I am grateful that amalgam is available for such situations, because I don`t know what else would realistically have a chance at working. I use Dyract for most pedo restorations, but I am thankful that amalgam is available for those little hell-raisers where you feel lucky to have accomplished anything.
I wish I had the charisma or confidence or whatever it is that allows some dentists to perform ideal dentistry on all of their patients. I know what is ideal and what can be done, but I rarely see apathetic patients make miraculous changes in oral hygiene and spending habits so that this becomes a reality. I admire dentists who are widely published, who lecture internationally, and who always do ideal, excellent dentistry, because it gives me something to shoot for. But I don`t think I have to think of myself as a lower life form because I don`t limit my practices to composites only.