Old amalgam post, I mean old post about amalgam 
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 Old amalgam post, I mean old post about amalgam

Hoild true?

I have to read it!

Joel M. Eichen DDS


Subject: Re: Body piercing, the IRS, and Michelangelo
View: Complete Thread (32 articles)  
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Newsgroups: sci.med.dentistry
Date: 2000/06/17

Don't believe it. Amalgam is an excellent choice in many

Hans' response:
People must wonder how Dr S Fawks, me and a few more thousand
dentists manage to stay clear of amalgam in *all* circumstances ?

Hans, I could be very {*filter*} rich just filling teeth that cosmetic
dentists say cannot be filled. Well, some patients get the crown while
other patients slink away until the tooth needs extracting. How else
can you account for 34 million Americans with no teeth?

Amalgam cracked their teeth?


> And it is alos far more easy on part
>of the dentist to place it because the techniques with
>composites makes dental life more difficult.


Not true.

I'd like to see a study on how many people are unhappy with
composites. It is a percentage of the population from what I can tell.

A percentage? Probably more unhappy with their amalgams.
But let them be unhappy - who cares if they cannot pay for
anything else but amalgam.

Amalgam is as good as the operator who installs it.

Not true. Amalgam placement requiers the least of skills and is
accepted by the dental community as non-technique sensitive.

A condensed amalgam stays put. A composite drips
back out of those upper teeth!

Raise your budget for continued education and you will find
out that this is not true.


Joel M. Eichen skrev i meddelandet ...


>>Summary of post below:
>>Amalgam is to be used mainly on poor people, and
>>especially if they have limited skills in English.

>Don't believe it. Amalgam is an excellent choice in many

>Hans, I could be very {*filter*} rich just filling teeth that cosmetic
>dentists say cannot be filled. Well, some patients get the crown while
>other patients slink away until the tooth needs extracting. How else
>can you account for 34 million Americans with no teeth?

>> It should
>>also be used on regular Americans if you want to avoid
>>insurance hazzle.

>No hazzle. In fact, insurance won't allow inlays.

>> And it is alos far more easy on part
>>of the dentist to place it because the techniques with
>>composites makes dental life more difficult.


>I'd like to see a study on how many people are unhappy with
>composites. It is a percentage of the population from what I can tell.

>>On part of the dentist.
>>Nice post, Joel, you are getting more and more closer to
>>the practicalities  (not meant as sarcasm ... I think).
>>Michelangelo would have had a hard time chiseling marble
>>instead of working "al fresco" on the ceiling of the Sistine
>>Chapel since he was lying on his back when doing his master-
>>piece. Amalgam will never be a masterpiece, no matter how hard
>>you try.

>Not true. Amalgam is as good as the operator who installs it.

>> Even if you do all your amalgams lying on your back.

>That is one of the amazing things. A condensed amalgam stays put. A
>composite drips back out of those upper teeth!

>>>I could not unscrew this post
>>Probably a Dentatus that the previous dentists had screwed in !

>It was some weird one!

>>Bye for now,

>>>Body piercing, the IRS, and Michelangelo

>>>This makes a very serious case for amalgam usage.

>>>A patient of mine brought her mother over to the dental
>>>office with a certain tooth problem.  The mother could not
>>>understand or speak one single word of English.  The
>>>daughter herself has very limited English skills.

>>>"How much to fix this tooth?" they asked.

>>>"Let's look," I answered.

>>>There in sight was an upper left molar with the palatal and
>>>distal surface completely gone, and broken right down to the
>>>root.  There was also a broken composite filling in the top
>>>section of the tooth.  A nifty post had been inserted into
>>>the palatal root, but alas, it was now bent out at a right
>>>angle to the long axis of the tooth.

>>>In other words, it looked like a miniature version of one of
>>>those neat lever handles that people sometimes install on the
>>>doors of their houses. Those are the ones replacing the round
>>>doorknobs that give the house a bit of a colonial appearance.
>>>This tooth post also swung back and forth just like the lever
>>>door handles.

>>>I could not unscrew this post, and hardly even tried. What I
>>>did do was to power up my air turbine and zing through it
>>>just like a hot knife zings through a stick of softened
>>>butter.  I also zinged out that old composite using a huge,
>>>serrated diamond cylinder drill.  Nnyarrowww, nnyarowww,
>>>nnyarroww.  You get the picture here, I am sure. I widened
>>>first, then I deepened the occlusal portion of the cavity
>>>preparation and I widened the isthmus too. It was now
>>>designed and engineered to properly retain the filling.

