Posted by mattdds on May 8, 2003, at 14:33:45
In reply to Re: Dental amalgam increases disease? (long) » mattdds, posted by Larry Hoover on May 8, 2003, at 9:57:19
Hi Larry,
It is always a waste of time to try to convince someone else of something they have a strong bias or opinion against. This type of exchange will only lead the both of us to strengthen our existing opinions.
However, I was not impressed with either the sources you cited or the quality of studies they performed. You did provide an overwhelming **number** of studies, but I think the quality of most of them was pretty poor. A few of them, seemed like zealots, with strong biases. Kind of like the anti-fluoridation zealots or the people that say that using psychiatric drugs will cause creepy, mysterious diseases. If one wants to find evidence supporting something, it can be found if one looks hard enough. All it takes these days is a search on Google or pubmed. The problem is, in the meanwhile, better performed studies may overlooked, because they don’t fit the preconceived notions.
You quoted “The Rocky Mountain Research Institute” a couple of times. One of their articles was attempting to make a link between dental amalgam and Alzheimer’s disease. I thought that they pretty much had the etiology of Alzheimer’s nailed down; having to do with beta-amyloid plaques that accumulate in the brain. You are taking a very controversial and unsupported view on this one. And you will have to do better than one small study containing 48 people, performed by a highly biased “research” group.
For what it’s worth, here is the statement from the Alzheimers Association, who as far as I know, are advocates for those with the disease, don’t give a damn about us quack American dentists (as you put it) being sued, and don’t have any connection with the evil dental amalgam manufacturers:
"According to the best available scientific evidence there is no relationship between silver dental fillings and Alzheimer's." (Alzheimer's Association)
On a similar note:
Saxe SR, Wekstein MW et al. "Alzheimer's disease, dental amalgam and mercury", JADA 1999 Feb;130(2):191-9This study consisted of 68 human subjects with diagnosed Alzheimer's disease and 33 control subjects without Alzheimer's to determine mercury levels in multiple brain regions at autopsy and to ascertain the subjects' dental amalgam status and history. Conclusions: Mercury in dental amalgam restorations does not appear to be a neurotoxic factor in the pathogenesis of this disease. The authors found that brain mercury levels are not associated with dental amalgam, either from existing amalgam restorations or according to subjects' dental amalgam restoration history. Furthermore, dental amalgam restorations, regardless of number, occlusal surface area or time, do not relate to brain mercury level.
I think these are pretty clear.
You quoted the same group as having done some research about a link between multiple sclerosis and amalgam. Boy, these guys are on a roll!
Here is what the National Multiple Sclerosis Society said about that:
"There is no scientific evidence to connect the development of MS or other neurological diseases with dental fillings containing mercury." (National Multiple Sclerosis Society)
Again, pretty clear, I think.
The Academy of Pediatrics has said this:
"There is no scientific evidence of any measurable clinical toxic effects [of dental amalgam]." (American Academy of Pediatrics)
From reading your posts, I picked up on a sense of mistrust of large health organizations. E.g. the ADA, and perhaps groups like the ones I just cited. Am I correct on this? If so I apologize. If it is true, I would be curious as to why you feel that your opinions are better than the overwhelming majority of your peer scientists.
Also, you wrote:
>>Were I to rewrite that phrase today, I would use "place" instead of "store". I did not mean to suggest environmental concerns in any respect. You're a dentist, right? It just hit me that you are mattdds. You have very exacting protocols on what to do with excess amalgam, right? You wear rubber gloves to protect against even trivial dermal exposure, correct? But you have no problem placing an amalgam on a buccal surface, guaranteeing exposure to cheek skin, right? Or on an occlusal surface, even in bruxists? Doesn't this seem to suggest different standards being applied in these two situations?
First, no I’m not a dentist...yet. I am a 4th year dental student.
