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Dr Howard

Confessions After 20 Years of Practicing Dentistry

Wow! I can’t believe I graduated 20 years ago! It seems like yesterday! Fifteen crowns. Fifty amalgams. Twenty composites. Fifteen root canals. Fifteen dentures and then they turn you loose. Reflections are running through my mind. First let me turn to dental school education. Everyone likes to rag on dental schools and whine about everything they don’t teach you. How would you like to be in charge of taking a room full of young adults, fresh out of college, and in four years turning them loose as dentists? Not me!

I shudder at that responsibility. I think it is amazing that they can do it at all. I refuse to jump on the beat-up-on-the-dental-schools bandwagon. Sure, every person, place and institution can be improved upon, but overall, they do a pretty good job, especially considering their clientele – children! Every time I lecture at a dental school I am amazed at how young the student body is. Either I am very old at the age of 44, or they are very young.

I always hear dentists saying crazy things like, “They should be teaching dental students to be placing implants and doing sinus lifts!” Do you really think that a 22-year-old who has only placed 10 amalgams is ready for a sinus lift? Give me a break! A 22-year-old isn’t even ready to remove a wisdom tooth! Older dentists don’t even remember how green they were back in dental school, so give the dental schools a break!

But what are my confessions? What am I embarrassed about looking back? Well, I did a lot of dentistry twenty years ago. I earned my FAGD, then my MAGD. I earned my diplomat in the International Congress of Oral Implantology, my fellowship in the Misch Institute, my master’s in business administration from Arizona State University, and a whole list of other accolades, and what did I learn yet not act upon?

The amalgams I did 20 years ago still look great today, yet I haven’t placed one in 15 years! How crazy is that? The composites I did 20 years ago look like crap, yet that is all that I place today! Why is that? Because I bend over to the market place (my patients)!

If a dentist tells you that composite lasts longer than amalgams he has an IQ less than the average temperature in Siberia. Amalgams are metal, composites are plastic. Hello! Remember all the baloney we bought from all the lecture gurus 20 years ago? They told us how composites bonded the walls together while amalgams expanded and contracted fracturing the walls apart! Wrong! Read the research. Talk to Gordon Christensen! Or just practice for 20 years.

But what do I do about it? Composites! I confess! Call it the tail wagging the dog. Am I a wimp? No, I’m a businessman! It sure has nothing to do about mercury toxicity. Mercury in amalgam is bonded to silver, copper, zinc and tin forming an insoluble salt. Swallow an amalgam and you will pass the entire amount. The mercury that shows up in your organs is from ethyl and methyl mercury from seafood. In fact the ocean has gone from one part per million mercury to four parts per million in the last 50 years from burning coal. There is nothing more funny than an anti-mercury amalgam dentist preaching to me at lunch while eating seafood. They already recommend pregnant women not to eat seafood, especially tuna, during pregnancy.

The gold inlays and onlays I did 20 years ago actually look better today than the day I placed them. The all-porcelain anything, whether it is crowns, inlays, or onlays had at the very least a five-percent chip, fracture, or endo failure rate yet patients still talk me in to placing them today. I beg patients to do gold and I succeed at about a 30-percent rate; mostly men and elderly. After that I beg them to let me do porcelain to metal and that wraps up the vast majority. But I still have the few who want to do metal-free and I cringe because I know what it will look like when I am 65!

Let’s talk veneers. Have you seen your veneers 20 years later? I could write for another 10,000 words on veneers. First of all, peeling off the enamel on the front 10 teeth could never be a good idea. How could a dentist, the savior of oral health, champion peeling off the enamel of the upper 10 maxillary teeth. This is oral abuse! Why do we still do it? For beauty?

I don’t care what anyone says, I can spot 10 veneers from across the room. They don’t look natural. They don’t look translucent! The very best veneers still look like veneers from 20 feet away! Everyone in society knows they are fake and no one cares. Just like everyone in society knows that lipstick is fake! Just like everyone knows that mascara is fake! So if everyone knows they are fake, and since no one cares they are going to look like veneers, you might as well leave all the enamel on.

Bob Ibsen DDS of Denmat pioneered his No-Prep Cerinate porcelain Lumineers which are as thin as contact lens. You simply take an impression of the teeth and they make Cerinate Porcelain facings that you cement to uncut or slightly modified enamel. They look awesome! I love them. I don’t have to worry about the health of the pulp 20 years later. I can always take them off since they are reversible. Many labs offer similar ultra-thin laminates.

Look at some of Dr. Ibsen’s cases:

The bottom line after 20 years; be more conservative! Go easy with the bur! Leave as much tooth structure as possible. Instead of veneers try orthodontics and bleaching. If they want instant orthodontics, try minimal-prep veneers. I know they don’t want it but always remember amalgams last longer than composites. Go easy on the all porcelain stuff, it breaks, chips, and the bonding causes more endo down the road than you realize! Do more gold! Do more gold! Do more gold! If you have to do the white stuff, overlay it with gold; as in PFM. Call me short, fat, bald and conservative; I can live with that!

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