Sameer Puri As clinicians, we are often faced with decisions on when to restore a tooth. Take the old amalgam on #18 (lower left 2nd molar). The patient presented for an exam and the exam revealed the offending tooth with the old amalgam restoration.
Now the cervical decay on #19, the tooth in front is a no brainer. Clean it out, place some glass ionomer or resin and you are good to go.
But what about the tooth behind it? What do we do with that tooth? There is no radiographic decay, there is no clinical decay. Yes, there is some slight leakage around the margins but the tooth is not blown out by any means. The patient is completely asymptomatic.
So if we choose to leave the tooth alone and "watch it" then are we leaving an area underneath the amalgam that will eventually cause the demise of the tooth? If we choose to go in and treat the tooth, then find that the amalgam goes so far sub gingival, so now instead of a simple composite or GI restoration, we are faced with a much more challenging and expensive procedure for the patient.
If we choose to replace the amalgam, are we in essence speeding up the demise of the tooth so that instead of letting sleeping dogs lay, we are now causing them to wake up and make the situation worse than it is.
These are not easy decisions for clinicians on what to do. I think the take away message from this is when we restore a tooth, decide what type of restoration to place, what material to use, we are not making that decision in a vacuum. We are not immune from the consequences of that decision. We are in fact going to have to live with the consequences of our treatment that we provide for patients for years to come.
Id like to get the community's opinion on this. What would you do?
Treat now or treat later?
