Amalgam or not?

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tanwe461

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Well, just want to have an overall view of you guys.....
What actually do you think of amalgam restorations?? This is still a very wide debate in the world...some suggesting that we use amalgam, some not. However as far as I am aware, we use amalgam for posterior teeth or so, and composites or GIC for anterior teeth. But then again, many patients are still very sceptical of the mercury content in it. Although we have tried to convince patients that the mercury level is pretty safe, but they somehow don't really buy our story.
What do you guys think about this issue?
 
what we were told is that the manufatures try to push composites because it's really cheap to make and the profit margin is very high (for them), but much lower for amalgam.
 
They told you that the profit margin was larger for composite? I wonder why? It has to be for charging the patient more, because amalgam is cheaper to work with! I like amalgam, actually better than composite for its properties, but I hate the fact that the mercury vapor is there.

It may or may not be harmful, who truely knows, but one things for sure, I do not like breathing it!!!
 
manufacture profit, not the profit of the dentist....
 
amalgam is safe and on its way out

why is on its way out? Not bec its bad for you, but bec technology has advanced and newer better materials are coing out

Its like TV...the CRT tv's that are probably in 95% of homes are on there way out being replaced by plasma. Not everyone is going to have plasma overnight just like not everyone is going to switch to newer materials overnight

As the cost of new materials con't to drop, amalgam will be gone for sure. Our society is very self conscious and doesn't want a mouth with these sliver things all in them bec they make think others think its ugly...so society is demanding materials that look more like natural teeth

So two factors are leading to the disuse of amalgam

1) Newer better materials
2) Simple supply and demand
 
No amalgam will not be out of dentistry, there will always be cases for it. Like a kid thats biting pinching spitting etc.. Amalgam is the way to go, Also you use amalgam for endo and its a cheap core, compared to a gold cast one.




Brocnizer2007....What materials are "better" than amalgam, certainly not composite! I say gold all the way, cause its by far the superior material, but price and looks are way out.




ItsGavinC..... If your school doesn't teach any amalgam, you need to go to another school while you are just startin, cause you will need to use amalgam!

Stargirl! I see what you are talking about now!
 
Those materials I speak of are still in testing/trial period...when I was at the UF interview we talked about it but I forget the name.

And there is a law that is coming out shortly (around 5 years) that will ban amalgam in this country. I don't see a need for a ban, but some dorks in congress do. I'll rumage through my papers and get the congress womans name that wrote the bill. Damn, those papers are in FL...can you guys wait unitl thanksgiving???
 
Originally posted by ItsGavinC
There's a high chance that we'll never learn about amalgam at my school.
Click to expand...

That's interesting; very forward looking of the school. I think there's value in learning historically used techniques in your field, though.

ie, in ENT a true radical neck dissection is really not done much anymore except in particularly advanced cases. Selective and modified radical necks are much more common. However, I still need to know the full technique for those rare cases when it's called for.

Seems like you might want to learn it if not for history's sake, then at least for those times that you're on a trip to South America or an underserved clinic and they only have amalgam available for you.
 
I think in some ways amalgam has it's goods as well. I mean, it self seals and doesn't shrink and expand like composite. The thing is the appearance is not too nice, and also the mercury scare thing is an issue too. That is why we only use it on posterior teeth where appearance isn't too important as compared to composite. Amalgam is definitely MUCH cheaper....
 
Originally posted by ItsGavinC
There's a high chance that we'll never learn about amalgam at my school.
Click to expand...

i think it's pretty ironic that a school that aims to train their students to serve the less wealthy would deny their students the opportunity to learn about one of the cheapest most proven dental restorative materials that are currently available. I don't think amalgam is gonna be on it's way out soon..or will there be a law banning it (i'm sure the ADA will have a thing or two to say about that...) Although it isn't esthetically pleasing, it is easy to work with and it doesn't require several trips to the dentist to complete. (as opposed to say a crown which may require 2 or 3 visits) I'm sure there are plenty of great materials that are being developed and tested but until they are actually tried in the clinic and we discover how long those materials actually last in a real mouth, amalgam will be with us for a while.

p.s....not everyone likes tooth colored material...there are patients that we've studied that have requested gold crowns for anterior teeth...and love to show off their metal mouths! 😀
 
FEDERAL BILL TO BAN AMALGAM

H.R. 4163: "To prohibit after 2006 the introduction into interstate commerce of mercury intended for use in dental filling, and for other purposes."

If passed, the bill will

Creates an immediate ban on the use of mercury/silver amalgam dental fillings in children, pregnant females, and nursing mothers.


It will require health warnings to all patients receiving mercury amalgam fillings.

Total ban on mercury amalgam fillings by 2007.

On 10 April 2002, Representative Diane Watson (D-CA) and Representative Dan Burton (R-IN) introduced this bill, H.R. 4163, into the United States House of Representatives.

