Is dental mercury a threat to health?

[Darrell]

(My first attempt to post this failed. I'll try again.)

THE OPPOSITION NO SHOWED

I don’t think there is much chance that any anti-amalgamists are going to present themselves at this impromptu debate. Looking back at the invitation, I probably should not have mentioned the word “ambush.” In my defense, it had occurred to me that the event might need to be hyped a little in order to lend the adventure promise of something wild and dangerous. It’s a debate about dental filling materials, for crying out loud. My bad.

Just because I carelessly frightened away my opponents doesn’t make this effort is a complete failure. Oh heavens no. I’ll just continue without them. I’ll turn it into a one-sided public debate not unlike Jeff Jarvis’ Dell Hell a few years ago. Like shy anti-amalgamists, Dell’s leaders considered themselves above wrestling free-style, down in the dirt. They chose to ignore Jarvis’ complaints about poor service in a traditional bureaucratic way - silent disrespect. Jarvis took the fight online and publicly whipped the snot out of Dell - showing all who were paying attention that silence is obsolete defense.

I still hold out hope for an open debate with anti-amalgamists. Perhaps one or two will pass by, recognize their names, read what I have to say about them and scratch together enough courage to stand up for themselves and their mercury-free dentists. This is a neutral playground, and as far as I can tell, the owner doesn’t mind.

As a gang, anti-amalgamists are loud when they control the conversation, but when they find themselves suddenly out in the open - alone in a frontier of transparency they become really shy.

Soon, I’ll start with my very short conversation with Tom McGuire DDS. He has been scaring naïve people for a couple of decades now. Here is his Website http://www.dentalwellness4u.com/

If you wish to, visit his Website. I’ll be back soon. DK Pruitt

[Darrell]

CHALLENGING DR. TOM

I just noticed something. Tom McGuire DDS actually advertises on this very Website. If one clicks on “Mercury Free Dentists” at the top of this page, it leads directly to Dr. Tom. Now that is rich. In a way, Tom himself is supporting our discussion about him. Sweet.

Less than a week ago, I asked Tom about the safety of BPA fillings. Here is his reply:

> Dear Darrell,

I've been researching them and put what I know about them up to this point in my book, The Poison in Your Teeth. I get 100's of emails a month with questions about many subjects and I simply don't have time to respond to them all and that is why I wrote my books. I could not afford to take the time to answer your question in an email and I hope you understand. It is an important question and although the definitive studies haven’t yet been done there is enough information to make an educated decision about whether to have them put in or not. In my opinion, they are infinitely safer than mercury amalgam fillings, but there are also options to composites and there are composites without the controversial Bisphenol A. I wish you the best.

In health, Tom <

I took that at face value and responded:“Sorry we could not discuss this more. Darrell”

I thought we had parted ways when suddenly he fired me a strange email:

>Darrell,

I detect a frustration. I might ask you what you do for your livelihood and ask you how much free time you have to discuss things regarding your business that you provide for free, especially in an email format that is totally inefficient for this kind of thing. I have a wife, family, and business to run and I’m not even close to being wealthy enough to be able to provide all of my time to those who need it for free. I’ve spent many thousands of hours/years, researching and writing about these subjects and I can assure you that I don’t have a guilt complex about not providing all of this information to all those who seek it from me for free. I’m sorry you don’t understand and respect my position but I wish you the best in your search for information.

Sincerely, Tom <

And to think, he didn’t have the time to discuss my question. Incredible.

I’m sorry I asked, Tom. But not nearly as sorry as you are, I bet. Would you care to explain your answer to my straightforward question for our audience or would you prefer silence to speak on your behalf? DK Pruitt

[Darrell]

Don't get me started.

[Darrell]

OK, already. You got me started.

On Monday, I wrote that one no longer has to silently tolerate lies from those who market irrational fear to sell products, such as books about poisonous fillings. One can grab a voice and fight back. The anti-amalgamists are just one class of fear-mongers whose sales techniques have been successful in the past, but whose future is threatened as people talk with each other more and more, like we are doing here. Together, we have discovered that for all of their bluster, anti-amalgamists are a surprisingly uncreative, as well as an incredibly shy bunch. Has their calculated deceit caused harm? Without a doubt, and in a very cruel way. We may never know how many handicapped children and adults endured tedious and expensive dental appointments to needlessly have fillings replaced. It is my opinion that anti-amalgamists are slimy because they prey on people who will do foolish things, including spending money they cannot afford, just on the hope of health. It is too bad our laws cannot hold anti-amalgamists accountable. I’ll do it myself, care to join me? All you have to do is grab a voice.

