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BONDING AMALGAMS: USE WITH CARE: Author's response
ETEIIRSThe February edition of JADA, called "Dental Technology: Scanning the Horizon," was both an uplifting and a depressing preview of coming events. It was uplifting in the sense of what the future holds for dentists being able to utilize the exploding technology that surrounds us for the benefit of the public. It was depressing in the sense of how easily these technological advances can be maneuvered toward an end that might not be as noble. In a Draconian sense, one could envision the collection of dental treatment data and the use of the many new "dental toys" in the process as foolhardy for the dentist. Dr. Kenneth L. Zakariasen, writing in the February issue of JADA, warns of not employing a healthy dose of skepticism where new technology is involved in patient care. He does, however, applaud the advances made to date as being beneficial to all parties concerned. My concern is for the dentist who is supposed to use these devices and techniques in everyday patient care. Will he or she become little more than an overtrained robot in a treatment arena where professional judgment will have been replaced/ displaced by statistics-driven treatment protocols?
Perhaps the dental surgeon general should require a label to be applied to these new dental devices. Warning: the use of this technology may be hazardous to all. Lawrence J. Singer, D.D.S. Wallingford, Conn. SETTING A STANDARD
I congratulate Drs. Brian Muzyka and Michael Glick for
412 JADA, Vol. 126, April 1995
one of the most outstanding articles in the annals of dental literature (January JADA). Their article "Review of Oral Fungal Infections and Appropriate Therapy" constitutes a course of study in itself. It is extremely lucid, clear without being cumbersome and most comprehensive. Oral findings leave nothing to the imagination; unlike typical articles, these authors' descriptions require no illustrations. Their descriptions of etiology, sites, mechanisms of pathology and appropriate treatment were a pleasure to read. The information they provided on pharmaceuticals (specific modes of action, prescribing and average wholesale costs) is a real plus and serves to cap a thoroughly professional and expert study. This article, in my opinion, sets a new standard of competence for your journal. I think this review makes us all better dentists. Herbert Hoffer, D.D.S. Valhalla, N.Y. BONDING AMALGAMS: USE WITH CARE
In the article by Dr. Gordon Christensen concerning amalgam bonding agents (October JADA), I had some difficulty in determining Dr. Christensen's recommendations for the use of these products. The following excerpts from his article lead to some confusion: "Long-term research is lacking on amalgam bonding materials." "It is too soon to make decisions about the long-term effectiveness of amalgam bonding strength properties. Strictly on the basis of current amalgam
bonding agents bonding to tooth and amalgam, the need for their continued use is at best moderate." "Based on continuing basic science research and empirical observation by thousands of dentists over several years, I must conclude that bonding amalgams is the state-of-the-art procedure for amalgam restorations." The history of restorative dentistry exhibits examples of the use of materials and procedures that have not been carefully researched in clinical trials and which proved to have ill-fated consequences (for example, the early direct filling resins). Although laboratory studies show promise for amalgam bonding agents, the lack of results from clinical studies at this time suggests a more prudent approach than the wholesale use of these materials. David B. Mahler, Ph.D. Portland, Ore.
Author's response: Dr. Mahler is correct in observing that there is need for long-term research in the area of bonding amalgams, as I noted in my article. However, until such research is available, clinical acceptance of some of these materials has been excellent over the past few years that they have been in existence. This is because of the undeniable prevention of tooth sensitivity provided by these products and the very promising in vitro tooth strength studies. All of us hope that they provide long-term service as adequately as the short-term evidence indicates. Gordon J. Christensen, D.D.S., M.S.D., Ph.D. Provo, Utah
Perhaps the dental surgeon general should require a label to be applied to these new dental devices. Warning: the use of this technology may be hazardous to all. Lawrence J. Singer, D.D.S. Wallingford, Conn. SETTING A STANDARD
I congratulate Drs. Brian Muzyka and Michael Glick for
412 JADA, Vol. 126, April 1995
one of the most outstanding articles in the annals of dental literature (January JADA). Their article "Review of Oral Fungal Infections and Appropriate Therapy" constitutes a course of study in itself. It is extremely lucid, clear without being cumbersome and most comprehensive. Oral findings leave nothing to the imagination; unlike typical articles, these authors' descriptions require no illustrations. Their descriptions of etiology, sites, mechanisms of pathology and appropriate treatment were a pleasure to read. The information they provided on pharmaceuticals (specific modes of action, prescribing and average wholesale costs) is a real plus and serves to cap a thoroughly professional and expert study. This article, in my opinion, sets a new standard of competence for your journal. I think this review makes us all better dentists. Herbert Hoffer, D.D.S. Valhalla, N.Y. BONDING AMALGAMS: USE WITH CARE
In the article by Dr. Gordon Christensen concerning amalgam bonding agents (October JADA), I had some difficulty in determining Dr. Christensen's recommendations for the use of these products. The following excerpts from his article lead to some confusion: "Long-term research is lacking on amalgam bonding materials." "It is too soon to make decisions about the long-term effectiveness of amalgam bonding strength properties. Strictly on the basis of current amalgam
bonding agents bonding to tooth and amalgam, the need for their continued use is at best moderate." "Based on continuing basic science research and empirical observation by thousands of dentists over several years, I must conclude that bonding amalgams is the state-of-the-art procedure for amalgam restorations." The history of restorative dentistry exhibits examples of the use of materials and procedures that have not been carefully researched in clinical trials and which proved to have ill-fated consequences (for example, the early direct filling resins). Although laboratory studies show promise for amalgam bonding agents, the lack of results from clinical studies at this time suggests a more prudent approach than the wholesale use of these materials. David B. Mahler, Ph.D. Portland, Ore.
Author's response: Dr. Mahler is correct in observing that there is need for long-term research in the area of bonding amalgams, as I noted in my article. However, until such research is available, clinical acceptance of some of these materials has been excellent over the past few years that they have been in existence. This is because of the undeniable prevention of tooth sensitivity provided by these products and the very promising in vitro tooth strength studies. All of us hope that they provide long-term service as adequately as the short-term evidence indicates. Gordon J. Christensen, D.D.S., M.S.D., Ph.D. Provo, Utah