The Amalgam Debate: How you scored it!

July 1, 1999
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."

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 likely reflect the final tally for the April issue; 824 readers "voted." At press deadline for the July issue, readers were still responding to the writers` comments in the May issue, and the June issue had not yet been distributed. We will keep you updated.

Opening remarks

Steven opened the debate by stating that many lecturers in dentistry make practices who still use amalgam feel "terribly inferior." While supportive of "revolutionary techniques," he said amalgam remains a "time-tested ... valuable service that should be available to all patients." Dickerson countered that lecturers such as himself "go on a rampage" to build up dentists` self-esteem, not tear it down. He also questioned research that amalgam is "the most durable, serviceable ... safe restoration," referring to research that crowns have a longer life span.

Your vote: 66 percent agreed with Steven; 28 percent agreed with Dickerson; and 6 percent declared it a draw.

Round 1

Steven opened it up by stating, "It`s all about money!" He asserted that seminar leaders push "cosmetic dentistry" as a solution to the "busyness problem." He wrote, "The best way to launch a career in lecturing is to gain prominence by advocating an amalgam-free practice." Dickerson was quick to reply that Steven`s assertion was "purely libelous." Dickerson added that many leaders in dentistry take a "political risk" in going against the "popular view." He wrote, "I also believe that the reason most lecturers don`t do amalgam is that they honestly don`t feel it is a worthy restoration."

Your vote: 57 percent agreed with Steven; 35 percent agreed with Dickerson; and 8 percent called it a draw.

Round 2

Steven said "bread and butter" dental practices treat "average" patients, who are unable to pay the fees "Bondodontists" charge. He said practices limited to cosmetic dentistry can resemble a "Mercedes dealership," if they desire it. All other general dentists, though, should have "optional treatment choices." Dickerson countered by saying patients are not "properly educated" about the "value of keeping their teeth." He said patients have the choice of going to a "cheaper" dentist." He stressed, though, "But just as patients should have a choice, I also should have the choice of not having to place a restoration I find ethically reprehensible.

Your vote: 60 percent agreed with Steven; 33 percent agreed with Dickerson; and 7 percent said it was a draw.

Round 3

Steven said that many dentists begin turning away patients who don`t want "quality" dentistry. Cosmetic procedures are a tough sell, he said, and practice income does not necessarily increase with the new procedures. Dickerson argued that quality of life is an important issue to consider, too. He wrote, "These doctors stopped the assembly-line process, work fewer hours, see 85 percent fewer patients, have the time to spend with their patients, enjoy what they do for a living much more, and didn`t lose a dime in the process." He said he was unaware of dentists being unable to increase income as a result of not placing amalgams.

Your vote: Both debaters got 42 percent of the votes; 16 percent said it was a draw.

Round 4

Steven said "cocktail discussions" among dentists frequently lead to criticism of peers who are guilty of "overhangs, open contacts, thumbprint anatomy, etc." in amalgam restorations. He was skeptical of "turning loose" dentists to do posterior composites. "In the real world of dentistry, you`re dreaming if you think it`s [commitment to the extreme detail required in cosmetic dentistry] going to happen with the majority of dentists." Dickerson opted to refer to an earlier criticism by Steven that lecturers demean dentists who use amalgam. He accused Steven of being hypocritical. "What you are saying is that, since there are a lot of lousy dentists who are not good enough to do composites, we should stop telling them that they can." Dickerson then said he "truly believed" that "any" dentist can be trained to do esthetic restorations correctly.

Your vote: 48 percent of readers agreed with Steven; 41 percent agreed with Dickerson; and 11 percent declared it a draw.

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