Question for Tony B

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ChuckMSRD - 09 Jan 2005 10:37 GMT

You seem to be a very fair, informed professional. I have a question for you. I
am not doing this to criticize or second guess in anyway, but just for
curiosity.
Hypothetical patient situation:

30 y/o Mary Smith, Hx Maternal Fibromyalgia, Lupus, Paternal, Depression,
Alcoholism, yadi yadi, otherwise unremarkable

MS: "Hi Dr. B, just got from my honeymoon, we are looking forward to having a
few children soon as my clock is ticking, laugh laugh".
TB: "Looking at your x-rays, you have three nice size cavities Mary"
MS: "Oh, I'm not surprised you found something as I have had some discomfort
and that is mainly why I am here, but I *am* surprised as I have never had
cavities before"

In your opinion, amalgam is the best restorative material for these particular
cavities

Question: Do you.....
a) Place amalgam
b) Ask patient if they have anything against you placing amalgam, act according
to their wants.
- if they don't know what amalgam means or is you place it?
- if they have been reading Eichens blather they say they'd rather be safe
than quite possibly start behaving like him :-)
c) Consider near future pregnancy and opt for another restoration material
d) Consider maternal auto-immune issue and opt for other material
e) Probe deeper into medical history.....
f) other?

Again, pure curiosity as to what level headed Dentists are doing these days.
TYIA

Chuck

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StovePipe - 09 Jan 2005 17:29 GMT

> Question: Do you.....
> a) Place amalgam
[quoted text clipped - 4 lines]
>
> Chuck

I'm butting in where I was not invited here, but I, personally would
start with a good deep cleaning around those broken teeth, give the
patient some floss and some RotaPoints, let the gum tissue heal up for a
week or so, and place composites.

There are reasons for this:

1) If the gum tissue will let you, placing composite is not that
difficult, and you can even go somewhat sub-gingival if the gums are
happy.
2) If these teeth are sore now, they'll likely need root canals now or
soon. Composite gives you a good anchor for the rubber dam and it is
easily pierced.

3) As you know, composites have their drawbacks as does Am, but there
has not been any documentation showing that the presumed estrogenic
effects of these resins are a danger to the system.

4) IMO Am should be relegated to the last choice, but should be used if
necessary to save the teeth.

If the patient doesn't want to invest a whole lot of $$$, you can have
Fugi 9 placed as a 'temporary-sedative' filling, with the understanding
that it will be covered with something harder later.

This is just my 2 cents, and is completely independant of the purported
effects that Am may cause...

Hope Tony Bad gives you his take on your question.
SP

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Not a real Addy, yet

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Tony Bad - 10 Jan 2005 04:34 GMT

> You seem to be a very fair, informed professional. I have a question for you. I
> am not doing this to criticize or second guess in anyway, but just for
[quoted text clipped - 30 lines]
>
> Chuck

These kind of questions are hard to answer, as no one answer fits all
similar situations...but...in general terms, I would probably say may
approach is closest to choice "b", however, I usually make sure people
understand the options before I ask the question. If they don't know what
amalgam means, or why I'd be asking, I explain it to them. While my position
in online debates may seem narrow minded, in practice, my priority is doing
what patients want and feel comfortable with. As I have said before, a ban
of amalgam would have little impact upon my practice. About the only change
would be that some teeth with large areas in need of restoration would
require a cast restoration instead of a filling.

How did I do?

T

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ChuckMSRD - 29 Jan 2005 23:08 GMT

>How did I do?
>
>T

Fine, thank you

Chuck

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