It may take a moment or two to recognize the significance of modern conversation in the future of our nation. Ultimately, one has to agree that the phenomenon we are sharing right now is a small but powerful expression of freedom from oppression Americans have rarely celebrated, ever.

This is all about transparency and its gift of natural accountability. Today, conversations in the Internet hold people accountable for what they say, and on a world-wide stage. Let me show you what I mean. Yesterday, I posted blistering criticism of Tom McGuire DDS’s anti-amalgam book business, and less than 24 hours later the comment “Challenging Dr. Tom” became his number 11th hit if one googlesearches - if Tom himself searches -“Tom McGuire DDS.” It could be in the top ten (first page) by tomorrow. Won’t he be surprised.

God bless America.

If you are interested in learning more, the power of voice that I have illustrated is consistent with the theories described in the book “The Cluetrain Manifesto,” about Internet conversations that I mentioned earlier, as well as in Scoble and Israel’s 2006 book “Naked Conversations,” which is about how weblogs are changing society.

This has been a tremendous success as well as loads of fun. Thank you, audience. For this conversation to attract so much googlejuice in such a short period of time, it can only mean that a lot of people are reading. I’ll try not to bore you. DK Pruitt

[Darrell]

I recently had contact with a company called the Institute of Progressive Medicine, headed by Dr. Sosin. I’ll tell you more soon. Darrell

[Darrell]

About a week ago, I promised I would return soon with a response from the Institute of Progressive Medicine, headed by medical director, Dr. Allan Sosin.
http://www.iprogressivemed.com/index.html
Please be patient. We are all awaiting his executive director Nick Sosin, who told me that it would take a couple of days to put together a reply about BPA in composite fillings. The delay itself is suspicious. There is nothing progressive about a physician being uncertain about the safety of dental materials that he recommends dentists use to replace amalgam fillings. DK Pruitt

[Darrell]

DEBATE RESUMES - CHECKLIST, part one.

While waiting for a response from the Sosins, I came across a PRWeb press release for a free seminar where dentists can learn how to remove amalgam fillings without harming their patients or dental staff.
http://www.prweb.com/releases/holistic_dentis...

The ad was purchased by dentist and entrepreneur Dr. James Rota, who describes himself as a “biological” dentist. I am unfamiliar with the use of “biological” in that context, but I am certain that Dr. Rota explains the buzzword on his Website. http://www.americanbio-compatibledental.com/o...

He runs a business called American Bio-Compatible Dental, Inc. Like other anti-amalgamists, Dr. Rota is in the fear business.

His Website offers a checklist of qualities that patients should look for in selecting their dentists. To the lay person, the items might appear to be of value. He’s good. However, to virtually all dentists, his checklist is oh so transparently misleading. If you are a mercury-free dentist and you disagree, let’s talk about it right here in front of everyone and down in the dirt. I’m not a lay person and some call me unprofessional, but don’t let that scare you away.

The very first item on Dr. Rota’s IAOMT-approved checklist concerns safely removing amalgams. In my opinion, Dr. Rota and the IAOMT already caused harm. Unnecessarily alarming patients about dental treatment keeps people away from dentists - causing their problems to only get worse. Dr. Rota himself cannot make money off those he scares away.

In the second item, Dr. Rota and the IAOMT recommend “compatibility” testing:“Before having your amalgams removed, speak with your dentist or an M.D. that will conduct the testing necessary to ensure that the replacement material being used will not cause you further problems.” Note that he did not say “allergy” testing. Consumers know what that is.

I suppose Dr. Allan Sosin of the Institute of Progressive Medicine understands what must me a brand new branch of immunology science called “compatibility testing,” and I assume that his Institute sells it. Perhaps both Dr. Sosin and Dr. Rota would like to join us in discussion about why patients should see physicians for tests, even before their toxic amalgams are removed. Now that would be entertainment.

