I read with interest Dr. John Dodes’ literature review, "The Amalgam Controversy: An Evidence-Based Analysis" (March JADA). Analyses can be biased, tainted by what they omit, as well as by what they contain. Scientific analysis and resultant hypotheses must be congruent with and explain clinical experience.
I was disappointed that there was no mention of Dr. David Eggleston’s reporting of hand tremors in dentists with high mercury levels; in a report on amalgam published in the California Dental Association’s Jan. 15, 1991, CDA Update, Dr. Eggleston referenced a study conducted at the University of Pennsylvania.1,2 Especially noticeable by its absence was any reference to the uncontrolled expansion of amalgam restorations, marginal leakage and the incidence of recurrent decay and cuspal fracture in clinically intact, asymptomatic and apparently healthy amalgam-restored teeth.
In my experience, having removed several thousand amalgam restorations for reasons other than restoration failure (repair of cuspal fracture, bridge abutment preparation, new proximal caries on the unrestored proximal surface, and so on), I find at least 50 percent and possibly as much as 85 percent have either undiagnosed recurrent caries, cuspal fractures and/or occlusal and pulpal floor fractures visible with x 3.5 telescopes, with the tooth isolated under a rubber dam.
There is rarely a day that goes by that I do not see this morbidity of both well-placed and poorly placed amalgam restorations. This leads to speculation as to whether amalgam restorations, especially older ones, that appear "successful" really are.
The reason to abandon amalgam restorations is not because of the mercury toxicity, which, as Dr. Dodes notes, is questionable, but because there are now better treatments and techniques, including gold, that do not carry with them the severe treatment morbidity that most amalgam restorations do.
We are, or at least we should be, scientists as well as healers. We should seek objective evidence to help us in our decision-making process. Nevertheless, dentistry is also an art. The artist sees what the technician does not.
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