Sunday Dental Thread: Leaking Composite Restorations and the Kennedy Assassination: [View all]

[PCIntern]

Do I have your attention? Perhaps? Good...then please read this entire post before you start spitting out your cornflakes or wheat germ or whatever...

In the early 1980's, what with all the narcissism, self-help books, ego-boosting, People Magazine buying, self-improvement kicks, one of things which people took note of was the presence of "unsightly" metal in their mouths, specifically amalgam and gold restorations otherwise known as fillings. In order to achieve a Hawthorn-ian Perfection of appearance, patients asked their dentists if they could place composite, normally specified only for front teeth, in their premolars and molars. The dental manufacturers, sensing a good thing, developed composites which were marginally appropriate for back teeth, if what you want to define as "marginally appropriate" was horrendously poor by then-community standards. This material began to fail, for the most part, before the check for the services rendered cleared the bank. Of course, the last thing a dentist wanted to do in those days was to have to revisit a tooth he or she had restored within 10-15 years and the practitioners were upset and most agitated that they were not having their usual 95-99% success rate. You must understand that 95% success over 10-15 years was considered poor back then. So the companies started working on their composite materials day and night and you cannot imagine the number of different brands proffered to the profession since then.

Now this is the interesting part of the story thus far: the economic pressures to increase production at the practitioner level brought a level of carelessness not often seen in the profession. We have a term for each material which we utilize which is how "technique sensitive" it is: that for example, you can place an amalgam restoration in the presence of some moisture, which you would call saliva, and be assured that it will have some fair success, say 10-12 years rather than 25-40 years. So amalgam is not too bad in this regard. Composite, however, has to be placed in an absolutely dry field and the etching for the placement of the unfilled resin has to be 100%...not 98...not 95...100% or it will begin leaking immediately leading to recurrent decay and virtually certain doom for the dental pulp of the tooth, necessitating a root canal, or if left undetected long enough, fracture and extraction. Now that is not the only problem: there are many others associated with composites. For example, if you place too much composite in a tooth which has a wide isthmus, or channel on the biting surface, the material will shrink, and since it is bonded to the outer and inner cusps of the tooth, it will tend to pull them together causing constant pain, as though someone placed extraction forceps on the tooth and squeezed continuously. This pain can be relieved, by the way, by channeling medio-laterally through the restoration and refilling it, thus relieving the internal tensions.

Now, what with all this going on, the manufacturers might have been screwn as they say, but no. They just kept merrily producing this stuff to this day and denying that there are any problems associated with its placement. Meanwhile, the technic (yes that is spelled correctly in dentistry) requires the use of aids to place it properly which are extremely time-consuming, intricate, and often simply fail: these include but are not limited to, fancy matrix bands and wedging techniques in order to establish a contact so food doesn't pack between the teeth, bases and liners which protect the nerve inside the tooth from the harm which might befall it due to the nature of the treatment materials, and other arcane issues which require resolution in order to have a satisfactory outcome. And of course, since there is a big big big profit motive here, and I say this without a smile on my face, there is NO CREDIBLE EVIDENCE THAT THIS MATERIAL CAUSES PROBLEMS WHEN USED CORRECTLY. As an aside, my friends who are endodontists who do root canals all day, were well-pleased that some of their referring practitioners use this composite even for upper second molars which even we have problems visualizing with a mirror and bright light. Now of course, the manufacturers are dealing with people who are actually pretty bright, so instead of publishing a comprehensive study which would demonstrate that there is a dental morbidity and mortality associated with its use, they published literally hundreds of studies with all kinds of variables which were so confusing when read that you had no idea whether you were coming or going. And now, composite is the "material of choice" for back teeth. Anytime you attempt to quote a study which might demonstrate that there are significant problems, someone else will come up with three papers showing fifty different conclusions and you spend much of your time debating the experimental issues rather than the issues at hand.

And so it is with the assassinations of the Sixties and beyond: they put out so many theories, some sounding reasonable, some, not so reasonable, and some downright insane, that many people who can't distinguish one form the other, lump them all together and say, well, since I can't make heads or tails out of all this, then the official version must be true. Those who deny that there was variance with the Reports which emanated from official sources have many techniques for doing so which include but are not limited to: pure denial, denial of the existence of any credibility of any evidence to the contrary of their stated "facts", diminishing of the individual by associating them with such "wacky" issues as ostensibly faked moon-landings, disproving of the individual by pointing out one possible flaw in the entire argument, postulating that eyewitnesses are notoriously unreliable, stating unequivocally that there is an absolute profit motive surrounding the perpetuation of the issue, and many others.

To these and others I say, hogwash. The truth is staring you in the face, but the Establishment and others have set up so many two-way mirrors and falsities that you have no idea what is truth now and what is fiction. But the manufacturers have convinced many that their product is sound, we have come to accept failure as routine as a populus so that not only will you get restorations replaced in your mouth every five years instead of twenty-five years and that is all right, and also, incidentally, that you can have your President, his brother, and the leading Civil Right figure shot down in their primes and it really does not matter who might or might not have been involved. Good luck to all of us in these, and all respects. We are going to need it.