If you think dental work could not get more expensive, I will tell you more about the Rota/IAOMT checklist soon. It is a creative piece of PR work.

As for safely removing amalgam fillings, it has been done for 150 years, friends. Personally, I think that if it is an unsafe risk to perform the procedure in whatever way, damage would be apparent long ago. We should not stray too far from common sense.

I may attend Dr. Rota’s seminar. I am always looking for new material to lampoon. It might be fun to see his live act. I’ll bring veggies. DK Pruitt

[toothdk]

I agree Darrell. It is the patients choice, not the governments. Research, etc., should all be available to the public, to make their own decision. Methacrylate is in the majority of adhesives and restorative materials, like in fake fingernails. Buyer Beware. I just don't like the way the ADA "governs" and forces dentists to essentially shut up or lose your license. So much for free speech.
http://www.drgolab.net

[Losing Soul]

One point that we would have to accept (even if reluctantly) is that there are many European countries banning amalgam or is in the process of doing it.

Even that aside I have some opinion:(readers I am not a dentist so please use your discretion - Also pros please point out my misunderstandings and enlighten the non pro readers)

It looks like Amalgam even if not toxic can start causing trouble to teeth because its coefficient of thermal expansion is more than the teeth so it can cause trouble to teeth in terms of cracks or making it brittle.

Composite Resins on the other hand if we discount BPA issue also has similar set of trouble, it does not have much of thermal expansion but the surrounding teeth structure will expand or contract thus causing the filling to fail / contribute to already possible issues of micro margins.

In addition Composite Resin filling requires skilled dentists like Darrell (going by the comments of some of his patients - assuming he is the same DK pruitt who practices in fort worth,tx after googling).

Someone please tell us how find one terrifically skilled.(someone who has researched or can discuss the benefits of lamination technique of layering a swab of GIC and then Composite on top of it or if that is not good then why not. In addition the dentist should be in a good mood because it needs right level of layering and curing!)

This brings us back to the query by Darrell if not Amalgam / Composite then what to fill the teeth with?

Why not conventional glass ionomer cement? It looks like its wear capability has shown to be poor in many studies. Even special strength ones are suggested only for geriatric or primary teeth use.

Please note that this does not include exotic concoctions like Resin Modified Glass Ionomers / metal reinforced...(folks please use your imagination you would get more variety)

I suggest that us lay folks who are a bit curious take a look at one each of 3M's product MSDS (that is one of GIC, RMGIC, & Composite's material safety data sheet). Just the two sections of material composition & health hazards would be sufficient to point towards the better type of the lot.

So it looks like ADA's position is not too bad of saying 'folks let us use informed consent', that is let the patient know and understand what is in store for her/him.

I have some sympathy for Dentists due to people like me questioning what they do because it is not life threatening... I guess I would not be able to wake up from sedation and question my heart surgeon what stent he uses in the bypass!

Finally all who are participating in this thread are doing a great job of informing readers so kudos all.

And Sir(not used mockingly) Darrell, Fear business is the only business that does well... from insurance to identity theft to beauty business (fear of not being good looking).
Do we need to even mention about the business uncle sam is in!!!

Hopeless.... Losing Soul.

[toothdk]

Amalgams, by the manufacturers instructions, are not to be used in children under 6 years old, or pregnant women, yet this is done daily. As well, amalgams, due to the expansion and contraction, should be replaced every 7-10 years, per the manufacturer. That is not followed. Along with BPA, is methacylate, not good either.
Regarding Glass Ionomers, these by default leach Fluoride.
There is no perfect material. You just pick the lesser of all evils. Be reasonable, and select the best. Unfortunately, in dentistry, as in other professions, there are different levels of knowledge and care. Remember, people getting "2nd opinions" means just that. An "opinion," not a factual accurate diagnosis, so remember that. The "pro-amalgam" dentists tout that merucry fillings are "cheap" and easy to do. Monkeys could do those fillings with little error. Composite adhesive dentistry is incredibly technique sensitive, and require much more skill, time, expense, and effort, just like doing crowns/caps, are a no-brainer to grind a tooth to a peg, but doing conservative inlays and onlays, is very difficult, so it's done by few dentists.
www.drgolab.net

[Darrell]

Dear Losing Soul:

Even though you are not a dentist, you have a remarkable understanding of dental materials. On behalf of all who are following this thread, thank you for sharing your tedious research with us. Caring people like you and those you touch are less likely to be harmed by fraud. You are the kind of consumer who retires quacks - making our nation a safer place to live. I salute you.