I attached the bill going through congress

What a mess...I wonder who gave her the bright idea for this. Hopefully the bill will die if it hasn't already
 

Attachments

There are many "dumb" bills out there that will never get passed, that being one of them!
 
I'm surprised Ralph Nader hasn't gotten involved. I mean this sounds pretty goofy...stupid holistic dentists 😉
 
Why would they want to pass a bill to ban amalgam? There is no concrete studies that shows that it's harmful....
 
Why would they want to pass a bill to ban amalgam? There is no concrete studies that shows that it's harmful....
Click to expand...

...Nor was there ever any evidence that silicone breast implants caused any harm. That didn't stop the lawyers from making millions off it. It didn't stop the FDA from banning them.

You have to realize that our legislative and legal systems no longer make decisions based on logic; important, life-altering decisions in this country are now often based solely on emotion. Things have to look good in a 30 second campaign ad. Science and logic take too long to get across to voters so these have been abandoned in favor of tear-jerking, (our seniors are eating dog food so they can afford their medicine; we need more medicare) and scare-your-pants-off (the Republicans/SUVs/amalgam/etc... will kill you if you don't vote for us) tactics.

That is why I think amalgam is on it's way out. I do think it's a darn good treatment modality, but one that is becoming less politically viable everyday. Legislators are not scientists, and will never be able to understand anything other than the fact that it contains mercury. It wouldn't surprise me at all if the use of amalgam was banned within the next 5-10 yrs. The end is near. 🙂
 
Why haven't they experimented with other metals on the periodic table? Just curious. They've been saying amalgam is on its way out for decades, but the fact of the matter is it'll be here for a long long time. It's too cheap and accessible to just be taken off the market. Overhead baby, overhead! 🙂
 
Whose overhead would that be, exactly? Oh yeah, dentists.
Unfortunately, it isn't dentists who will ultimately get to make this decision. 🙁

I do think it's definitely premature for a school just to strike it from the curriculum, but the end is coming.
 
Supernumerary Who is teaching you this? I would like to know? I am 99% sure that amalgam even if it was found to be harmful would not be gone, why> Its cheap, its quick, its easy, an assistant can carve it, no extra tools needed like adhesives, bonding agents, etc.... It is a great material because it corrodes at the margins and prevents residual caries.

SHortly Put, The ADA will never let amalgam die. There are a lot more materials that will be out before amalgam. Heck sealants have been traced to breast cancer, when are they going to be out?????
 
Nobody is teaching this to me. These are my opinions. Informed opinions, but still... just opinions. And in fairness, many of my instructors would disagree with me.

A few of the reasons I have formed this opinion are:

1)public ignorance - the general public doesn't have a clue when it comes to anything health/science related. If it is ever presented to him, Joe Schmo will buy the anti-amalgam agenda hook, line and sinker.

2)the ability of the media to create a crisis out of anything - Reader's Digest, 20/20, 60 Minutes, et al, thrive on inducing panic and hysteria in their audience. The science doesn't matter; it's about how great a story titled "Your dentist may be killing you" would be.

3)historical precedent - people pushing these bogus agendas often encounter setbacks for a number of years, but eventually some lawyer hits the first jackpot and it's all downhill from there. Tobacco, silicone, etc...

I know the ADA has done great job protecting the profession up until now, but I just don't feel they have the kind of absolute power that so many on this board seem to ascribe to them. All in all, I'd say they're kinda weak. Of course I'm going to support the ADA when I'm out in practice; they serve an important function. But organized dentistry just isn't big enough (compare it with other professional organizations like the AMA) to have the necessary clout to stave this off indefinitely.

Then again, I could be smokin' something funny. 🙂
 
Originally posted by Brocnizer2007
And there is a law that is coming out shortly (around 5 years) that will ban amalgam in this country. I don't see a need for a ban, but some dorks in congress do. I'll rumage through my papers and get the congress womans name that wrote the bill. Damn, those papers are in FL...can you guys wait unitl thanksgiving???
Click to expand...

:laugh: You've got to be kidding me. If you honestly think amalgam is going to be banned by law in the next 5 years, I want some of what you are smoking.

I'm not trying to rip on you, but I see you are in your 1st semester of dental school. You did say these are merely opinions, but they lack a lot of knowledge. Do you have any idea how many bills are proposed, may of which are a joke, that end up getting squashed.

Amalgam is a hot topic every now and then when 20/20 has nothing good on their lineup so they feel the need to pollute people's mind with anti-amalgam crap that is completely unfounded.

As far as people not wanting amalgam in their mouth because of esthetic reasons?? How many patients have you treated in the 1st year? Your perception may be that they won't want them, but you will see from experience that a lot of people don't mind. They would rather have something put in that lasts 10+ years than a posterior composite that has a much shorter shelf life. I'm not saying that nobody wants post composites, but to say amalgam will be out because people won't want them is not a very logical comment.