>>>Next, I applied a matrix band and I took out some of my huge
>>>condensers that I keep around especially for this purpose.
>>>They look much too big for human teeth! In fact they are too
>>>big for normal teeth with normal cavities. I filled that
>>>tooth right up with a nice, dense, well-condensed amalgam.

>>>Now I could have used composite I guess, but composite is
>>>what failed for this patient the last time around. I am not
>>>sure if it was the materials or if the problem was how it was
>>>placed, but restoring this tooth with composite might be
>>>pushing the envelope.

>>>Quite honestly, I have done some huge composite build-ups in
>>>my day too, if only to see for myself how durable the stuff
>>>really is. However, I have not done nearly enough to have
>>>complete confidence in this material.  Amalgam, by contrast,
>>>is very very sturdy. A properly placed amalgam is not going
>>>to crack anytime soon.

>>>A second advantage with amalgam is that I am working "al
>>>fresco." This means I am "working in fresh plaster," so to
>>>speak.  With composite, you are not working "al fresco."

>>>Michelangelo and those guys were the masters of this
>>>technique.  First, they would eat their lunch, then they'd
>>>clean up, and afterwards they would put up a whole section of
>>>wet plaster.  They would put up about as much as they thought
>>>they could complete before the plaster set.

>>>Then they went to work on it in earnest.  Slowly, slowly,
>>>they applied the color while the plaster was still wet.  A
>>>little more blue, a little less green, they would work
>>>quickly and efficiently. This was do-able as the wet surface
>>>allowed you to practice your artwork.

>>>This is why you eat your lunch first. If you have to
>>>interrupt your work in the middle to grab a quick bite,
>>>you'll come back to find out that the darned stuff has
>>>already set up. Now it is too late to fix up the wall.  I
>>>guess if it is the Sistine Chapel, the Pope might get pretty
>>>mad at you too.  In the dental office, it is certainly less

>>>However, this is also the case with amalgam. I like to use
>>>the sides of the tooth, the height of the adjacent teeth, the
>>>slope of the cusps, etc, to fashion a most pleasing contour.
>>>Next, the patient is instructed to bite very lightly. VERY
>>>lightly.  From this I can pretty accurately judge the point
>>>of contact.  Carve, carve, carve, bite again. Carve, carve,

>>>From that point, I can expertly carve in a valley here, an
>>>accessory groove there, all very quickly, and all very
>>>nicely.  Remember, I already mentioned that I am working "al
>>>fresco." I do not stop for my lunch in the middle either.  I
>>>already mentioned the part about the Pope.

>>>With composite, once you hit the restoration with the curing
>>>light, it is completely hard.  Completely! This is NOT "al
>>>fresco" at all. It is the opposite.  I guess that it could be
>>>called "al cruncho."

>>>To get everything to the right height and contour takes
>>>considerably longer.  First off, you are working with rotary
>>>instruments instead of with those nifty carvers.  You are now
>>>using diamonds and carbides.  You are basically grinding into
>>>the restoration to correct the occlusion.  This is more like
>>>Michelangelo chiseling marble instead of working away "al
>>>fresco" on the ceiling of the Sistine Chapel.

>>>I do not like to see a complete flattening off the tooth
>>>(yikes! no anatomy) either, so this takes me quite a while
>>>longer in the circumstance of a huge restoration.  I could
>>>flatten it. But I don't care to. Remember, just like that
>>>Sistine Chapel ceiling, I have to continue looking at this
>>>thing for many years to come! And the Pope has got to look at
>>>it too.

>>>When I told this patient how much money, did I add up all of
>>>the surfaces and all of the materials that I thought I'd
>>>need?  Absolutely not.  There's no need to. I can judge
>>>pretty much how long this job will take.  That is what
>>>matters most to me.  Its time.  That is the only non-
>>>replaceable commodity around here.

>>>I am sure that a strong case could be made for a crown
>>>lengthening, some scaling and root planing, and a post and
>>>crown. But hey! As I looked around the mouth, I sensed that
>>>this would not fly at all.  It would be like trying aviation
>>>before Kitty Hawk and the Wright brothers.

>>>Unfortunately, this is also the case with at least 30% of the
>>>American population.  You, the dentist, know many ways of
>>>fixing any one single tooth.  However, your patient might
>>>only have a simple extraction in mind!

