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 June 1999 issue; the range included 203 readers "voting" on the tenth round to 175 votes on the ninth round.
The results of the first eight rounds were printed in the July and August issues.
Steven briefly raised the mercury toxicity issue. "There`s nothing I can say to change the minds of the small minority of dentists who believe that it`s the source of all illnesses," he said. He just asserted that "many intelligent" dentists continue to place amalgams in patients and "loved ones." "Why would we do this if we truly thought this would do harm?" he asked. Dickerson essentially agreed, but he noted that "everyone" acknowledges that mercury is a "poison." "Why is the mouth the only safe place to store amalgam scraps?" he asked, adding, "I find it hard to justify placing a poison in my children`s mouths when I know of a superior restoration."
Your vote: Steven: 58 percent; Dickerson: 34 percent; 8 percent said it was draw.
Steven cited the statistic that 85 percent of all adults have periodontal conditions related to poor hygiene. He asked how the placement of cosmetic restorations in these cases could be justified. "I will facetiously ask them if they want to set up their six-month recall to redo these fillings," he said, "because if they don`t improve their hygiene, they will have recurrent decay." He said he "strongly" discourages these options unless hygiene is improved, thereby improving the success rate. Dickerson said he did not think cosmetic alternatives would "fail." "I think they will last as long as any restoration I could place," he argued.
Your vote: Steven: 60 percent; Dickerson: 31 percent; and 9 percent called it a draw.
Steven said the "Dr. Bondos" do not present all treatment options. When they do, he said, "it`s usually a choice between a direct or indirect cosmetic restoration or gold." He asked, "What`s wrong with sharing all the facts with your patients about all restorations and letting them decide?" Dickerson rebutted that he does let the patient choose, explaining, "They have the choice of doing what we recommend or going to another dentist." He added no one should "feel guilty" about having this approach or "believing passionately enough in an issue to lose a patient."
Your vote: Steven: 62 percent; Dickerson: 28 percent; and 10 percent said it was a draw.
Steven started off by listing reasons why his practice could be considered "cutting edge (air abrasion and intraoral cameras, for example)." Despite these trendy services, amalgams remain a vital part of his practice. He asked, "Just possibly, do you think that many dentists like me really do know what is right for the majority of our patients?" He said he could jump on Dickerson`s "bandwagon and make more money." But he can`t "cross the line of rationalization in order to increase my bottom line." Dickerson focused on the "learning curve" in dentistry. "There is a vast amount of knowledge that I have not even been exposed to," he said. While he praised Steven`s mastery of amalgam restorations, he asserted that dentists who master the "learning curve" in "esthetic dentistry" are capable of doing restorations the "right" way.
Your vote: Steven: 57 percent; Dickerson: 27 percent; and 16 percent said it was a draw.
Steven said he could comprehend the "exclusion of amalgams" in an "ideal world." In such a place, money is not an obstacle, frequent replacements of restorations are acceptable, and complications such as sensitivity do not occur. But he added, "In the real world, this ain`t gonna happen." Steven concluded by pointing out that Dr. Gordon Christensen "doesn`t have a problem with amalgam." Dickerson focused on the latter point. What Christesen later said, according to Dickerson, was "the reason amalgam has survived all these years is because dentists have given this service away."
Your vote: Steven: 52 percent; Dickerson: 33 percent; and 15 percent said it was a draw.