Secondly, amalgam is never going to be replaced because there is NO better material for dentistry overall. C132 made some good points, there are treatments that make amalgam the treatment of choice. They have been constantly making new materials in dentistry, but it is doubtful any will approach the overall efficiency of amalgam. This was taught to me in a semester-long Dental Materials course by one of the leading Dental Materials researchers in the world, Dr. Stephen Bayne.

If you guys ever needed any advice as to what to tell your patients when they have amalgam concerns, we had some lectures about it that provided some good comparisons and some people friendly articles that patients will believe (ie. consumer reports is the one that I give them, people seem to trust that publication as being unbiased). As someone previously said, though, some people still won't be happy unless you remove all 8 of their amalgams for composites, but hey, that's money in our pocket I guess.
 
I seriously don't think that amalgam would be out and gone. Probably with the years to come, and this is unless they have found another restorative material that is SPECTACULARLY good in aesthetics and its bonding, amalgam is still usable in terms of cost and quality.
Yes it might me bad for aesthetics, but tell me..how many people would scrutinise your post teeth when you smile or laugh? Chances are they might not even be aware that they are there.
The mercury level that is available in amalgam is NOT as hazardous as many people thought of it to be. Even when it's manufactured, manufacturers do not insert too much mercury in it because of strength and property reasons.
Unless researchers have found something that can substitute amalgam in terms of aesthetic reasons, it won't be out that soon.
Composites are not ENTIRELY that good either. Other than the good aesthetics, it does not self seal and this can create lots of problems like microleakage etc
 
I think you guys are missing my point. I am not anti-amalgam. I agree with just about everything you've said. Amalgam is superior to other materials in terms of longevity, ease of placement, cost, inhibition of microleakage and recurrent decay, etc... But this really doesn't mean anything to the people who will ultimately make this decision. Ask any plastic surgeon what makes better boobs, silicone or saline? They'll undoubtedly tell you silicone. Didn't matter one bit, though.

Lawyers keep filing amalgam suits and they're going to keep filing them because the guy who finally gets one to stick is gonna be rich beyond his wildest dreams. Yes, the ADA has been successful at protecting our interests against these scumbags up until now, but it's unlikely that even the ADA can win 'em all.

Amalgam is already out in certain places in Europe.

And there are some pretty heavy hitters involved in setting up Arizona's curriculum who apparently think the same way I do. The fact that they are even considering striking amalgam from the curriculum is pretty telling to me that amalgam just might not be around much longer.
 
Who cares I'm first year...that doesn't mean I have 0 experience with patients.

I have 1000's of hours logged in with dentists i've worked for and in Jax, Fl a majority prefered other materials than amalgams. Maybe it has to do with my shadow area which was Ponte Vedra near the TPC

If it gets squashed then another will go up bec this isn't the first one. As you said with 20/20, public opinion is a heavy thing to fight. If they put enough crap into peoples heads then the public will get what they want. Look at what 20/20 did with dentists and the water they use. They compared our water to toliet water that we were putting if peoples mouths and at the time when the show came out, people refused to go to dentists that did not have some sort of filter system.

I'm not anti-amalgam at all and I hope I will get to work with it. Actually I was so interested in the topic of amalgam safety that this was my senior thesis and I PROVED it was safe...not through experimens but a lit review and a heavy one at that
 
to Broc:

Yep, you will certainly learn amalgam. That's because NYU prepares you for the NERBs, and you have to do one Class-II restoration during the NERB licensure exam. And it will certainly be around for the next 3 years.
 
Silicone boobs for one went out because they were not the superior material. I have many doctors in my family and ask them about this. The reason they went to saline is because so many breakages with silicone. The body does not breakdown silicone very well and these people would find huge pools of silicone in their knees and other joints. When a breast would burst, the silicone was slow to leak and they didn't even see any signs of breakage until it was over.

To me, this is not a "superior" material, thus they got rid of its ass.

The ADA is established so the "ignorant" people cannot make or break rules. Some joe smoe off the street cannot influence the law makers anywhere near what a panel of say 5000 dentists can.

There will always be talks of amalgam. There will always be people wanting to benifit (tv shows) from amalgam problems. And finally, There will always be amalgam!!!!!!!!!!!!!!!!
 
c132

... and also insurance companies ..... amalgam will be here forever....
 
Originally posted by Supernumerary
But organized dentistry just isn't big enough (compare it with other professional organizations like the AMA) to have the necessary clout to stave this off indefinitely.
Click to expand...

Don't think at all that the ADA doesn't have enough clout. From every ASDA meeting I've attended, we've always been told that a greater percentage of dentists belong to the ADA (like 70%) as opposed to the AMA (closer to 50%).

