If you don't want to use mercury?

[GH253]

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I'm not trying to start a debate about the value of mercury products, but suppose you don't want to use it in your practice, or are only willing to use it minimally. What impact will this have on your ability to succeed financially? My thinking is that, in the event of universal healthcare, the government will never pay for anything other than mercury, so whoever doens't want to use it will be **** out of luck.

 

[Sajitude]

I'm not trying to start a debate about the value of mercury products, but suppose you don't want to use it in your practice, or are only willing to use it minimally. What impact will this have on your ability to succeed financially? My thinking is that, in the event of universal healthcare, the government will never pay for anything other than mercury, so whoever doens't want to use it will be **** out of luck.

There are many dentists that choose not to use mercury for a wide range of reasons in their practices and they are as financially successful as the ones that do. BTW many of their reasons not to use mercury is environmentally related.

 

[DMDreaming]

I agree with the previous poster but would like to point out a couple of things. First, insurance typically will reimburse at a lesser amount for composite fillings in posterior teeth. Some patients get bent out of shape about this so you will need to learn how to present it to them because they will be reponsible for a larger amount. This is one key to success in amalgam-free practices. Second, to initiate changes in reimbursement for posterior composites, dentists need to encourage their patients to tell their insurance company or HR they want this to be covered better. Insurance companies won't listen to the dentists but they may listen to those people who are paying for their services. Until they raise a stink, nothing will change.

 

[gryffindor]

If you don't want to use amalgam, you can always use gold.

 

[aphistis]

If you don't want to use amalgam, you can always use gold.

Or IRM.

 

[ItsGavinC]

Or IRM.

or pink IRM like we sometimes do in pedo. 😀

 

[doc toothache]

I'm not trying to start a debate about the value of mercury products, but suppose you don't want to use it in your practice, or are only willing to use it minimally. What impact will this have on your ability to succeed financially? My thinking is that, in the event of universal healthcare, the government will never pay for anything other than mercury, so whoever doens't want to use it will be **** out of luck.

A practitioner can certainly decide not to use amalgam in his/her practice but does have an obligation to present various treatment options. The final decision rests with the patient.

 

[aegdboy]

I never did Amalgam in school because my patients did not want it. I did 2 amalgams out of 217 restorations in d-school.

Guess why I did those two, I couldn't get good isolation.

I am not anti-amalgam as I could not imagine doing a successful composite in those two instances. They do have their time and place.

I like amalgam for a two reasons: 1) it's tried and true 2) fast as hell to place

I hate amalgam because: 1)they are silver for gosh sakes! 2) you need to take out more tooth structure than composite

To ban them will be a mistake and this is coming from someone that doesn't even use it. They do have their time and place and the public needs to accept that. It they are scared of mercury, well they better ban canned tuna with it because the biologic exposure from canned tuna is higher than from placing an amalgam in your mouth

 

[DrJeff]

I never did Amalgam in school because my patients did not want it. I did 2 amalgams out of 217 restorations in d-school.

Guess why I did those two, I couldn't get good isolation.

I am not anti-amalgam as I could not imagine doing a successful composite in those two instances. They do have their time and place.

I like amalgam for a two reasons: 1) it's tried and true 2) fast as hell to place

I hate amalgam because: 1)they are silver for gosh sakes! 2) you need to take out more tooth structure than composite

To ban them will be a mistake and this is coming from someone that doesn't even use it. They do have their time and place and the public needs to accept that. It they are scared of mercury, well they better ban canned tuna with it because the biologic exposure from canned tuna is higher than from placing an amalgam in your mouth

Very good post! Agree 100%

It will be the financial implications to government healthcare more than environmental and fictitious health reasons that will keep amalgam available to clinicians as a restorative material for years to come IMHO. And I'm not just talking about current, new restoration costs either.

Think about it for a minute, the literally millions of people that what way overreact if the gov't suddenly decides to ban amalgam😱

 

[BillytheEchidna]

What is the general cost difference between a composite and an amalgam restoration, in terms of the materials themselves?

 

[DrJeff]

What is the general cost difference between a composite and an amalgam restoration, in terms of the materials themselves?

Just grabbed my office's Henry Schein catalog to get you some 2009 pricing numbers here. For arguements sake, we'll asume that you'll use the same basic supplies (2x2 cotton squares, cotton rolls, anesthesia, etc) for each.

The Tytin Sperical Alloy, double spill capsules(what I use in my office when I use amalgam and argueably the "standard" amalgam on the market) has a cost of $119.99 for 50 capsules - lets say that 1 capsule will restore 1 tooth(although with many "standard sized" preps, a double spill capsule will often get you 2 or 3 teeth restored) - so the material cost is about $2.25 per tooth.

For a composite, I'm going to for cost sake, I'm going to use the pricing for Kerr's Premise Composite (a universal nano composite), which is what I use as my primary composite material. A unidose refill kit is $99.99 per 20 unidose ampules and once again for arguements sake, we'll asume that 1 ampule = 1 restored tooth. So even before you factor in cost of bonding agent and etch, you're upto $5 a tooth for materials. Figure $7 to $7.50 per restoration by the time your done materials wise then. Also, depending on what brand/type of composite + bonding agent you choose to use, you're costs could be a few $$ less per tooth OR a few $$ more per tooth.