You accurately pointed out that there is not a perfect dental filling material. Your understanding of the differences in thermal expansion of an amalgam versus tooth structure is accurate. Whether the stress between the dissimilar materials causes abnormal damage to the tooth is hard to say. Even teeth without fillings naturally develop visible microfractures, as well as significant cracks because of the differences in expansion rates of glass-hard enamel on the outside of the tooth and the underlying resilient dentin, which contains a higher percentage of organic material. In addition, sometimes teeth that have no restorations break even with normal use.

Even though the thermal expansion of composites may be similar to enamel and dentin, composites bring their own set of problems, including the risk of causing teeth to fracture from a different cause. When composites are used for large fillings on the biting surfaces of molars, where most of the grinding occurs, they wear faster than enamel and amalgam, which wear at about the same rate. Please imagine the middle of molars as valleys between cusps. When a filling washes out of a large hole, it exposes the interior slopes of the cusps to increased lateral forces while chewing food (or ice… or tongue jewelry), causing the tooth to be wedged apart.(I know that was an unpleasant image for at least a few readers, and I sort of apologize). The same thing occurs when glass Ionomer cements (GIC) are used for the biting (occlusal) surfaces of molars. GIC fillings wear even faster than composites and are much too weak to be used to restore occlusal surfaces if the cavity extends onto a side of the tooth. Only metal and porcelain have adequate strength and durability for large restorations in back teeth. That is my opinion.

On the other hand, if a cavity is small, composite fillings are preferable almost everywhere in the mouth because the plastic resin that surrounds the harder filler particles is physically and chemically bonded to teeth, and therefore does not require a minimum thickness for strength like amalgams do. Sealants, which lack the filler particles, are an example of bonded resin.

Lastly, let me say that I am selfish. As a dentist, I demand to have the right to use both amalgam and composite filling materials so that I can provide the best care possible for my patients according to their needs. I and most dentists I know would actually stand to make much more money by pushing patients into buying the more expensive composite fillings when longer-lasting amalgams would serve them better.

Shifting the topic laterally, let me repeat that most dentists feel the same way I do, even if it is difficult to tell. Dentists just don’t say much. It is my opinion that their shyness comes from a bastard form of self-serving and perpetual hierarchical professionalism that is taught to dental students across the nation by an abundance of authoritarian instructors who lack people skills as well as compassion. Dental schools naturally attract the type, I suppose. I hereby declare that it is graduation time for dentists of the nation. Our patients clearly need our support, regardless of how unprofessional transparency might seem at first. Have some courage. Grab a voice. The air is safe.

Thank you, Losing Soul. Because of you, as well as others who agree and disagree with my opinions, it is no longer hopeless. DK Pruitt

[Griff DDS]

Thermal expansion is not a problem if moisture contamination of amalgam is eliminated. "Black" fillings usually were put in on kids in a sea of saliva. Keeping the preps dry, either with good suction or (gasp!) a rubber dam, and using premium dispersed phase alloy, is the ket

[Losing Soul]

Whew! It is not easy to consistently maintain chat in a thread (takes a lot of personal time), Hope I will be pardoned for poor English (being a non native speaker).

Dear Doc Griff,

Are you saying that if hypothetically we achieve zero moisture then there is zero thermal expansion after the fillings are placed?

Dear Readers,

Please pay attention to what pros in this thread and other threads are telling us... they are invaluable... These folks are people with good heart to take time to give opinion for free!

Well my lay man opinion for whatever its worth...

Like mentioned in some other thread don't get a cavity.

If you do go for the most conservative of restorations, because it is like a ball dropped from the top of a stairs it will ultimately result in teeth removal (if you live sufficiently long)

It might be best to go for Gold or porcelain

I would use conservative short-term fillings like GIC until I get funds ready. I would rather buy a ford focus and then spend on health care than set eyes on BMW.

I would prefer Crown than inlays and onlays, because I do not know any dentist personally and it is somewhat like presidential candidate and party workers in rally. Would you not have known the president more personally than just the new hi & handshake?

