The replacement of failed restorations is a major dental health care expense. In addition, the replacement of failed restorations often leads to more complex restorative procedures, which can lead to tooth loss.
When you combine this with a throwaway attitude that fillings are like light bulbs—they need to be replaced—you have a crisis in the making. In this time of fast food, sound bites and quick service for everything from automobile maintenance to health care, what could be wrong with returning to an attitude that craftsman-ship means longevity in what one produces?
With the attack on dental amalgam in full swing, the public may soon have even less access to long-term serviceable restorative dentistry. To some extent, the media, the insurance industry and the dental supply houses drive what is being offered in the average dental office throughout the United States. We seem to have spawned an entire generation that is more interested in production than in excellence.
Both cast and direct gold still offer the patient restorative work that not only will outlast anything available, but also will be the most trouble-free over time. People are living longer today. Therefore, their teeth are required to function for a longer life expectancy.
Once the first cut is made into existing tooth structure, the quality and longevity of the restorative material is of paramount importance. In fact, the majority of first-time, pit-and-fissure caries repair involving penetration into the dentin are restored with gold foil in my office. These are usually performed on patients who are in their late teens or early 20s. In these instances, I am seeking a restorative material that can be counted on to last well beyond the average life of the newer restorative materials.
Another important reason for learning to do both direct and indirect gold restorations is that, if one commits to the discipline required to learn and do the procedures, the process will permeate every other aspect of your professional life. I am convinced that if dental students were taught to do gold foils today, the process would elevate the skill level in all disciplines.
The most alarming thing to me as a dentist, as a member of the ADA, as a delegate from the 17th district, as an officer of the Florida Dental Association and as a fellow of the American Academy of Gold Foil Operators is the apparent attitude of the editor of JADA toward an excellent and proven restorative material and technique. I am concerned that the statements of a respected dentist, in a position of influence, could have a negative influence on younger members of our profession.
A dentist should not discard a technique just because it happens to have been around for a few years. Treating patients in the real world requires that a dentist bring into focus a complete understanding of all restorative options available. Only then can a dentist make a decision as to the best procedure to obtain the best results over time. As a dentist, you have the responsibility to your patient to be competent in the placement of all available restorative materials.