>>>This lady just needed a bit of my help (a quick fix that is)
>>>to correct this annoying little swinging lever problem.
>>>Without some help, this tooth most certainly would have
>>>become lost.  It would have opened the door to more dental
>>>problems! Cool metaphor, eh?

>>>Now is this a dental service? I say it definitely is. Some of
>>>you may disagree with me. I doubt that these folks (language
>>>problem, remember) could be convinced even with a whole bunch
>>>of fancy words, and arm waving too, about the value of
>>>running up the dental bill into the thousands.

>>>Sometimes the words only get in our way. I knew what I had to
>>>do and that was really all that mattered.  You know, it was
>>>kind of gratifying too. Hey! That's dentistry. Or I should
>>>say that WAS dentistry.

>>>So what did this all cost? Far less than you would imagine.
>>>After all, there were no insurance companies to deny or
>>>to approve my claim, no waiting around for the mailman with
>>>the check, and no accountants poring over the books either.

>>>It was a simple payment for a small repair. What could be
>>>better?  It just points out to me how dental insurers,
>>>replete with their rules and regulations have almost ruined
>>>the practice of dentistry for half of the population.  Only
>>>fluoride has saved them.

>>>I recalled another guy, a very nice patient, who had either
>>>abrasion or abfraction lesions near the gum line of several
>>>upper teeth. These were on the {*filter*} surfaces of an upper
>>>molar and an upper bicuspid.  Of course, I used what is best
>>>- that was composite in this case.  Amalgam, with its
>>>distinct requirements for mechanical retention, would have
>>>clearly endangered the pulps and nerves of the teeth.

>>>The insurance company, Delta of California, DDP*Delta
>>>promptly sent back the transmittal with some very bad news.
>>>It stated,

>>>"No payment for composites on posterior teeth.  This service
>>>is the patient's responsibility."

>>>Now please recall that this patient IS ALREADY paying for
>>>dental care through his dental premiums. What do I tell him

>>>Well, he is a very good guy and I also just completed twelve
>>>units of bridgework for him very recently. So I just threw
>>>that {*filter*} piece of paper right into the trash without a
>>>second thought about it.

>>>Supposing another guy comes in with the same insurance and
>>>the same cavity, but without the need for the 12 units of
>>>bridgework?  Do you see how this puts the dentist right in
>>>the middle? The assumption here is that the dentist does not
>>>know how to extract the necessary money from the insurance

>>>By the way, this is not correct.  I am very good with

>>>What it leads to are diagnoses that are not necessarily in
>>>the patient's best interest. Another very reasonable
>>>alternative solution could be suggesting two additional
>>>crowns, possibly with root canals thrown in for some good
>>>measure.  That is not at all unreasonable.

>>>This diagnosis is always more difficult for the insurance
>>>company to argue with, especially since they are only looking
>>>at two-dimensional x-rays. But in any event, it may not be as
>>>good for the patient.

>>>Does this happen? Of course it does. Does it happen often?
>>>You bet it does.

>>>A second pet peeve of mine is where the insurance company (1)
>>>deducts $50 right from the get-go, or (2) sends the
>>>reimbur{*filter*}t check directly to the employee rather than to
>>>the dentist. This is technically known as "failing to honor
>>>an assignment of benefits."

>>>A formerly very good patient with excellent dental insurance
>>>found that there was suddenly a $50 deductible (per year)
>>>exclusion imposed on his dental insurance. Guess who has been
>>>ducking the dentist for the past two years? He is still my
>>>patient. I see him at Wawa from time to time and his wife
>>>comes over here faithfully.

>>>About sending the check to the patient.

>>>Remember, the IRS has initially allowed employers to deduct
>>>the premiums as ERISA benefits.  As such, they are not
>>>subject to income taxation, FICA, etc.  They are technically,
>>>employee benefits.

>>>If the insurance company then sends the benefits check to the
>>>worker, then at the very least, the IRS should require
>>>government notification from insurance carriers to the IRS of
>>>patient payment through a 1099 document.  If the patient
>>>claims no taxes are due, then the patient should also be
>>>required to establish that he/she has indeed forwarded the
>>>check to the health care provider.

>>>If the patient has failed to forward the benefit check to the
>>>health care provider, then they should be held accountable
>>>for any unpaid income tax. Failing that, they should be
>>>prosecuted for tax evasion, which is exactly what it is.  In
>>>fact, they have converted what was a health care benefit into
>>>their own tax-free income.

