News From The Wealthy Dentist #44: May 9, 2007
by Jim Du Molin
Ten Ways Mercury Raises Strong Feelings Among Dentists
I knew I was stepping in a big pile of controversy when I recently decided to run a survey about mercury fillings, but I was curious to see where you all stand on the issue.
If I was hoping for a clear answer one way or the other, I certainly didn’t get it!
Dentists are split right down the middle on this one. You sent in a record number of responses to this question. (Read the dentists’ comments.)
Well, let me resolve the issue once and for all in this short article.
Ha! Just kidding. I don’t pretend to be a clinical expert or a scientific researcher; I’m just a marketing guy who knows a lot about dental practices. All I can do is give you my take on the issue.
Let me respond to some of the issues – both for and against mercury amalgam – most commonly raised by dentists.
- People don’t want silver fillings because they’re ugly.There’s no denying the fact that we live in a cosmetically conscious society. Last year, Julia Roberts received some heat from the press when a photographer captured not just her laugh but a mouthful of silver fillings as well.
- Silver fillings can last for 50 years.It’s true, but silver fillings also break down.
- It’s not clear that composite materials are safe.It’s true that composites have not been proven to be safe (scientifically, it’s hard to prove anything is safe), but studies have also not indicated they’re dangerous, and they don’t seem to pose the same risks as silver/mercury fillings.
- It’s public fear-mongering to question the safety of amalgam.Last time I checked, we still had freedom of speech in this country, right? It’s a valid concern, and it’s the right of a free society to discuss any issue.
- The ADA and the FDA say amalgam is safe.Let’s talk to the FDA about a few other things too: Agent Orange, thalidomide, DDT…
- How can it be safe inside your body but toxic waste outside of
It actually can become more dangerous as you remove it. Many dentists who remove but do not place amalgam fillings have high levels of mercury in their systems. It’s like asbestos – most toxic during removal. I remember a few years back seeing courses on how to remove amalgam safely for the patient and yourself.
- Amalgam works better in some situations.Did I say I was a dentist? You’re the doctor trained to make clinical decisions. If you want to use amalgam on DL of #31 with poor moisture control and a patient who doesn’t floss, that’s your call to make. But is there really any need for a 3-surface amalgam?
- Mercury is a health hazard to dental professionals.This is absolutely true, and I hope it’s something you’re aware of and test for. I knew a dentist who bought an old practice not realizing the whole place was saturated with mercury. After the staff of five women suffered three
miscarriages in five years, they finally did a toxicology study. You wouldn’t believe how expensive it was to decontaminate.
- Silver amalgam is a clinical issue, not a marketing one.You’re a dentist, so you might see it that way. I’m a marketer, and to me it’s a marketing issue. First, composites let you avoid the safety issues of mercury. Second, restorations look better with composite materials. Seems pretty straightforward to me.
- Calling it “mercury amalgam” reveals
Listen, I tried as hard as I could to keep the wording of my survey neutral. I understand that many of you prefer the term “silver amalgam.” To me, that’s a linguistic question. The term amalgam used to mean a mercury-based mixture of metals, but it has come to mean any homogenous mixture. According to the older definition, the material would be called “silver amalgam,” while the modern popular definition leads to the phrase “mercury amalgam.”
The coin toss on this issue is siding with a “mercury-free” solution. But the real decision will be not be made for you by the FDA or the ADA, but by the consumer’s perception of what is right. And guess what? In the consumer’s mind, mercury is a poison.
Many thanks to all the dentists who responded to our poll; your comments were invaluable.
Jim Du Molin
Survey: Dental Equipment
In this poll, we asked dentists: Have you ever been disappointed by expensive equipment your dental practice has purchased?
Sellers beware! Dentists haven’t been pleased with some of their pricey purchases. Eighty-three percent of dentists in our poll responded, “Yes; many tools do not live up to their advertised promises.” The remaining 17% replied, “No; every piece of equipment has a learning curve, and the equipment we’ve bought has met my expectations.”
Here are just a few of the comments our dentists had to share:
“Are you kidding? Damn near every piece of equipment has been over-hyped. The drawbacks are omitted before the sale. If suppliers were real estate brokers, physicians, or even dentists they would have all lost their licenses years ago. It’s more like buying a used car than a piece of professional equipment.“
“Digital x-ray and electric handpieces have made a huge impact in my practice.”
“I bought the Zoom lamp. Though it does work, it was not worth the money.”
“In the past, dealers would let you try before you buy. No more.”
“I believe the learning aspect is very important and should be addressed before purchase. It sometimes keeps us from utilizing the full potential of equipment.”
“My new KAVO operatories are a sham… Schein has done a really poor job.”
“Too much hype! Then reality sets in and you feel taken. Plus, you can’t charge any more for the WOW! factor for patients. They aren’t buying it.”
In the War Against Eating Disorders, Dentists Can Play a Vital Role
Bulimia is an insidious eating disorder whose binge-and-purge cycle can be difficult to detect. The women (and increasing numbers of men) who suffer from bulimia tend to be high achievers with normal body weights. They eat in public and vomit in private, with their friends and family members completely unaware of their condition. Even GPs will often miss a diagnosis of bulimia.
But dentists are another story completely. Dentists can often diagnose bulimia before anyone else. And just because you don’t treat patients for eating disorders doesn’t mean you don’t have a responsibility to diagnose the condition and refer the patient to someone who can treat them.
What are the dental signs of bulimia?
- Enamel erosion, particularly on the inside surface of the upper front teeth
(in some patients, these signs will appear within months; in other patients,
enamel erosion may take years to become visible)
- Tissue trauma from vomiting or inducing vomiting
- Increased caries
- Dental pain
- Damaged dental work
- Bleeding gums
- Enlarged salivary glands or reduced saliva
If you suspect bulimia, remember that sensitivity is essential; many people with eating disorders are not eager to be diagnosed. However, you have a responsibility to your patient not to ignore evidence of disease. You should first address your patient’s dental health, then give a referral to an eating disorder specialist.
A good place to start is, “You have erosion of your tooth enamel. This is often seen in people who vomit. Do you vomit frequently?” This question dodges the bulimia diagnosis. In fact, there are other conditions that can cause similar enamel erosion: acid reflux, morning sickness, etc.
Advise the patient that people who vomit have special dental needs. Patients should rinse with water but not brush after vomiting. Patients may also require extra dental care, artificial saliva, and additional calcium. Restorative dentistry should not begin until after the patient has been successfully treated and has stopped vomiting.
It’s important to also provide the patient with a referral to a professional qualified to handle eating disorders, not just the patient’s general practitioner. Your local eating disorder clinic can help you find the right person for these referrals.
How do you handle patients who show signs of bulimia? Share your stories by posting to our blog.