Howard Speaks by Howard Farran, DDS, MBA, MAGD

Dentistry never ceases to amaze me. Every time you think you have an excellent technique down pat, something new comes along that is significantly better. I can still remember bonding during my dental school days at UMKC from 1983 to 1987. DO NOT get the acid on the dentin or you will kill the nerve! Block out the dentin with Dycal. Bonding is for anterior teeth only. Only unethical dentists use composites on the posterior teeth. In fact, right before we graduated from UMKC we were given a handout for our patients explaining why we would not use posterior composites because they were in fact unethical.

Patients demanded tooth-colored restorations so by 1991, four years out of dental school, I threw away my amalgamators and went cold turkey into posterior composites. Placing posterior direct composites at that time was at least 10 times harder than placing amalgam. To say posterior bonding was stressful at that time is an understatement. One of the biggest problems was getting tight contacts. Two systems that solved this problem for me were the Composi-Tight System from Garrison Dental and the Palodent Sectional Matrix System with the BiTine Ring sold by Dentsply Caulk.

The second issue back then was sensitivity. From 1991 through 2000, we were told the reason for the sensitivity was that dentists were doing something wrong. Voodoo solutions on how to reduce sensitivity seemed to get deeper everyday…extra steps, lotions and potions. I can still remember publishing articles in what was back then called The Farran Report on the Top 10 ways to reduce sensitivity. Reading those articles today is amusing, considering that when the manufacturers changed their own chemistry kits, the sensitivity went away overnight.

Sensitivity seems to have vanished for a wide variety of bonding techniques. In fact, on last month’s poll at www.DentalTown.com, 12% of dentists claim they never get sensitivity. Seventy-nine percent claim they rarely get sensitivity and only 9% claim they frequently get sensitivity. The fact that 91% of dentists are now rarely getting sensitivity has far more to do with the improvements in our chairside chemistry kits than anything we are doing with our technique.

Shakespeare’s dentist once said, “To desensitize or not to desensitize, that is the question. Whether ‘tis nobler in the mind to suffer the slings and arrows of dental gurus, or to take arms against a sea of Townies and by opposing, end them.” The poll conducted at www.DentalTown.com revealed 24% of dentists use a dentin desensitizer while 76% do not.

Self-etch verses total-etch is the biggest buzz in bonding. Over 52% of Townies polled use self-etch while 47% claim to use total-etch. The rapid advancement in self-etching is due to the fact it shuts down sensitivity because you cannot etch deeper than you can penetrate with resin. In addition, since the smear plugs are never removed, tubules are not opened; therefore there is no need to seal them.

When dentists were asked their primary reason for picking a bonding agent 41% of dentists polled said ease of use was their primary reason, 35% said it was bonding strengths, 23% said it was recommended by a guru and I am so proud to say, only 2% of the dentists chose their bonding agent on cost. Who said dentists were cheapskates? (Oh, wait a minute…maybe that was me!)

Sixty-three percent of dentists polled use a single-bottle adhesive and 37% use a multi bottle adhesive. For multi-bottle adhesive systems, Townies tend to talk the most about Tenure A & B, All Bond 2, Scotchbond Multi-Purpose Plus, OptiBond FL, and Wetbond. For single-bottle adhesives Townies tend to talk the most about OneStep, Bond 1, Cabrio, Single Bond, Solo Plus, EZ Bond, and Prime & Bond NT. For self-etch, Townies are raving fans for Simplicity, Clearfil SE Bond and Touch&Bond. Den-Mat’s latest version of Tenure is now single-bottle as well.

Don’t even ask me about rubber dams. Whether or not you need to use a rubber dam is such a hot debate on the message boards that we chose just one of scores of rubber dam threads to use for this month’s Point Counterpoint section. If you want to read the entire thread, or any other rubber dam threads, log onto www.DentalTown.com, click message boards, click search, and type in the words rubber dam.

If you are having any bonding problems, questions or concerns remember you are not alone. Our online DentalTown community has now grown to over 10,500 registered dentists. Over 300 log on everyday, over 5,000 log on at least once per week. Our motto is with www.DentalTown.com no dentist will ever have to practice solo again. So if you are among the 9% of dentists still having sensitivity problems, log on and read what others are saying about it or just log on and tell us about your problems! The only thing I can assure you of is that there’s a very good chance your question has already been asked and answered. If your question or problem has not been asked, and you ask it, someone, sometime, from some country, will answer it! When you do find your online DentalTown solution, you will discover you’re having so much fun making so many new online dental friends, you will probably forget that you used to have a dental problem!