>>>I would also suggest a mandatory 6-month prison sentence be
>>>imposed upon conviction of this crime. Maybe we'd have to
>>>build a few more prisons, or alternatively, we could release
>>>some of the {*filter*}ers and rapists instead. We'd be much safer
>>>now that the real bad guys are locked up.  Several lawyers
>>>have also suggested property forfeiture through RICO laws.

>>>By contrast, here is United Concordia. In exchange for
>>>sending me the check directly with no fooling around at all,
>>>I have signed a contract with them to accept their allowance
>>>as payment in full. Well, okay.

>>>Q1120 "As a Participating Provider, you have agreed to accept
>>>the allowance as full payment for covered services."

>>>How much? Well it just depends.

>>>Here is one case, a straight forward deal, a decent patient
>>>for whom I constructed a lower partial denture. This
>>>consisted of acrylic attachments plus a cast stainess steel
>>>base.  What is the allowance?

>>>D5214 - Lower partial ---- $494.
>>>United Concordia sends me half --- $247.
>>>The patient pays me half too.

>>>Fair enough!

>>>  **

>>>We are overloaded with information in this information age,
>>>while we are simultaneously underwhelmed with knowledge.
>>>Using a touch-tone phone, we can track any dental claim for
>>>any service with just about any dental insurance company.
>>>That way, they cut way back on their need for live people. We
>>>just punch away at phones to our heart's content.

>>>Three weeks ago, we had traced a certain dental claim for
>>>$85 (date of service: 4/21/2000) and found out that it was
>>>paid on 5/24/2000 with check number 10496431.  Not bad so
>>>far.  That is information.  That comes very cheap in a touch-
>>>tone-activated, computerized world.

>>>Here is the little piece of missing knowledge:

>>>If you guys paid the claim, just where is the money anyway?


>>>Where is it? Ahhhhah!

>>>They sent it to a wrong address! I am certain it was opened,
>>>stamped and already 'accidentally' deposited by now. "We will
>>>issue a new check. We will stop payment on the old check!"

>>>I have been trying to get this same insurance company to
>>>change my address for over three years now. They won't do it.
>>>Do you see what I mean when I tell you that a quick deal
>>>involving the 'coin of the realm' is still much preferred?

>>>Thinking back, this jogs my memory. I had another claim from
>>>this same company several years back. It involved my having
>>>to have notarized three separate forms (cost me eight bucks
>>>too!) and it took over eigh{*filter*} months until they would send
>>>me a replacement check for $155. Oh Jeez, I hope we are not
>>>going there again!  (See ** ADDENDUM below).

>>>Here is a second pre-treatment determination that has gone
>>>completely astray - back and forth already so much that I am
>>>starting to even like the Billy Joel Piano Man music that
>>>they always broadcast across our speaker phone. That's one of
>>>the perks of this new computer information age!

>>>Here is the little piece of missing knowledge:

>>>Do you think the employee will still be working at his same
>>>job (and still covered by your dental insurance) by the time
>>>you guys decide to give me the approval?

>>>Customer Service: "We are so sorry. It is our mistake."

>>>Organized dentistry should have become involved with many of
>>>these inequities a very long time ago. Unfortunately the
>>>American Dental Association's abbreviation is not really ADA.
>>>Its actually spelled more like W-U-S-S.

>>>Now you might be wondering, "Why did Michelangelo have to
>>>clean up before laying down the plaster?"

>>>You will recall I said,

>>>"Michelangelo and those guys were the masters of this
>>>technique.  First, they would eat their lunch, then they'd
>>>clean up, and afterwards they would put up a whole section of
>>>wet plaster."

>>>You see, the first few times out, Michelangelo's assistants
>>>got some hunks of salami, a few slices of pastrami, a little
>>>mustard and some of the rye bread caught up inside the
>>>fresco. When Michelangelo saw it, he went completely nuts.

>>>However, in later years, this technique caught on Big Time.

>>>"Blue Poles," by the abstract expressionist artist, Jackson
>>>Pollack last sold at Sothby's for upwards of tens of
>>>millions.  Few people notice that it still has some of the
>>>original pastrami and rye bread stuck right in the middle of

>>>There was another piece where Jackson was eating a tongue
>>>sandwich. Part of the tongue (not Pollack's tongue) got
>>>caught in the collage.  I have already posted this story at
>>>rec.alt.bodymodification.  They just loved it over there.
>>>They simply love any kind of story that involves tongues.


>>>Joel M. Eichen, D.D.S.

>>>PS to RABbits:

>>>That's rec.alt.bodyslicers.

