Point / Counterpoint By: Joe Steven, Jr., DDS

We’re slipping! Yes, our profession is slipping in the polls! Ten years ago our profession enjoyed the honor of being ranked #2 in the Gallup Organization’s poll for rating the public’s respect and trust among various professionals. We were right behind pharmacists. Unfortunately, Gallup’s 2000 poll showed that we have slipped to 8th place, four places behind medical doctors. I don’t know about you, but I enjoyed that well-deserved honor of being #2 ten years ago. Now, I’m a little concerned about the direction our profession is headed right now.

I have entitled this article, Maybe We Should Ban Amalgam, because I personally believe this entire amalgam controversy is driving a huge wedge between members of our profession. It almost appears as if an unhealthy “class” division has developed. On one side you have the “metal-free” practitioners and on the other side the “traditional” practitioners, who for various reasons, offer their patients amalgam as a restorative option. Dentists who offer amalgam are viciously attacked for not offering “quality” dentistry. Dentists who offer composite fillings are often accused of only being concerned about charging and getting higher fees. I believe this dissention is truly weakening our public perception and trust.

Twenty years ago, a popular trend of providing quadrants of gold inlays and onlays emerged. During that time, I don’t recall a distinction being drawn or an attempt to make dentists feel guilty or inferior about the restoration choices for their patients. Offering gold to patients was presented as an upscale alternative for patients who wanted longer lasting quality restorations. With the amalgam controversies, we seem to have one side accusing the other side of cracking teeth and placing fillings that will always get decay under them. Even in my own hometown, a local dentist runs television ads that display schematic illustrations of how amalgam fillings crack teeth. Is this good for our profession when the large majority of people have amalgam restorations in their mouths?

Both groups love to cite particular research studies to prove their point. Let’s put the clinical studies aside and look at the most valuable research we have before us—our existing patients. I have to admit, I get offended when I hear dentists make blanket statements that all amalgams crack teeth. My rough calculations indicate that I personally have placed over 20,000 amalgams in my career. So, if the data about amalgams always cracking teeth is true, why do I only place around 50 crowns per month? I should be doing 200 or more if all amalgams crack teeth. Of course I have seen fractured cusps on teeth with amalgams. I’ve also seen fractured cusps on virgin teeth and those with composite restorations. I’ve actually had dentists say to my face, “Joe, keep placing amalgams and breaking teeth so that I can bond them with onlays later.” Does this rhetoric serve our profession well?

So, what does this have to do with us slipping in the polls anyway? As Dr. Paul Belvedere pointed out in a recent article, we are kidding ourselves if we think all this bickering is kept just among dentists. Some of our patients are attorneys who are well aware of this professional dispute, and this leads to damaging effects on our profession. Maybe we can’t stop the legal trappings that are rampant in our country, but we’re hurting our profession when we have such openly decisive verbal battles on certain issues within our profession. This leads to lawyers coercing dentists to testify against their colleagues as we are presently witnessing around the country.

Just to put things in perspective, I’d like to share with you an observation made by my brother-in-law who is a vascular surgeon. Steve and his family travel with us often and I frequently share dental literature and research with him. One day during a long flight, I shared some information on the amalgam controversy. After reading it, he looked over at me, shaking his head, and said, “You guys are just talking about teeth…aren’t you?”

Some may consider this article as nothing more than adding fuel to the fire. My intent and desire however is that it will at least draw a moment of reflection on the adverse effects to the strength and persona of our profession. There are more serious issues in dentistry that deserve our attention. We should be working to establish acceptance and respect within our profession. With that type of strength, we could work together towards strengthening our credibility and trust with the American public. I, for one, would certainly like to have that #2 position back…wouldn’t you?

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Dr. Joe Steven, Jr. has been a full-time practicing dentist in Wichita, Kansas since his graduation from Creighton Dental School in 1978. He is a member of the ADA, the Kansas Dental Association and the Mid America Dental Study Club. He is also president of KISCO, a dental products marketing company in addition to being the editor of the KISCO Perspective Newsletter. He presents a seminar called, “Efficient-dontics”, and along with Dr. Mark Troilo, “The $1,000,000 Staff.”