The great white hype, or the no-silver image?

You be the judge! Two well-known lecturers debate the trend toward no-amalgam practices. The first eight `rounds` of debate appeared in the April and May issues. The debate concludes in this issue, and Dr. Gordon Christensen offers some final thoughts.

You be the judge! Two well-known lecturers debate the trend toward no-amalgam practices. The first eight `rounds` of debate appeared in the April and May issues. The debate concludes in this issue, and Dr. Gordon Christensen offers some final thoughts.

Joe Steven Jr., DDS

William G. Dickerson, DDS, FAACD

Round #9

Steven`s Point

Let`s not even discuss the mercury toxicity issue about amalgams. 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.

Suffice it to say that there are many intelligent dentists who continue to place amalgams in the teeth of, not only their patients, but also their loved ones. Why would we do this if we truly thought this would do harm?

Dickerson`s Counterpoint

Another Clintonesque spin. Claim that we are all saying that the amalgam is the source of all illnesses and people will think we are kooks. I have never said that or even implied it. I have never said that amalgam can be shown to be responsible for any disease or illness.

But, everyone, even the amalgam proponents, claim mercury is a poison. And you have still not answered my question that I`ve proposed to you before: Why is the mouth the only safe place to store amalgam scraps? I understand you don`t think it will cause any harm, and you will put it in the mouths of family members. But I find it hard to justify placing a poison in my children`s mouths when I know of a superior restoration.

The fact that we can have differences of opinion on this issue is what makes our country great. But don`t try and make those that have a problem with the mercury issue out to be crazy. And all these other countries that are restricting and, in some instances, banning it, are just nuts, aren`t they? They just aren`t as smart as us Americans. Let`s just accept the fact that neither of us are knowledgeable enough to intelligently debate this issue.

Key Point: Why is the mouth the only safe place to store amalgam scraps? I find it hard to justify placing a poison in my children`s mouths when I know of a superior restoration.

Round #10

Steven`s Point

If you have patients with poor hygiene (85 percent of adults have a perio condition), how do you justify putting cosmetic restorations in their mouths when you know it`s going to fail? Sometimes, after I place anterior composites on patients with poor hygiene, I will facetiously ask them if they want to set up their six-month recall to redo these fillings, because, if they don`t improve their hygiene, they will have recurrent decay.

On these types of patients, I won`t do a posterior composite without strongly discouraging it and warning them that they probably won`t last long unless they improve their hygiene. Are we supposed to refer these patients with poor hygiene out of our office because we don`t have a more suitable material available for their needs?

Dickerson`s Counterpoint

You say, "How do you justify putting a cosmetic restoration in their mouth when you know it`s going to fail?" Therein lies the problem. I don`t think they are going to fail. I think they will last as long as any restoration I could place.

I believe the reason for your lack of faith in these restorations is because you don`t know how to properly do them. It`s not that you are incapable of doing them, but you just have not acquired the knowledge. Don`t think I`m criticizing you and don`t get your self-esteem all knotted up. Just take the first step and realize that you might not be able to get the knowledge from going to a one-day lecture.

If you agree with Dr. Steven`s argument, circle 4 on the Reader Service Card. If you agree with Dr. Dickerson, circle 5. If it`s a "draw," circle 6.

Round #11

Steven`s Point

Let the patient choose. That`s all I ask. Many of these Dr. Bondos say they do give their patients a choice. But it is usually a choice between a direct or indirect cosmetic restoration or gold - naturally favoring the more esthetic ones. They simply tell them that they discontinued using amalgam because of yada, yada, yada.

What`s wrong with sharing all the facts with your patients about all restorations and letting them decide? When a patient requests a white filling for a back tooth, I always tell them, "Great! They look beautiful, but I want you know that they are about 50 percent more expensive and may not last as long." When told the truth, 95 percent of our patients choose the amalgam restoration.

I could easily leave out the part about longevity and increase my production dramatically. But we solved the "busyness" problem years ago, and I do not feel compelled to push this more expensive service. There are cases where a bonded composite is the better choice for a posterior tooth - not many, however.

