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ut to try and buy time with less-invasive procedures —<br />
giving the pulp chamber a chance to become smaller,<br />
giving the dentinal tubules a chance to become smaller, and<br />
saving that more invasive procedure for their later years.<br />
When you do so, you minimize the number of root canal<br />
treatments that are required later, you minimize the amount<br />
of replacements that have to occur with crowns and the like.<br />
We will always, within my lifetime, I believe, have the need<br />
for full-coverage crowns. I’ve got one that my daughter put<br />
in my mouth just four years ago. It was an upper second<br />
molar that was a virgin tooth, but it succumbed finally to<br />
the “dental student syndrome.” Namely, when I was a junior,<br />
a senior student had to take out impacted wisdom teeth in<br />
order to graduate, and I became the volunteer. The student<br />
wasn’t the sharpest knife in the drawer and took out some<br />
of the buccal plate over my second molar, and I’m sure he<br />
leaned that elevator on that root. Later, bacteria got in that<br />
crack and it was discovered, much later, probably about<br />
eight years ago, when the tooth abscessed and became a<br />
sinus infection and all the rest. If you’ve got a tooth like<br />
that, or you’ve got a molar that’s taking a heavy load, or a<br />
tooth that’s had root canal treatment — you’ve got to put<br />
crowns on those kinds of things.<br />
MD: Of course! And I know you don’t hate crowns. I know that<br />
what you don’t like is the overuse of full crowns as the easy<br />
way out, or kowtowing to what the patient’s insurance might<br />
pay. Did you go with cast gold on that crown?<br />
DF: It’s solid cast gold on this upper second molar.<br />
MD: Good choice! We like to see that. That’s becoming an<br />
endangered species in the laboratory today. I guess part of<br />
that is gold hitting $1,700 an ounce. It’s also patients giving<br />
some pushback about having gold in their mouth — even on a<br />
second molar — which is kind of crazy, especially after we tell<br />
them it’s the best material we’ve ever had in dentistry.<br />
DF: Well, when you said, “Good choice, that’s what we like<br />
to see,” the truth is at the end of the day, you can’t even<br />
see it, Mike! (I’m teasing you a little based on the meaning<br />
here.) But, yes, it’s true: if nobody is going to see it, you<br />
can’t beat it. That being said, I am impressed with how<br />
zirconia continues to improve. In fact, boy, with the cost of<br />
metals and the like, thank goodness we’ve got materials like<br />
zirconia that are evolving to where they are.<br />
MD: Right. Let me share some numbers with you. In 2007,<br />
66 percent of the crowns that we fabricated here were PFM<br />
crowns and 23 percent were all-ceramic crowns. If you look<br />
at 2011 and the first half of 2012, and PFMs have gone from<br />
66 percent to 20 percent, and all-ceramics have risen from<br />
22 percent to 68 percent of the restorations, and it’s because of<br />
zirconia and lithium disilicate. It’s shocking to me, and even<br />
to us as a laboratory, to see how quickly dentists have changed<br />
their allegiance and have been willing to kind of drop the<br />
PFM. It has been an amazing transformation largely pushed<br />
on by zirconia and dentists being somewhat satisfied with the<br />
material because they continue to order it.<br />
Let me ask you about one other thing I find fascinating about<br />
you: your drive to find a cure for dental caries. I don’t think<br />
there could be a higher mission on the planet, and least in the<br />
dental world, than to tackle something like this, and I don’t<br />
hear anybody else really talking about this. In fact, I saw in<br />
a recent article that the city of Phoenix is thinking about not<br />
fluoridating their public water supply. Can you tell me how<br />
your drive to find a cure for dental caries is going?<br />
DF: The progress has been slow. Not because of the<br />
technology, but because of regulatory constraints that we’re<br />
up against with the FDA. We have a technology that we feel<br />
can go a significant distance on this. We’re being very active<br />
on it, and we feel like we’re making some good inroads<br />
relative to explaining the technology to the FDA. It’s a little<br />
device that in the first human studies — four kids in a lower<br />
social economic group for which oral hygiene is pretty<br />
low — was shown to decrease caries 76 percent. If we can<br />
reduce caries 76 percent, we can reduce the incidence of<br />
the abscessed tooth 95 percent, which is exciting to me.<br />
But, yes, we’re still battling that.<br />
That being said, and I don’t know if I told you this last<br />
time or not, Mike, but if we could bring about a cure to<br />
caries today, we’d still need more dentists. I mean, when<br />
you consider that in our country before the recession, onethird<br />
of our fellow Americans couldn’t afford to go to the<br />
dentist except for emergency treatment. When you consider<br />
that teeth are like tires — they’re good for so many miles,<br />
and then the treads wear out, the sidewalls give out. When<br />
you consider the jobs of the Western world, there’s hardly<br />
42 www.chairsidemagazine.com