L E T T E R S
tection, Listerine, chlorhexidine gluconate, prerinse, postrinse, premedication, rubber dam, high-speed evacuation, single-use disposable items, sticky cellophane handle covers (I prefer blue), handpiece condoms, needle-recapping devices, sharps containers, sharps disposal, water-line disinfection, mercury hygiene, Xray film processing hygiene, lab case hygiene, scrap amalgam management, hazardous waste bagging, hazardous waste disposal, high-volume rapid turnover office ventilation system (properly filtered), and several thousand dollars worth of vital plumbing backflow control valves. Somewhere in all of this there must be a way to manage hightech devices. Short of having to buy about 4,000 sets of virtual reality glasses (one set for each of my active patients), would the authors please tell me the recommended protocol for ensuring that this vital equipment won’t add to the potential for morbidity and mortality generated by the average dental practice? Thank you. Bruce C. Heilman, D.D.S. Des Moines, Iowa Author’s response: Certainly, infection control should be considered when purchasing or using any piece of equipment in the dental office. Disposable hygienic covers are manufactured for the speakers, forehead pad and head strap—the only parts that contact the viewer during use. The other parts are made of durable plastic and can be wiped with an Environmental Protection Agency–registered surface disinfectant that is both tuberculocidal and viroci-
dal (lipophilic and hydrophilic). In addition, the investigators apply a section of sticky cellophane cover to the underportion of the screens to help minimize contamination from below. Manufacturers of virtual reality glasses and their accessories can be found on the Internet. Cathryn Frere, B.S.D.H., M.S.Ed. Assistant Professor School of Dentistry West Virginia University Morgantown AMALGAM RESTORATIONS
“The Performance of Bonded vs. Pin-Retained Complex Amalgam Restorations: A FiveYear Clinical Evaluation” by Dr. J.B. Summitt and colleagues (July JADA) was a great article, and the restorations shown were great restorations. In an academic setting it’s great, but in a private-practice setting, the time to make a beautiful amalgam complex restoration is approximately one hour. The cost for the patient may be about $200. The cost to run a dental office today is about $300 an hour. Financially, if we do as suggested in the article, either the insurance companies and the dental community need to raise the fee for a complex amalgam filling to $400 or we go broke. Furthermore, indirect restorations as we know from experience and research have been shown to be far more protective and last longer. I feel that it would be a disservice to my patients with a complex amalgam. Peter Young, D.D.S. Full-time private
practitioner Assistant Professor, Restorative Dentistry Department Loma Linda University Loma Linda, Calif. Author’s response: We agree with Dr. Young’s assertion that third-party payers should increase the amount allowed for amalgam restorations that replace cusps. But the point of the article was that the filled bonding resin used in this study was as successful as mechanical retention features in retaining restorations. This could then be translated to smaller restorations that may need some added retention and that may be accomplished in less time. Since amalgam is not esthetic, we must assume that Dr. Young refers to nonesthetic indirect restorations when he states that indirect restorations provide better service. Certainly, well-done cast gold alloy restorations have been shown to perform extremely well, and, in most cases, may be preferred to complex amalgam restorations. However, there is a large difference in cost to the patient. Many patients are unable to pay for the more expensive restorations. Because complex amalgam restorations do provide good longevity and service, many practitioners incorporate them into their practices, whether the practices are private or governmental. As with any restoration, it is up to the private practitioner to decide if he or she is able to provide complex amalgam restorations in his or her practice. The decision may be based on income generated or on pref-
JADA, Vol. 132, December 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.