Ok let's try this ... the big anecdotal fight over the years has arguably
been the amalgam issue. I'm really confused as to why this is even an issue
any longer. Today I have in my practice materials that are reliable,
conservative, indicative, more aesthetically pleasing and while they take a
little longer to complete, I charge more for them. I've heard the arguments
against composites and while they might be more difficult, when done
correctly I don't experience any problems and nor do ANY of my patients ...
composites are technique sensitive ... so improve your techniques (dam, good
preparation, caries detector, rehydration of the dentine, curing thin layers
with a good powerful light, etc) and your selection of composites (I use
Esthet-X, Filtek and PrimeNBond NT) and everyone will be happy. As a guide,
composites should cost twice as much to the patient as amalgams.

I don't do amalgams ... but not because I have an opinion for or against a
mercury issue, because I find composites a better choice. If my patients
want their amalgams removed I'm more than happy to oblige them once I've
told them of the associated risks ...it's all about choice and informed
consent. I would not offer to replace amalgams unless they were overly
concerned about aesthetics. I would not offer amalgam as a choice for new
fillings ... if I'm really really concerned about strength I'll suggest all
porcelain crowns/inlays. If the patients ask for amalgams I'd suggest why I
think the newer materials are better but it is still their choice ...
however I have to admit nobody ever _asks_ for new amalgams.

Quit arguing about amalgams. Patients if you don't like them then don't get
them or ask for them to be removed at your own risk. If you feel better
after you've had them removed then be happy and get on with your life. If
you don't well hey you lost some cash but at least your teeth look better.
It's your choice. Dentists if your patients have their opinions then give
them yours and let them make their own choice or refer them to someone else.
Get yourself on to some Aesthetics courses and learn better composite
techniques ... if you find they are too tricky for you then refer patients
who don't want amalgam to someone else .. don't criticise because of your
own limitations.

Amalgam should not be an issue any more in the modern dental practice ...
perhaps we could discuss something more relevant ... like leeching?

Dr Karen Anderson BDSc

A couple of times up till about four years ago my dentist put a tooth-colored
filling in the side of my upper canine, but I kept getting decay under it so he
put amalgam back in.
Has new composite material become available in the last few years that's more
reliable than the stuff he used?

Under or around? Yes and No (not knowing what he used) ... and techiniques
have improved. While there could be other reasons for the decay, if caries
detector is used to remove all the decay and the prep is completely filled
then there is minimal risk of recurrence under the filling. The choice of
filling material if done correctly is irrelevant to the recurrence. I'd like
to know why he said it was because of the filling material (especially in a
tooth so easy to access)

I think he said it was because it contracted with temperature. Again, this was
about 5 years ago (I think!).

Pretty much what I've been doing for 17 years of my 22 year practice.

SWF DDS