January 1, 2003
by Neil Applebaum, DDS, Dip. Paedo
The era of “Cosmetic Dentistry” has impacted on every aspect of conventional dentistry. Today many dentists will only place “White Fillings.” Are they reacting to the public’s fear that using silver alloy restorations with mercury may result in some form of pathology? Has the public’s enthusiasm for restoring teeth with “white fillings” influenced or clouded our judgment as to what is the best dental material or the best technique to use in restoring posterior teeth? If we use alloy restorations in our office, are we afraid that the public will abandon treatment in our office in favour of a dentist who just does “white fillings”? What are the ramifications of restoring posterior teeth with resins? Have we increased the growth of the endodontist’s practice by using large posterior resin restorations?
In the last issue of “The Daily Discipline,” Dr. Smith of Anywhere, Canada, had replaced all of Mrs. Sore Teeth’s amalgam fillings with composite resins, subsequently making the local endodontist very prosperous. Mrs. Sore Teeth, angered at the outcome, was contemplating her options. Should she lodge a formal complaint against her dentist (Dr. Smith), take the advice of her lawyer and sue Dr. Smith, or seek some kind of dispute resolution through mediation?
During our practice years, we should be taking continuing education courses, reading the dental literature and consulting with our universities. This will allow us to critically evaluate new techniques and materials. But instead of doing this, many of us choose treatment options that ignore the “scientific method” — the long term proof of success. We often listen to the resident guru, who says use it “because it works.” However, these people do not have to take the responsibility when the procedure falls. And what about communication — the essence of our practices? Are there still some of us who provide dental services to patients without first explaining the pros and cons of each available option to our patient? This takes time, but must be done because the consequences of avoiding this step can be catastrophic!
Dr. Applebaum is editor-in-chief of The Daily Discipline, a publication of the Canadian Dental Protective Association.
The editorial by Dr. Applebaum and the reprinted papers by Drs. McComb, Lenkinski and Matsui concerning the increased use of composite filling materials are both thought-provoking and timely. They indicate both the dilemma confronting the clinician when ‘white fillings’ are requested by the patient or parent and the issues of informed consent for clinicians who practice in an amalgam-free environment. There are no easy solutions to any of these issues except that clinicians must fully apprise themselves of the advantages and disadvantages of all the materials they are currently using to restore teeth and these caveats, in turn, must be conveyed to patients and parents. The selection of materials must be ‘evidence based’. The anecdotal premise that ‘it works in my hands’ has no place in modern-day clinical practice.
By Keith Titley, BDS, MScD, FRCD(C