Amalgam good or bad, I don't want to discuss it. But I've encountered several clinical situations where putting a resin in would have been impossible (mainly in pedo, but also in adults). Saliva everywhere, rubber dam impossible to place, no assistant to effectively suction, etc. Placing a resin in that situation would definitely have been performance of sub-standard dentistry.

Gavin, If you are supposed to go out to do dentistry for the underserved at Arizona, I can't see how you could possibly serve these populations most efficiently and effectively without the use of amalgam.
 
With regard to the amalgam's mercury content, isn't it so minimal that it's vapors aren't even toxic? On top of that, the mercury isn't exposed unless you burnish the almalgam to be super shiny anyway, there isn't a problem in the first place. This is what I learned (or remember) so far about it.

Also, I've learned how the ADA and almagam has been challenged A LOT. But the ADA has a real strong pull in Congress, so I wouldn't worry about it becoming banned.
 
What about all the amalgam that is dumped down the dentist's sink? Working at a dentist, each day I've seen about 5 or 6 people come in with decay around amalgams, which would be drilled out and spit into the sink.

Perhaps the law is a good thing after all.

[QUOTEI don't see a need for a ban, but some dorks in congress do. [/B][/QUOTE]
 
Working at a dentist, each day I've seen about 5 or 6 people come in with decay around amalgams, which would be drilled out and spit into the sink.
Click to expand...

Well that is a violation of EPA and you better hope your dentist doesn't get ratted out bec he will pay big fines

I might be wrong, but that could also be a potential OSHA violation
 
Originally posted by DcS

If you guys ever needed any advice as to what to tell your patients when they have amalgam concerns, we had some lectures about it that provided some good comparisons and some people friendly articles that patients will believe (ie. consumer reports is the one that I give them, people seem to trust that publication as being unbiased).
Click to expand...

DcS,

Which issue was this in?
 
Jone.... BY LAW, The suction on the dental chair supposed to have a filter on it that has to been cleaned routinely. If an old amalgam is taken out, since amlagam is not water soluble and will not dissolve in H20, then it will get caught in the trap. I have seen these traps since I have seen some inlays get sucked down high speed suction, and in deed there is a lot of amalgam and also calculus pieces in there!
 
Don't think at all that the ADA doesn't have enough clout. From every ASDA meeting I've attended, we've always been told that a greater percentage of dentists belong to the ADA (like 70%) as opposed to the AMA (closer to 50%).
Click to expand...

Percentages mean very little here. There are many more doctors than dentists. Think of it this way: would you rather have 70% of $15,000 or 50% of $100,000.
 
On the other hand if you were in court and 50% of doctors believed this material was bad and should be out, this is only half the professional opinion. If I were in court and 70%+ of a profession was backing me up, I would feel way safer than if only 50% was behind me.

We are not talking numbers here, more of how many in the group "stick" together
 
c132 is correct; the strength of ADA's lobbying lies in their ability to tell politicians "70%-80% of the dentists in America think XYZ." With medicine, the AMA can say "we think ABC," but the politicians can ignore them by saying "but what about the huge number of physicians you don't represent?"
 
Sorry, but I don't think you'll ever be able to convince me that that ADA has more influence than the AMA. Everyone knows what the American Medical Association is. Their decisions affect literally hundreds of healthcare-related industries in this country, not just the direct practice of medicine.

And while the ADA is an important entity in it's own right, it is is not that big of a deal to those outside of our own little dentistry world. My guess is that most politicians who are first exposed to ADA lobbying know it only as "the people who make sure the toothpaste is O.K., right?"

Geez, am I thickheaded or what?! 🙂
 
When people stop getting caries subgingivally on the linguals of lower second molars (these folks will almost certainily be heavy salivators with macroglossia and hyperactive tongues to boot), then I'll get rid of the amalgam in my office.

Don't even get me started about the folks that get decay on the buccals on wsidom teeth and refuse your extraction recommendations, and demand composite. I jokingly call those types of restorations "future business"😀
 
I KNOW! You have to love those 3rd molar people! Here they teach you that the only type of dentistry you need to know for 3rds is extractions! I had a guy come in for a recall with a gold full and 7/8 crown. Totally refused extraction, but went with a lot more money in the crowns. It blew my mind people were so hard headed (being the first one like this that I seen), but like you said, its money!
 
Originally posted by Zurich5
DcS,

Which issue was this in?
Click to expand...

I'm not sure, our Professor gave it to us to give to Patients because they trust Consumer Reports. If a lot of people wanted it I could get it online but I have some exams right now (Perio surgery and Pharm yay) so it might take a little while.
 
It's in May 1991 Consumer Reports FYI.
 
I'm too lazy to read this entire thread, but I thought I'd point out for those who are interested:

DentalTown, November 2003 issue
Point/Counterpoint section: "Do amalgams cause cracks & cusp fractures in teeth?"
 
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