Dickerson`s Counterpoint

You say, "Let the patient choose." As I explained earlier, we do. They have the choice of doing what we recommend or going to another dentist. There is nothing wrong with this, and you should not make anyone feel guilty for adopting this philosophy or for believing passionately enough in an issue to lose a patient because of his or her principles.

Key Point: What`s wrong with sharing all the facts with your patients about all restorations and letting them decide?

If you agree with Dr. Steven`s argument, circle 7 on the Reader Service Card. If you agree with Dr. Dickerson, circle 8. If it`s a "draw," circle 9.

Round #12

Steven`s Point

I would like to think that I am a dentist on the "cutting edge" who incorporates many of the latest technologies into my practice and is not afraid to provide a full range of dental procedures. In our practice, we use air abrasion and intraoral cameras. We do most surgically impacted wisdom teeth extractions, full mouth extractions, and molar root canals. We do veneers, posterior composites, and gold inlays and onlays. So, why is it that I continue to do amalgams?

Do you really think it is because I can`t learn to do them properly? Next to a complicated, upper-second-molar root canal, a direct composite is a piece of cake! Just possibly, do you think I continue to place amalgams because I believe it is the best restoration for many of my patients? Just possibly, do you think that many dentists like me really do know what is right for the majority of our patients? Why else would I not jump on the anti-amalgam bandwagon and make more money with the higher-priced cosmetic restorations?

I just don`t believe in crossing the line of rationalization in order to increase my bottom line. Plus, you don`t need to cross that line; it`s much easier doing it our way.

Dickerson`s Counterpoint

You probably are a dentist on the cutting edge, as you claim. But I will also tell you that you don`t know what you don`t know. Just because you lecture and have a few high-tech tools doesn`t mean you know it all. There is a vast amount of knowledge that I have not even been exposed to. I know that and accept that I can`t be an expert at everything ... not even close.

You say, "Do you really think it is because I can`t learn to do them properly?" Absolutely not! I know you can. But it is obvious from this diatribe of yours that you don`t yet know how. Esthetic dentistry involves a learning curve and, at first, it will seem difficult as you claim. But when properly done, these restorations are not difficult, they just have to be done right.

If you agree with Dr. Steven`s argument, circle 10 on the Reader Service Card. If you agree with Dr. Dickerson, circle 11. If it`s a "draw," circle 12.

Round #13

Steven`s Point

In an ideal world, I can possibly accept the premises of posterior cosmetic restorations and the exclusion of amalgams. This assumes several things: 1) Money is not a concern. 2) Patients don`t mind having them replaced as needed. 3) All dentists would do them properly so patients would not suffer from sensitive teeth and other complications. In the real world, this ain`t gonna happen!

Someone needed to get this message out to provide a little balance to the one-sided discussions that we constantly hear about amalgams. I also hope that this message helps most dentists feel better about providing quality services to their patients when allowing the option of amalgam. Take pride in the care you render to your patients. Oh, by the way, there is someone else who doesn`t have a problem with amalgams. You may have heard of him; his name is Dr. Gordon Christensen!

Dickerson`s Counterpoint

What a sad indictment of our profession - no comment really is necessary. You claim that even Gordon Christensen likes amalgam. I think you will find that this is not the case. In an article several years back, Gordon wrote that he does not like amalgam because he doesn`t like putting mercury in someone`s mouth. He then went on to say that the reason amalgam has survived all these years is because dentists have given this service away. He is right, and your comments help continue that trend. Too bad for dentistry.

I totally respect your right to your opinions. I will defend to my death your right to have those opinions. I just wish you had thought about the rights of others before you libeled and slandered them. Dentistry does not need negative attacks and malicious propaganda in an effort to promote one`s agenda.

If you agree with Dr. Steven`s argument, circle 13 on the Reader Service Card. If you agree with Dr. Dickerson, circle 14. If it`s a "draw," circle 15.

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