Second, I don’t really understand what you are asking (or implying?) here. Since about 1950 we wear gloves ANYTIME we are in a patient’s mouth. This has nothing to do with amalgam but with infectious disease control. We follow the EPA’s and OSHA’s guidelines on amalgam removal and disposal not so much because we secretly and devilishly know how bad amalgam **really** is and want to avoid it ourselves, but more because we don’t want to get our practice shut down by the EPA. These aren’t **our** “exacting protocols" as you suggested (implying that we were trying to protect ourselves from "trivial dermal damage", while unscrupulously and maliciously placing buccal amalgams, while knowingly harming the patient) but ones that have been imposed on us by larger organizations outside our control, so we just follow the rules. As far as buccal pit amalgams, I am confused here too. First off, they are (or should be) placed with a rubber dam until the amalgam sets. Also, I thought the main concern was during mastication? At least that was when you claimed mercury was released, am I right? Mastication involves the occlusal surfaces of the teeth, not the buccal (unless you have some extremely abnormal occlusal morphology). So, I am actually **less** concerned about a buccally placed amalgam restoration. By the way, I personally don’t put amalgam in buccal pits. Amalgam is suitable for high-stress bearing areas, namely, the occlusal surfaces of posterior teeth. Composite is now the material of choice for buccal caries. As for patients who are bruxers, we have a few options. My own choice would be to place a gold or high-noble inlay, which most patients not to mention insurance companies will not pay for. We can also place a porcelain restoration – which would completely obliterate the opposing dentition, or fracture. Again these are tremendously expensive. We can also place a composite filling, for which the patient will definitely hate us, because they will either wear out within a week or fracture completely. Then we would have to remove the composite, and inevitably more tooth structure to place a new (probably a crown, this time) restoration. We can also let the tooth continue to decay, but that would eventually either require an extraction (most patients would prefer the nominal mercury exposure) or a root canal, then a post-core and crown (upwards of $1500, minimum). Lastly, we could place an amalgam for $75. If you were put in the same position, with similar economic restraints, what would you do Larry? If you have some secrets that you are holding from us morons in the American dental community, please reveal them to us! Help us out here, perhaps we are missing something terribly obvious. You see, I am damned if I do, damned if I don’t, don’t or don’t. Then I have to deal with people like you telling me how big of a quack I am for doing the best that I know how, without offering any good alternatives. Do you still wonder why dentists have a high suicide rate, Larry?
Your comments reveal a mistrust of dentists in general, I am curious as to why. Do you feel **all** dentists are similarly malicious? Or just the ones that use amalgam (almost all of them)?
Incidentally, I imagine in my practice, I will avoid amalgam altogether, even though I feel it is a superior restorative material, as well as a safe and affordable one. Composite resins are getting pretty strong nowadays, approaching the qualities of real tooth (amalgam is still quite a bit stronger). They are also quite esthetic. My school clinic is pushing posterior composites, such as Sur-Fil (a glass reinforced, packable resin composite). Anything that is too large for composite, I will probably treatment plan for a crown or an onlay. I am hoping that posterior composites will supplant amalgam, and think it will in the near future, just so I can stop hearing people freak out about it. I think the scare about amalgam in the teeth becomes just another source of obsession and hypochondriasis, which in my view are much more pathologic than the actual harm done by the mercury. Either way, I will not be sad to see it go.
Also, you said:
>>I would ask you this: "If mercury amalgams were being proposed today as an innovative restorative material for dental caries, do you think that they would get past the regulatory approval process in existence today?" I can guarantee you, they would not get past the committee stage, let alone get into animal trials.
Someone recently posed the same question about aspirin, and speculated that aspirin would likely not be deemed as safe for use. So I agree, amalgam would probably not even be given the chance to be used. But I am not so sure that would be a good thing. I still think aspirin is a great drug and safe, and still think that dental amalgam is a great material, and safe. The approval process is slow enough as it is, and getting slower. I think that the harm done by the over cautiousness of the regulatory groups is much more detrimental, and offsets the good they do by “protecting” us. Plus, I don’t think they are always right about things, e.g. they approved fenfluramine-phentermine combos in the recent past, only shortly later to find out they screwed up - big time. I don’t believe in a total Laissez-Faire attitude toward drug development, but believe that the process is much too slow as it stands.
Finally, the axiom of science you quoted is true, absence of evidence does not mean evidence of absence. So by this, you seem to be conceding somewhat that there is pretty scant evidence for what you are claiming. I think it is only in the X-files or conspiracy theory type thinking that absence of evidence equals evidence. You even mentioned being aware of major, large epidemiological studies that failed to show correlations between amalgam and disease. How do you reconcile these findings with your beliefs?
Sure, you are entitled to opinions. Believe what you will. But in the process, please make sure not to scapegoat people (dentists) for diseases that we know very little about. Who knows, maybe small, chronic doses of mercury from amalgams will indeed turn out to be the root of all evil. When this evidence turns up, I will concede, and resign to hell, which will be my rightful inheritence, along with the other dentists who sold their souls to amalgam for a Lexus. But I just don’t believe this evidence exists or ever will.
Thanks,
Matt
poster:mattdds
thread:223248
URL: http://www.dr-bob.org/babble/20030505/msgs/225158.html