Science or Common Sense?
August 16, 2011
Last week I started talking about how these new “squiggly” light bulbs we are all being forced to use by 2014 contain mercury. Because they contain mercury, they come with their own set of disposal instructions. Although I have not used dental amalgam as a restorative material for over 10 years, I can assure you there are no warnings on the packaging for this product before sticking it in your teeth…….and it is 50% mercury.
I had to replace a thermostat at home last weekend. The message below was strategically placed on a piece of paper to make sure it was not missed:
“Mercury Warning and Recycling Notice: Mercury is considered to be a hazardous material. If this product is replacing a thermostat that contains mercury in a sealed tube, contact your local waste management authority for instructions regarding recycling and proper disposal. It may be unlawful in your state to place it in the trash.”
Here is part of the statement posted on the website of the American Dental Association (ADA):
“Dental amalgam is considered a safe, affordable and durable material that has been used to restore the teeth of more than 100 million Americans. It contains a mixture of metals such as silver, copper and tin, in addition to mercury, which binds these components into a hard, stable and safe substance. Dental amalgam has been studied and reviewed extensively, and has established a record of safety and effectiveness.”
The FDI World Dental Federation and the World Health Organization concluded in a 1997 consensus statement – “No controlled studies have been published demonstrating systemic adverse effects from amalgam restorations.” Another conclusion of the report stated that, aside from rare instances of local side effects of allergic reactions, “the small amount of mercury released from amalgam restorations, especially during placement and removal, has not been shown to cause any adverse health effects.”
I don’t know about you but there are some things in life that I wholeheartedly trust science and research for and then there are other things where common sense takes over. Common sense tells me that if mercury has been taken out of all thermometers, and there are warnings on the packaging of all “new” light bulbs and thermostats, why do we still feel comfortable sticking a product that is 50% mercury in teeth?
Despite the fact that mercury vapor is released into the mouths of people who have amalgam fillings, the daily dose of mercury is not enough to cause concern with the ADA or anyone else. However, all dentists in the state of Massachusetts were mandated by the state to install and register an amalgam separating unit. When the filter needs replacement, it is considered hazardous waste and must be disposed of through a licensed waste management company.
Can a dentist advise a patient to have amalgam removed for health/safety reasons? The FDA has concluded that amalgam fillings cause no demonstrated clinical harm to patients and that removing amalgam will not prevent adverse health effects or reverse the course of existing diseases. So, although a dentist cannot legally advise you to remove amalgam fillings, he or she does have the right not to provide them as a service or require the use of certain techniques for their removal.
More next week.
The Golden Years
June 28, 2011
The Golden Years are much more “golden” if your teeth are in good shape. One of the most difficult areas I have had to address in my time as a dentist are issues concerning aging patients, specifically those who require assisted or nursing care.
Whether you are the one making decisions for someone else or you are older and can make your own decisions, it is easy to let home care and regular dental visits decrease as time goes on. Dental health needs to stay at the top of the priority list for many reasons. Quality of life and the link between oral health and systemic health are two big ones.
Patients I have seen for the past 15 years will come in and say, “I don’t need to fix that. How much longer do I really have to live?” And every time I respond the same way, “If you told me that you knew you weren’t going to be around next year I’d say I would agree with you…..but you’ve been saying the same thing for 15 years.” It’s worse when the patients lose key teeth when they had the opportunity to keep them for their lifetime.
When an elderly patient has a multitude of dental issues in which some significant decisions need to be made, I consider the following issues:
• What is the general health status?
• How old is the patient?
• What is the general prognosis medically?
• Has the patient ever worn anything removable in their mouth?
• What is the minimal amount of dentistry that can be done that will not alter the patient’s quality of life?
• What are other treatment options to maintain or improve the patient’s quality of life?
The general health status of the patient plays a big role in deciding how to approach a patient’s dental care. People who have medical problems and are well controlled are usually okay to receive general dental care. If a person is in good physical and mental shape it is hard to use age as a determining factor for dental care.
The most important factor which I believe needs to be considered is about quality of life. Studies have shown that loss of teeth results in a loss in quality of life. Some people with dentures have told me that they can eat anything. Others would pay anything to have their teeth back. The point is the enjoyment of eating. There is no one who could argue that eating with false teeth is as enjoyable as eating with real teeth.
In my opinion, the worst thing you could do to a 70+ year old person (or for that matter anyone, but the older you get the worse it is) is to remove teeth and make them wear something removable in their mouth. Dentures can be very difficult to adjust to and it is even harder when you are older. The problems with dentures not staying in, the patient not wanting to wear them, and impacting a patient’s nutritional intake are all issues that are much more difficult for the elderly.
The best way to avoid having to deal with major issues as you get older is to make sure you take care of your teeth while you’re younger. If someone you love ends up in a nursing facility, one of the most important things you could do for them is to make sure they get proper dental care. This includes the use of some home-care products on the market that greatly decrease the risk of dental caries.
Getting Ripped Off? – Part 3
May 29, 2011
For the last couple of weeks we have been discussing an online column that was forwarded to me called “Is Your Dentist Ripping You Off?” If you missed any of the columns, be sure to look them up online. This week I wanted to discuss more of the comments readers made after the column was published.
Many of the comments are rants from obviously angry people. As I read through the 9 pages of comments, it is obvious that people are mad about the cost of dentistry and things in general. It is also obvious that many of the contributors have a very negative opinion of the profession. This is a disturbing trend.
What does the following comment say about this particular person’s view of dentistry? “It is about time dentists got investigated. They over charge, they underpay and take advantage of their staff. Why do they use dangerous toxic materials like mercury in fillings?…….and the unnecessary braces they subject little kids to. They actually x-ray the whole head. This industry is ripe for massive investigations. Hopefully it will happen before more people are damaged by unnecessary or shoddy work.”
In addition to this comment being highly inaccurate, it is coming from someone who is probably angry at life in general, let alone dentistry. The point is that this is the trend. People are losing trust in professions that used to be well respected. Why? Life isn’t getting any easier. The cost of living seems to be continuously rising and loyalty and trust are slipping away as a consequence of just being able to make ends meet. As disposable income decreases, people are spending less on things they do not feel are essential.
I discussed a comment last week from someone who was complaining about the cost of a crown. What if you need 10 crowns and the cost is $15,000? Let’s get one thing straight – no one needs crowns. You may need a crown or 10 to save your teeth but you always have the option of taking the teeth out. That would cost a lot less. Someone might say – I can’t justify spending $15,000 on my teeth. There are people who will spend $40,000 on a car that they drive for 5 years and trade in for $10,000. Most people use their teeth more than they use their car and the teeth don’t depreciate. It is the responsibility of the dentist to educate the patient so that the patient can make the most informed decision on what is right for them.
Unfortunately, dentistry is not getting cheaper and the broken system we call dental insurance is not getting any better. So, for now, dentistry is one of those things you have to decide where to place on your priority list. Just keep in mind that your health, including the health of your teeth, has a direct effect on the quality of your life.
Now, as far as this trend of losing trust and loyalty, you have to make a decision about where dentistry falls on your priority list first. If your dental health is not important to you, you could be the one making all the negative comments about dentists and dentistry, probably do not go to the dentist on a regular basis, and will most likely suffer the consequences. If your dental health is important to you, seek someone you like and trust as a person. If you find that person, they will make sure to take good care of you. You have a choice.
