Patients willing to pay

I haven`t placed an amalgam in eight years, so I have been following the "Great Amalgam Debate" with interest. There is no question in my mind that amalgam has been a reliable restorative material for more than a century. I am amazed to see silver fillings in my patients` mouths, which obviously were placed decades ago, no pins, functional, and ugly as hell.

Steve Markus, DDS

Haddon Heights, N.J.

I haven`t placed an amalgam in eight years, so I have been following the "Great Amalgam Debate" with interest. There is no question in my mind that amalgam has been a reliable restorative material for more than a century. I am amazed to see silver fillings in my patients` mouths, which obviously were placed decades ago, no pins, functional, and ugly as hell.

There were problems at the beginning of the learning curve with posterior composites - recurrence, open margins at the base of the box, bite sensitivity. However, through continuing education with such masters as Feigenbaum, Kanca, Dickerson et.al., there is no comparison between amalgam and the results I can obtain using resin.

The learning curve is demanding. One cannot overemphasize the importance of utilizing rubber dam, the need to be extremely meticulous, the need to take substantially more time, and the need, therefore, to charge substantially higher fees for the procedure. My enjoyment of my profession has never been higher. My patients appreciate the art I am able to create in their mouths. No restorations need to be carved out of occlusion to prevent the dreaded fracture of the proximal box after carving. I don`t have to handle the respiration of mercury or worry about its proper disposal. Nor do I see cuspal fractures requiring crowns.

I do not practice in a particularly affluent area. Many of my patients come from "across the tracks" and understand that a $300 three-surface composite may only garner $70 from their penurious and arcane dental reimbursers. They willingly pay their high co-pays for a service they and I consider to be superior to a material that has not evolved significantly since it debuted on the market in the 1950s! New patients are educated by my staff and can decide whether to stay or go elsewhere for their restorations. We don`t lose many patients. Most are happy to have their ugly restorations replaced.

I am concerned that your survey on the great debate will not be scientifically based because you have not surveyed the participants as to their professional bent. I can guarantee the results will be skewed toward the pro-amalgam side, because they still are in the majority. So to ask your readership to take sides in the debate is a moot point. You could have saved publication of the debate and simply asked, "Who likes amalgam?" and "Who likes composite?" I would doubt that, as a result of the debate, the composite side has gained many. I would assume that there would be far less defection from Dickerson`s side.

There is no right or wrong in this issue. I often have said that after having practiced dentistry for 25 years, if it was still the same as it was when my dad got out of dental school, I?d be miserable by now. Thank God for Buonocore?s discoveries. Thank God for my personal savior, Norman Feigenbaum, whose courses got me juiced as a bondodontist, and for the work of all the other mentors who have energized our profession. Thank God for fiberoptics, magnification, and intraoral cameras.

I would never have suspected, 20 years ago, that I would be encouraging my own children to follow me into dentistry. I would never allow my kids to think about going to medical school because of the changes made by the insurance industry that have devastated many of my close friends. The only ones who are content are the ones who are free of insurance ... the plastic surgeons. Our profession has the capability to lift itself, practice by practice, away from the constraints of practicing to the dictates of third-party payers.

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