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A MESSAGE ON ADVOCACY
L E T T E R S
LETTERS ADA welcomes letters from readers on articles and other information that has appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. You may submit your letter via e-mail to “[email protected]”; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 60611-2678. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
A MESSAGE ON ADVOCACY
Dr. Paul A. Palo expressed his concern in his December JADA letter to the editor1 that we possess too much of a fee-forcommodity mentality, in response to Dr. Christensen’s September column2 advocating that we ensure we provide quality care at reasonable fees. Dr. Palo asks when we have ever heard a patient ask a surgeon, “How much for a coronary bypass graft?” If we, as a profession, are to believe Health and Human Services Secretary Mike Leavitt, who addressed the House of Delegates in Las Vegas, we will be publishing not only our fees but also a measure of our quality. He also indicated there will be system incentives for those who offer and those who purchase high-quality, competitively priced care. ADA members may access Secretary
Leavitt’s address at “www. ada.org/members/ada/ governance/hod/06_speech_ leavitt.pdf”. And because the federal government is involved, we had better do a very good job of advocating our positions at the negotiating table. That requires all of us to support the advocacy systems within the American Dental Association, namely the American Dental Political Action Committee (ADPAC) and the Grassroots Action Team Network. A mere annual $40 contribution is the minimum for ADA members to join ADPAC; consider contributing more via a membership in Capital Club at “www.ada.org/members/ advocacy/adpac/capital.asp”. And please sign up for the Grassroots Action Team Network at “www.ada.org/ members/advocacy/grassroots/ join.asp”. Jeffrey L. Parrish, DDS Chair American Dental Political Action Commmitee Duvall, Wash. 1. Palo PA. A ‘commodity-based model.’ JADA 2006;137(12):1639. 2. Christensen GJ. Is the wide range in crown fees justifiable? JADA 2006;137(9): 1297-9.
IMPLANTS, ENDODONTICS AND ORTHODONTICS
In Dr. Gordon Christensen’s October JADA column, “Implant Therapy Versus Endodontic Therapy” (JADA 2006;137[10]:1440-3), he mentioned many factors related to whether a questionable tooth should be extracted and replaced with an implant and implant-supported crown, or whether conventional endodontic and restorative therapy should be accomplished.
I liked his listing of the many things to consider when deciding on the best approach to this situation, but I think there should be an additional item to consider in his list—namely, any consideration of future orthodontic treatment. Extraction of teeth and their replacement with implants is becoming more popular as implant success rates, predictability and quality continue to improve. I think in some instances where a tooth could be treated with endodontics successfully, implant replacement sometimes is becoming the treatment of choice by default. However, I think clinicians should consider whether the patient may desire orthodontic therapy in the future, and consider endodontically treating that tooth as a contingency. Endodontically treated teeth are still surrounded by a periodontal ligament and, as such, can be moved orthodontically in the future. No such option exists with an osseointegrated implant. I think the finality, so to speak, of an implant should be discussed with the patient as part of the informed consent process. If there is any indication that the patient may desire better alignment of the teeth, then the patient should be informed of the benefits of having the tooth endodontically restored. If the tooth is deemed hopeless and the only option is extraction, informed consent should still include future orthodontic limitations with a fixed position implant. A referral to an orthodontist should be sought out prior to implant placement, if the patient indicates that he or she would consider orthodontics in the future.
JADA, Vol. 138 http://jada.ada.org Copyright ©2007 American Dental Association. All rights reserved.
February 2007
147
LETTERS ADA welcomes letters from readers on articles and other information that has appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. You may submit your letter via e-mail to “[email protected]”; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 60611-2678. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
A MESSAGE ON ADVOCACY
Dr. Paul A. Palo expressed his concern in his December JADA letter to the editor1 that we possess too much of a fee-forcommodity mentality, in response to Dr. Christensen’s September column2 advocating that we ensure we provide quality care at reasonable fees. Dr. Palo asks when we have ever heard a patient ask a surgeon, “How much for a coronary bypass graft?” If we, as a profession, are to believe Health and Human Services Secretary Mike Leavitt, who addressed the House of Delegates in Las Vegas, we will be publishing not only our fees but also a measure of our quality. He also indicated there will be system incentives for those who offer and those who purchase high-quality, competitively priced care. ADA members may access Secretary
Leavitt’s address at “www. ada.org/members/ada/ governance/hod/06_speech_ leavitt.pdf”. And because the federal government is involved, we had better do a very good job of advocating our positions at the negotiating table. That requires all of us to support the advocacy systems within the American Dental Association, namely the American Dental Political Action Committee (ADPAC) and the Grassroots Action Team Network. A mere annual $40 contribution is the minimum for ADA members to join ADPAC; consider contributing more via a membership in Capital Club at “www.ada.org/members/ advocacy/adpac/capital.asp”. And please sign up for the Grassroots Action Team Network at “www.ada.org/ members/advocacy/grassroots/ join.asp”. Jeffrey L. Parrish, DDS Chair American Dental Political Action Commmitee Duvall, Wash. 1. Palo PA. A ‘commodity-based model.’ JADA 2006;137(12):1639. 2. Christensen GJ. Is the wide range in crown fees justifiable? JADA 2006;137(9): 1297-9.
IMPLANTS, ENDODONTICS AND ORTHODONTICS
In Dr. Gordon Christensen’s October JADA column, “Implant Therapy Versus Endodontic Therapy” (JADA 2006;137[10]:1440-3), he mentioned many factors related to whether a questionable tooth should be extracted and replaced with an implant and implant-supported crown, or whether conventional endodontic and restorative therapy should be accomplished.
I liked his listing of the many things to consider when deciding on the best approach to this situation, but I think there should be an additional item to consider in his list—namely, any consideration of future orthodontic treatment. Extraction of teeth and their replacement with implants is becoming more popular as implant success rates, predictability and quality continue to improve. I think in some instances where a tooth could be treated with endodontics successfully, implant replacement sometimes is becoming the treatment of choice by default. However, I think clinicians should consider whether the patient may desire orthodontic therapy in the future, and consider endodontically treating that tooth as a contingency. Endodontically treated teeth are still surrounded by a periodontal ligament and, as such, can be moved orthodontically in the future. No such option exists with an osseointegrated implant. I think the finality, so to speak, of an implant should be discussed with the patient as part of the informed consent process. If there is any indication that the patient may desire better alignment of the teeth, then the patient should be informed of the benefits of having the tooth endodontically restored. If the tooth is deemed hopeless and the only option is extraction, informed consent should still include future orthodontic limitations with a fixed position implant. A referral to an orthodontist should be sought out prior to implant placement, if the patient indicates that he or she would consider orthodontics in the future.
JADA, Vol. 138 http://jada.ada.org Copyright ©2007 American Dental Association. All rights reserved.
February 2007
147