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Letters: Amalgam, yes

August 19, 2013

I felt compelled to respond to Dr. Carapezza's letter "The Silent Opinion" (July 15 ADA News).

My observations in my practice have mirrored what Dr. Carapezza related concerning amalgams and composites and the need for sedation of pediatric patients. Even though I am a general dentist, I have, and have had, a number of pediatric patients.

I cannot help but wonder what we in dentistry have bought into and what effect this has had on our patients.

I have also practiced for over 40 years and now have patients that once were young patients of mine who are now parents bringing their children to me. The parents, when young, had amalgams placed, with local anesthesia only, with excellent results. With esthetics being the rage now days, I do a lot of composites. If no professional issues dictate a particular material being used posteriorly, I leave the choice to the parents. Often times they elect the more esthetic composite and it works reasonably well; however, my clinical experience has shown more problems with the composite, long term, than with amalgam, everything else appearing equal.

As for sedation, some children (even some adults) really need it, for they have such fear and difficulty dealing with almost anything, and the sedation helps them and the dentist. I guess we have to adjust to accommodate society and its cultural changes, but when I first opened my practice over 40 years ago, I may have had to refer one to two children out of five to a pediatric dentist. Now I have to refer four out of five. But, then, about four out of five adults have symptoms related to bruxism. Forty years ago it was only one to two out of five. We definitely live in an uptight society. In addition, I do not think a number of parents are able to teach their children to deal with unpleasant things in their lives because the parents, themselves, are unable to deal with them.

Another issue that I have noticed is that when I first began my practice, only about 10-15 percent of patients, at the most, had any type of third-party payment; and yet, patients had cleanings, recalls, restorations, crowns, bridges, root canals, etc. Now, about 55 percent of patients have some type of third-party payment, and patients have difficulty having anything done that requires any payment on their part. Obviously, there has been a major change in choices and philosophy in our society. I think too many people think that others should be responsible for their necessities. I asked a banker a couple of years ago if many people have savings accounts. She answered "No," and then added that those who did were my age (old). We were brought up believing that we were responsible for ourselves.

Whatever the reason, or reasons, there has definitely been a change over the years in patients, young and old; and I do have concerns as to how dentistry is dealing with these changes.

Just a few observations, but they are experienced ones.

Paul L. Powell, Jr., D.D.S.
Siler City, N.C.