>>>The purpose of these posts is (1) to illustrate some simple
>>>common-sense principles about dentistry, (2) to take a couple
>>>of pot-shots at the dental insurance industry, and (3) to get
>>>some discussions going.  It is also meant (4) to amuse
>>>somewhat, however this is sometimes a stretch.

>>>Thanks for helping out anyway.

>>>Body piercing and {*filter*}piercing? I could care less. It really
>>>does not affect me, not even one single bit. Trust me on
>>>that. I am not that interested. Well, wait a minute, come to
>>>think of it .  .  .

>>>But thanks for being good sports and joining in with our very
>>>lively dental discussion group.  I know that "lively dental
>>>discussions" sounds like an oxymoron.  Don't worry.  Perhaps
>>>you'll help spread the word that this is really the place to
>>>come for some really GOOD dental advice!

>>>Did my little scheme work? Of course it did! Look at how many
>>>of you guys are reading this post right now!  Remember that
>>>with all things, that he who laughs last, laughs last.

>>>Sorry for all of the brouhaha that I got you guys got in so
>>>deep over.  Brouhaha?  Yeh that's like having a brewski or
>>>two and telling a few jokes . . . I guess.


>>>** Addendum

>>>Joel M. Eichen, D.D.S.

>>>Ms. XXX

>>>July 20, 1998

>>>Dear Ms. XXX,

>>>This will confirm our conversations of
>>>12/27/97 where you mentioned that you have
>>>received my notarized affidavits for the
>>>missing check #64167267 endorsed by some
>>>unknown person.

>>>You had also told me on 4/21/98 that you would
>>>check on the progress of a replacement check.

>>>I spoke with you on 6/2/98 and you said that
>>>you would get back to me. I have not heard
>>>from you.

>>>You have contacted me after my last letter on
>>>June 10, 1998.

>>>You mentioned that your "fraud department" was
>>>working on this. Can you send me name and number
>>>of someone in that department so that I can
>>>contact them directly and proceed with this matter.


>>>Joel M. Eichen, D.D.S.


>>>[old post]

>>>Bum Check

>>>This is one of my most egregious cases of getting "ripped
>>>off" and its a pretty good example of why dentistry is
>>>getting mighty expensive!

>>>I'd like to share it with you.

>>>In March 1997, I was issued an insurance check for $155 as
>>>payment for something or other. When we inquired about some
>>>patient's outstanding bill, the issuing insurance company
>>>referred me to that check.

>>>Who? What check?

>>>Turns out it was endorsed by someone else. Who? I don't know.
>>>Its still a mystery. The handwriting is Eastern European, but
>>>I don't know where this check was deposited or how they got
>>>hold of it.  This is the banking industry's problem, not the
>>>dental office's problem.

>>>So, in December, 1997 I filled out the necessary affidavits
>>>and spent another $8 having them notarized. Now I got eight
>>>bucks invested so I can't even forget about it any more even
>>>if I want to.  Its now the middle of June, 1998 and the
>>>insurance company's fraud department is still "working on

>>>Makes you kind of wonder, doesn't it?  They work at two
>>>speeds over there: (1) slow and (2) stop.

>>>  **

>>>We are almost down to the bottom of the page. That is, if
>>>anyone is still reading! Almost every line of the post is
>>>about people -- its about dentists and their patients --
>>>treating one another sometimes fairly and other times not so

>>>I suppose that some young people look around them and they
>>>see all of this nonsense. Meanwhile, they are thinking to
>>>themselves, "How will I ever be able to make my way in this
>>>world?  It seems impossible.  And come to think of it, do I
>>>really want to?"

>>>So what do they do?

>>>Well, they join a brotherhood or pledge themselves to a
>>>sisterhood where they irrevokably cut themselves off from
>>>competing in this stuffy, trashy establishment world. Well,
>>>my friends, green hair still grows out.  Those Mohawks still
>>>grow back.  But just place a few pieces of metal in your
>>>face, and you are clearly making an impressionable statement!

>>>Does that make any sense to anyone?  Ahh, what an exciting
>>>journey it has been so far! So many things learned along the
>>>way and so many things still to improve. Where do we begin?
>>>What do we start?

>>>Start with what?

>>>Making for ourselves, a brand new, "Brave New World." A brand
>>>new "Shangi-La."  What's my method? first, I get your
>>>attention! Its harder than it appears.



>>>Joel M. Eichen, D.D.S.

Sun, 07 Aug 2005 04:03:00 GMT
 [ 1 post ] 

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