I would trust Amalgam's toxicity (touted?) more than Composites. Add to this some terrific advances in amalgam fillings composition and techniques.
But Amalgam's true downfall is that it is not a very conservative restoration, it destroys teeth more than it conserves.(please also see my question to Dr Griff above)
Composites like Filtek LS might add strength to what Doc Darrell says about composites for posterior occlusal restorations, but it is supposed to be on a new flanged notion called silarone chemistry (do manufacturers even take time to educate dentists about it or is it just few free samples and then please provide feedback for a complimentary this or that?)

And in all honesty 3M has a nice letter posted in their website about the differences of BPA & BISGMA.(of course there are others I guess TEGDMA, UDMA etc)

I have more respect for FDA than ADA (someone somewhere said ADA was created for the sole purpose of championing amalgam!) but I guess even they approve products that can be recalled later. It is our take to be an educated consumer to decide on the products (The para below 'I liked your wry humor' might be of interest to some)

Dear Doc Darrell,

C'mon are you telling that the supercilious authoritarian 'this is they way it works...' kind of coterie that typify premier schools in north and some bulge bracket investment banks in New York exists down south (oil & energy industry is excluded of course).

While the point of using all the option at a dentist's disposal is taken, should not some weightage be given to side effects (/ toxic substances).

I liked your wry sense of humour (or may be because you commended me),
when you mentioned about the bpa free composite being more suitable to plumbing industry. To add more ammo to your armory... I am not sure if the company that manufactures this product (And I think the filling restorative is Diamond Lite not Diamond Crown) even has a decent website, also my googling gave me the impression its a company with not more than a million $ in revenues and not more than 10 employees. I would rather use and sue (if need be) an established manufacturer.

True some of the best invention & discoveries in medicine are by individual geniuses but then like most of what I said above it is just my opinion from limited knowledge of things... its probably best I shut up!!!

Doc not only are your detractors like Dear Freya dropping out...

Bye all!
Don't expect to be pain free when visiting a dentist, but do expect to be pain free after (few days or months depending on if you had a surgical extraction or a major maxilofacial reconstruction).

[Losing Soul]

Whew! It is not easy to consistently maintain chat in a thread (takes a lot of personal time), Hope I will be pardoned for poor English (being a non native speaker).

Dear Doc Griff,

Are you saying that if hypothetically we achieve zero moisture then there is zero thermal expansion after the fillings are placed?

Dear Readers,

Please pay attention to what pros in this thread and other threads are telling us... they are invaluable... These folks are people with good heart to take time to give opinion for free!

Well my lay man opinion for whatever its worth...

Like mentioned in some other thread don't get a cavity.

If you do go for the most conservative of restorations, because it is like a ball dropped from the top of a stairs it will ultimately result in teeth removal (if you live sufficiently long)

It might be best to go for Gold or porcelain

I would use conservative short-term fillings like GIC until I get funds ready. I would rather buy a ford focus and then spend on health care than set eyes on BMW.

I would prefer Crown than inlays and onlays, because I do not know any dentist personally and it is somewhat like presidential candidate and party workers in rally. Would you not have known the president more personally than just the new hi & handshake?

I would trust Amalgam's toxicity (touted?) more than Composites. Add to this some terrific advances in amalgam fillings composition and techniques.
But Amalgam's true downfall is that it is not a very conservative restoration, it destroys teeth more than it conserves.(please also see my question to Dr Griff above)
Composites like Filtek LS might add strength to what Doc Darrell says about composites for posterior occlusal restorations, but it is supposed to be on a new flanged notion called silarone chemistry (do manufacturers even take time to educate dentists about it or is it just few free samples and then please provide feedback for a complimentary this or that?)

And in all honesty 3M has a nice letter posted in their website about the differences of BPA & BISGMA.(of course there are others I guess TEGDMA, UDMA etc)

I have more respect for FDA than ADA (someone somewhere said ADA was created for the sole purpose of championing amalgam!) but I guess even they approve products that can be recalled later. It is our take to be an educated consumer to decide on the products (The para below 'I liked your wry humor' might be of interest to some)

Dear Doc Darrell,

C'mon are you telling that the supercilious authoritarian 'this is they way it works...' kind of coterie that typify premier schools in north and some bulge bracket investment banks in New York exists down south (oil & energy industry is excluded of course).

