The debate over amalgam use in our profession continues, as seen by the responses to my last blog posting and recent letters to the ADA News discussing the issue. I clearly stated in my last posting that I do not feel amalgams pose a health threat to us, but I am still mystified as to why we as dentists cling to this material.
The energy amalgam proponents spend on defending amalgam would be better spent demanding that newer materials be developed to restore severely decayed teeth. Large composite buildups are not indicated; it was dentists who did not understand the limitations of composites and used them for the same clinical situations that an amalgam would be used.
The best talking point I've heard mentioned is that clinicians can get away with doing sloppy dentistry with amalgam because it works despite improper isolation, prep design, and improper occlusion. It is successful even in the hands of the most unskilled operator. A second-year dental student can do an above-average amalgam, and in some states assistants place and carve amalgams. It takes years to feel comfortable with the proper handling of composites, and knowing the chemistry and science of the resin is essential. Most dentists do not invest the time to learn adhesive dentistry properly, and many of the new dentists cut corners to save time and rush through the procedure.
In additional, the dental companies pushed 7th generation bonding materials, and many dentists jumped on board because they did not know what they did not know. There are just too many chemicals in one bottle that most likely was not shaken before the drop was dispensed, resulting in low- to no-bond strength. Of course there will be leakage and recurrent decay.
If composites are placed properly and their indications are not abused, they are a superior treatment. It is time we stop blaming the materials and look at ourselves and our abilities to treatment plan and make the proper material selection. When was the last time you took a hands-on, full-day composite course or an onlay course?
As mouth physicians, we owe it to our patients and our profession to provide the best dentistry we can.
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