In defense of metallic-based dentistry

I have just skimmed the November 2004 issue and found three articles that refer to “Metal-Free Dentistry.” This is a phrase I hear bandied around frequently of late. I have even heard it used as a brag factor - “I have a metal-free practice.”

There is a growing trend in this area and it disturbs me to observe the wave of acceptance of this and many related concepts. I guess I’m no longer a young turk and have to accept my entrance into the dental codger realm. I remember what it was like to try to match five natural teeth with a single PFM and the difficult balance of optical illusion this required. I was jubilant at the introduction of all-porcelain veneers and the subsequent modified veneers which have revolutionized cosmetic dentistry and expanded the possibilities to a tremendous degree.

A colleague of mine recently recounted a story of a thirty-something Crest-generation young woman who had the misfortune to fracture the incisal edge from an otherwise virgin lateral via a bicycle accident. My friend had a recent dental graduate visiting his office. He was quite pleased to be able to offer a flawlessly matched porcelain veneer to restore the young lady’s smile. After she left the office, the visiting dentist stated that my friend had undersold the case by seven units. My friend was speechless because the postorthodontic young woman had a beautiful natural smile which many of us would have been reluctant to alter. What happened to integrity? Are the pressures to succeed financially so great that we can be forced to consider over-treatment as an option?

I have had the luxury of practicing in Sun City, Arizona, for 16 years. Due to the cosmopolitan nature of the resident population, I have seen dentistry from all parts of the United States and several foreign countries as well. When I see a restoration that is obviously quite old and still functioning well, I ask about where and when it was performed. I have been doing this rather informal oral survey since I began practicing here. It has led me to some conclusions that have shaped my treatment recommendations.

Some of them are 1) Gold works better than anything in the mouth. 2) Even a poorly contoured amalgam can last in excess of 40 years if the preparation and the condensation are correct. 3) Non-precious metal substrate crowns seem to fail in less time than precious metal substrate crowns. One only needs to see a 60-plus-year-old gold foil or one of Dr. Richard V. Tucker’s 48-year-old inlays to believe in gold.

In Dr. James F. Fondriest’s article (November Dental Economics, page 96), I found some comfort in his almost-metal-free concept, but most of the time it appears the tail is wagging the dog. Dental offices have become boutiques, or spas, or some other peculiar vision of health-care delivery. We no longer have patients - we have guests or patrons or, God forbid, clients.

It is really disheartening to see what was once a noble profession become a market-driven entity that spends more time handing out warm towels and utilizing aromatherapy than delivering something that remotely resembles health care.

I guess I’m just an old-fashioned codger purveying antiquated techniques to arrest ancient diseases. It is unfortunate that although we may well live long enough to see the failure of metal-free dentistry on a grand scale, we’ll probably be gone before much of the metallic-based dentistry is recognized for its superior longevity.