While the point of using all the option at a dentist's disposal is taken, should not some weightage be given to side effects (/ toxic substances).

I liked your wry sense of humour (or may be because you commended me),
when you mentioned about the bpa free composite being more suitable to plumbing industry. To add more ammo to your armory... I am not sure if the company that manufactures this product (And I think the filling restorative is Diamond Lite not Diamond Crown) even has a decent website, also my googling gave me the impression its a company with not more than a million $ in revenues and not more than 10 employees. I would rather use and sue (if need be) an established manufacturer.

True some of the best invention & discoveries in medicine are by individual geniuses but then like most of what I said above it is just my opinion from limited knowledge of things... its probably best I shut up!!!

Not only are your detractors like Dear Freya dropping out...

Bye all!
Don't expect to be pain free when visiting a dentist, but do expect to be pain free after (few days or months depending on if you had a surgical extraction or a major maxilofacial reconstruction).

[Darrell]

I submitted the following comment on The Malibu Times Website this morning.
http://www.malibutimes.com/articles/2008/08/1...
A question I submitted yesterday on the site was refused, and I expect this scathing comment to be denied as well. That is why I am posting it here on my surrogate blog. Just so that Melonie Magruder knows that I hold her accountable for causing harm to naïve consumers, I have already returned to The Malibu Times Website and left her a message about you guys. My pleasure. Darrell
----------
Comment submitted to The Malibu Times

Yesterday, Melonie Magruder posted her article praising Dr. James Rota, who vows to personally ban amalgam fillings in the nation. She wrote,“The FDA has recently reversed its stance on the fillings containing mercury,” and added that the FDA considers amalgam to be too hazardous to be used safely as a filling material.

It turns out that her information was premature by about a day. Today, the FDA posted an article on their Website titled,“Dental Amalgam Exonerated by Expert Panel.”
http://fdanews.com/newsletter/article...

“The European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks has concluded that dental amalgam is safe for use in patients and that its overall risks and benefits are no greater than those of alternative restorative materials.”

Who are we to believe? The European Commission and FDA, or Dr. James Rota - the ambitious entrepreneur?

Yesterday, I tried posting a question for Dr. Rota about BPA in composite fillings and polycarbonate crowns that are used for baby teeth, but it was ignored. Why is that? If this is a Malibu Times PR piece, then that means Melonie Magruder must be nothing more than a PR hack, and a very careless one at that.

I would not want to be responsible for causing handicapped children and adults with Alzheimer’s to endure needless dental procedures to remove safe and functional amalgam fillings. That is beyond cruel, Melonie. Where are your ethics? Have you no compassion? DK Pruitt

cc: spamgroup

[toothdk]

Dear Losing Soul:
BPA, as noted by the FDA, is safe, and is blown out of proportion.
Amalgam's mercury poisoning, is blown out of proportion.
Composite wins out clearly because it 1. Strengthens the tooth due to adhesive technology. 2. It is far more conservative and requires incredibly less tooth structure to be removed.
This all assumes proper technique, rubber dam isolation is imperative, etc..

However, I take issue with your stance on wanting a crown rather than an inlay or an onlay. Are you serious? Why would you remove and grind down any remaining healthy tooth structure? Why?
If you're looking for an interim restoration,find a great dentist who uses rubber dam properly, in every case, and go for a composite filling.

And liking the ADA's stance? Are you kidding me? They have chastised dentists for years, taking away their licenses, for DENTIST'S informing people of the risks, all the while the ADA was hiding mercury from the public.
www.drgolab.net

[Darrell]

I appreciate toothdk joining the discussion. He adds experience and professional knowledge. I see that we agree on some items, and disagree on others.

I agree that BPA is safe. The threat of toxicity is a calculated scare, driven by those who stand to profit from creating doubt in the marketplace - just like the amalgam scare.

I disagree that there is a clear choice between composite and amalgam as restorative materials. When toothdk states that composite “strengthens the tooth due to adhesive technology,” he is correct only when compared to amalgam - which does not adhere to dentin or enamel. However, I think toothdk would agree that the bond strength of adhesive is miniscule compared to chewing forces, and that it will not prevent weakened teeth from fracturing at the edge of composites - just like teeth with amalgams. We have both seen this often with large fillings as well as inlays, which are the most unreliable and least cost-effective restorations in dentistry.