The other factor, is that because of the increased steps involved in placing a composite, you're using more chairtime to complete the same restoration, and that IS a factor that needs to be considered too since for myself as I'm planning out my schedule I know that on average due to the increased number of steps and curing time, I generally plan that a composite restoration will take me an additional 5 minutes to complete compared to that exact same amalgam restoration.

 

[Guy Smiley]

Just grabbed my office's Henry Schein catalog to get you some 2009 pricing numbers here. For arguements sake, we'll asume that you'll use the same basic supplies (2x2 cotton squares, cotton rolls, anesthesia, etc) for each.

The Tytin Sperical Alloy, double spill capsules(what I use in my office when I use amalgam and argueably the "standard" amalgam on the market) has a cost of $119.99 for 50 capsules - lets say that 1 capsule will restore 1 tooth(although with many "standard sized" preps, a double spill capsule will often get you 2 or 3 teeth restored) - so the material cost is about $2.25 per tooth.

For a composite, I'm going to for cost sake, I'm going to use the pricing for Kerr's Premise Composite (a universal nano composite), which is what I use as my primary composite material. A unidose refill kit is $99.99 per 20 unidose ampules and once again for arguements sake, we'll asume that 1 ampule = 1 restored tooth. So even before you factor in cost of bonding agent and etch, you're upto $5 a tooth for materials. Figure $7 to $7.50 per restoration by the time your done materials wise then. Also, depending on what brand/type of composite + bonding agent you choose to use, you're costs could be a few $$ less per tooth OR a few $$ more per tooth.

The other factor, is that because of the increased steps involved in placing a composite, you're using more chairtime to complete the same restoration, and that IS a factor that needs to be considered too since for myself as I'm planning out my schedule I know that on average due to the increased number of steps and curing time, I generally plan that a composite restoration will take me an additional 5 minutes to complete compared to that exact same amalgam restoration.

How fast does the amalgam you are using set? I find that for Class II preps, composite doesn't take me any longer to do than amalgam - but the reason for this is I feel like I often have to let the amalgam sit for 3-5 minutes to set up so it doesn't crumble out of the box when I remove the matrix. At the clinic I work at, we use Henry Schein Ionosphere, double spill. I think it is just a regular set because it doesn't say anything about set times on it.

 

[BillytheEchidna]

Thank you so much, Dr. Jeff! That was very interesting.

 

[DMDreaming]

Just grabbed my office's Henry Schein catalog to get you some 2009 pricing numbers here. For arguements sake, we'll asume that you'll use the same basic supplies (2x2 cotton squares, cotton rolls, anesthesia, etc) for each.

The Tytin Sperical Alloy, double spill capsules(what I use in my office when I use amalgam and argueably the "standard" amalgam on the market) has a cost of $119.99 for 50 capsules - lets say that 1 capsule will restore 1 tooth(although with many "standard sized" preps, a double spill capsule will often get you 2 or 3 teeth restored) - so the material cost is about $2.25 per tooth.

For a composite, I'm going to for cost sake, I'm going to use the pricing for Kerr's Premise Composite (a universal nano composite), which is what I use as my primary composite material. A unidose refill kit is $99.99 per 20 unidose ampules and once again for arguements sake, we'll asume that 1 ampule = 1 restored tooth. So even before you factor in cost of bonding agent and etch, you're upto $5 a tooth for materials. Figure $7 to $7.50 per restoration by the time your done materials wise then. Also, depending on what brand/type of composite + bonding agent you choose to use, you're costs could be a few $$ less per tooth OR a few $$ more per tooth.

The other factor, is that because of the increased steps involved in placing a composite, you're using more chairtime to complete the same restoration, and that IS a factor that needs to be considered too since for myself as I'm planning out my schedule I know that on average due to the increased number of steps and curing time, I generally plan that a composite restoration will take me an additional 5 minutes to complete compared to that exact same amalgam restoration.

Great synopsis! Don't forget that composite finishing burs cost another $7-10 per bur but they can be sterilized and used multiple times.

 

[DrJeff]

How fast does the amalgam you are using set? I find that for Class II preps, composite doesn't take me any longer to do than amalgam - but the reason for this is I feel like I often have to let the amalgam sit for 3-5 minutes to set up so it doesn't crumble out of the box when I remove the matrix. At the clinic I work at, we use Henry Schein Ionosphere, double spill. I think it is just a regular set because it doesn't say anything about set times on it.

I use fast set in my office. By the time I'm done condensing, burnishing and doing my initial carving (maybe 1 minute worth of time), I'm taking that matrix band off without any problems (when I actually use amalgam for a class II).

Between the etch time(40 seconds between application, rinsing and drying), the bonding agent cure time(15 seconds), the incremental fills + curing time(90 seconds for each increment to place and cure) and then the final finishing, my composites on average will take me an extra 5 minutes per tooth over an equivalent sized bulk filled amalgam.

 

[seansk]

or pink IRM like we sometimes do in pedo. 😀

do you mean cavit??? and non of these restoration material are permanent restorative materials.

 

[aphistis]

do you mean cavit??? and non of these restoration material are permanent restorative materials.

I suspect he means pink IRM. If he meant Cavit, that's what he would have said. 😉

 

[tinman831]

and non of these restoration material are permanent restorative materials.

It was a joke. 🙂