His second point that composites are more conservative is also partially correct, in my opinion. If the decay is small, a bonded composite filling is ideal because only the decay has to be removed prior to placement of the filling. Amalgam fillings, on the other hand, require a minimal thickness for strength, as well as more extensive undercuts to mechanically hold the metal filling in place. However, a composite is only as conservative as the hole it fills. Herein lays the weakness of composites. They wear out faster than amalgam fillings when exposed to the tremendous grinding forces between the back teeth, increasing the risk of new decay as well as increasing the fracture risk significantly if the filling is large.

I disagree with toothdk about inlays. It is my opinion that if a tooth has a cavity that is too large to be restored with a filling, it should have a crown that completely covers the tooth. In the long term, crowns are more conservative than inlays because they lessen the risk of bad things. Think about it. An inlay is a wedge. A crown is a thimble, and they cost about the same. A crown eliminates the risk of the tooth splitting while an inlay encourages it. In addition, the total length of the margin of a crown is shorter than most inlay margins, which go across the biting surface instead of around the neck of the tooth - where chewing never occurs.

Finally, I strongly disagree with toothdk’s harsh assessment of the American Dental Association. Like many Americans who have been members of the same organization for 26 consecutive years, I do not agree with all of the leaders’ decisions. However, I believe in the benevolence of my profession, which the ADA embraces - always. Public opinion and popularity are not science. Amalgam fillings are as safe as composites.

And to clear up one last point, the ADA does not license dentists. States do. DK Pruitt

[Darrell]

Remember Dr. James Rota, the biological dentist? He has been courageously responding to statements on the Malibu Times Website:
http://www.malibutimes.com/articles/2008/08/1...

A day ago or so, I attempted to post a nasty question concerning accountability for causing autistic children to undergo needless dental procedures, but it was not allowed. I am sure it was ruled “inflammatory.” And it was.

Here is what I posted a few minutes ago that doesn’t appear to be inflammatory. But it is:

“Dr. Rota, on your Website, you suggest that before patients even have their fillings removed, they should find a physician who will perform a ‘compatability test.’ Do you mean an ‘allergy test’? DK Pruitt”

Maybe this stinker will slip by the censor at Malibu Times.

Thanks for your time. I felt I just had to share this with you.

[Doug]

You're feeling alright
Ain't feeling so good myself

[Losing Soul]

Dear Toothdk,

With great experts talking... I was thinking of quietly slipping away, but looks rude if I do not answer at least some of your queries;

"Are you serious? Why would you remove and grind down any remaining healthy tooth structure? Why?"

The same reason that I cut my hair short the chances of a full fallout is much lesser. In addition the key is in your chat post itself, that is finding a great dentist.(the reason I mentioned the presidential candidate line)

While all of us want to be professional, we do the extra bit for someone we have known earlier.

Composites & Inlay are too much technique sensitive, In addition there are already (scholarly?) debates about methods, for example is it best to use a sandwich or layering technique of applying a GIC layer before doing a composite or not (ie directly apply composite).

Micro leakage would also be a worry for me, if I have great deal of money then I would probably go for gold inlay and request the dentist to do an only as well to postpone teeth grinding (for crown placement).

And like Doc Darrell said since cost comes to the same then may be good to spend on crown.

"And liking the ADA's stance? Are you kidding me?"

I am not sure if I communicated properly. I have more respect for FDA than ADA, just my impression... FDA is less lobby prone (aint it so?)

Dear Darrell,

Ouch you too! BPA aint safe!! bisgma, tegdma etc are... and that is what all composite manufacturers claim... that their products has no or very little BPA.

May be I am wrong (you are the pro), and 'plastics in Dentistry' has the ability to be a separate thread in itself.

Also my take on amalgam is that when you mention about the chewing forces it is very important to consider binding to dentin cause i think its dentin that an amalgam has to face after a dentist's handiwork. In addition even Amalgam has different composition / technique levels which can cause failure if not wisely chosen.

Great thanks for your insightful discussions (both).