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BAD BREATH
L E T T E R S
tive to replacement in many clinical situations. Valeria V. Gordan, D.D.S., M.S. Associate Professor Ivar A. Mjör, B.D.S., M.S.D., M.S., Dr.Odont. Professor and Academy 100 Eminent Scholar College of Dentistry University of Florida Gainesville 1. Bader JD, Shugars DA. Understanding dentists’ restorative treatment decisions. J Public Health Dent 1992; 52(2):102-10. 2. Clark TD, Mjör IA. Current teaching of cariology in North American dental schools. Oper Dent 2001;26(4):412-8. 3. ADA Council on Access, Prevention and Interprofessional Relations. Caries diagnosis and risk assessment: a review of preventive strategies and management. JADA 1995; 126(supplement):1S-24S. 4. Mjör IA, Toffenetti F. Secondary caries: a literature review with case reports. Quintessence Int 2000;31(3):165-79.
BAD BREATH
I was very interested in the February JADA article, “Oral Malodor,” by the ADA Council on Scientific Affairs. I found the article to be extremely complete and well-documented. After retiring from the practice of orthodontics, treatments for bad breath became my main focus of professional interest. I’ve been a member of the International Society of Breath Oral Research for a couple of years, and I certainly know that halitosis is more than a minor condition or a mere cosmetic complaint. If you consider the definition of health given by the World Health Organization (“health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”), patients who come to my office because of bad breath can be considered 680
to suffer from a complex social, emotional, physical and spiritual misbalance. They need help, and I like to see myself as a sort of therapeutic partner trying to have their demands satisfied as soon as possible. I agree with the report that more studies exploring the etiology and treatment of bad breath odor are needed. But I think that the time has come for dentists, physicians, psychologists and other health care professionals to deal actively with the problem, and to suggest the best therapeutic approach according to our current level of knowledge. I hope that this excellent report leads the way to a better understanding of the condition, and helps encourage colleges to include it in the curricula. Our patients will acknowledge our effort to integrate them into society. Again, I feel it is high time we tackle bad breath without hesitation. If we do not put out our hands to help sufferers, treatment will remain in the hands of many nonacademic providers, and patients will have no other option than to be assisted by employees of supermarkets or drugstores instead of competent professionals. Bernardo Levit, D.D.S. Buenos Aires, Argentina RETAINING THIRD MOLARS
In response to the question, “The Unresolved Problem of the Third Molar: Would People Be Better Off Without It?” (Drs. Anthony Silvestri Jr. and Iqbal Singh, April JADA), I would like to relate my personal experience. Up until my late 70s, I had a full dentition with fully erupted
functioning third molars on the left side and no third molars on the right side. In the past few years, the upper right and left first molars had to be extracted. The quote from the first paragraph in the article, “third molars add little to the chewing efficiency of the dentition,” does not hold true in my case. My chewing efficiency on the side with third molars in place is a good 50 percent better than the side with no third molars. Now, in my early 80s, I would love to have functioning third molars on both sides. I realize that mine is a very specialized situation. However, there probably are many other specialized situations where the presence of a third molar could be critical. Martin Ettinger, D.D.S. Camarillo, Calif. THE BUSINESS OF DENTISTRY
I have two comments on Dr. Jeffcoat’s March JADA editorial, “Management Help at Hand: Boning Up on the Business of Dentistry.” Regarding one quote—“we have always welcomed manuscripts on practice management from ‘wet-fingered’ [sorry, make that ‘wet-gloved’] dentists”—well, Dr. Roger Levin is an expert in practice management, but is he a “wet-gloved” dentist? (Editor’s note: Dr. Levin, a practice-management consultant and JADA columnist, maintained a private dental practice for 10 years.) The other quote, which I may take out of context and comment on, concerns the gathering of statistics regarding how often “specific procedures” are “rejected by insurance plans.” If we are not to fall into the same web of insurance intrigue
JADA, Vol. 134, June 2003 Copyright ©2003 American Dental Association. All rights reserved.
tive to replacement in many clinical situations. Valeria V. Gordan, D.D.S., M.S. Associate Professor Ivar A. Mjör, B.D.S., M.S.D., M.S., Dr.Odont. Professor and Academy 100 Eminent Scholar College of Dentistry University of Florida Gainesville 1. Bader JD, Shugars DA. Understanding dentists’ restorative treatment decisions. J Public Health Dent 1992; 52(2):102-10. 2. Clark TD, Mjör IA. Current teaching of cariology in North American dental schools. Oper Dent 2001;26(4):412-8. 3. ADA Council on Access, Prevention and Interprofessional Relations. Caries diagnosis and risk assessment: a review of preventive strategies and management. JADA 1995; 126(supplement):1S-24S. 4. Mjör IA, Toffenetti F. Secondary caries: a literature review with case reports. Quintessence Int 2000;31(3):165-79.
BAD BREATH
I was very interested in the February JADA article, “Oral Malodor,” by the ADA Council on Scientific Affairs. I found the article to be extremely complete and well-documented. After retiring from the practice of orthodontics, treatments for bad breath became my main focus of professional interest. I’ve been a member of the International Society of Breath Oral Research for a couple of years, and I certainly know that halitosis is more than a minor condition or a mere cosmetic complaint. If you consider the definition of health given by the World Health Organization (“health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”), patients who come to my office because of bad breath can be considered 680
to suffer from a complex social, emotional, physical and spiritual misbalance. They need help, and I like to see myself as a sort of therapeutic partner trying to have their demands satisfied as soon as possible. I agree with the report that more studies exploring the etiology and treatment of bad breath odor are needed. But I think that the time has come for dentists, physicians, psychologists and other health care professionals to deal actively with the problem, and to suggest the best therapeutic approach according to our current level of knowledge. I hope that this excellent report leads the way to a better understanding of the condition, and helps encourage colleges to include it in the curricula. Our patients will acknowledge our effort to integrate them into society. Again, I feel it is high time we tackle bad breath without hesitation. If we do not put out our hands to help sufferers, treatment will remain in the hands of many nonacademic providers, and patients will have no other option than to be assisted by employees of supermarkets or drugstores instead of competent professionals. Bernardo Levit, D.D.S. Buenos Aires, Argentina RETAINING THIRD MOLARS
In response to the question, “The Unresolved Problem of the Third Molar: Would People Be Better Off Without It?” (Drs. Anthony Silvestri Jr. and Iqbal Singh, April JADA), I would like to relate my personal experience. Up until my late 70s, I had a full dentition with fully erupted
functioning third molars on the left side and no third molars on the right side. In the past few years, the upper right and left first molars had to be extracted. The quote from the first paragraph in the article, “third molars add little to the chewing efficiency of the dentition,” does not hold true in my case. My chewing efficiency on the side with third molars in place is a good 50 percent better than the side with no third molars. Now, in my early 80s, I would love to have functioning third molars on both sides. I realize that mine is a very specialized situation. However, there probably are many other specialized situations where the presence of a third molar could be critical. Martin Ettinger, D.D.S. Camarillo, Calif. THE BUSINESS OF DENTISTRY
I have two comments on Dr. Jeffcoat’s March JADA editorial, “Management Help at Hand: Boning Up on the Business of Dentistry.” Regarding one quote—“we have always welcomed manuscripts on practice management from ‘wet-fingered’ [sorry, make that ‘wet-gloved’] dentists”—well, Dr. Roger Levin is an expert in practice management, but is he a “wet-gloved” dentist? (Editor’s note: Dr. Levin, a practice-management consultant and JADA columnist, maintained a private dental practice for 10 years.) The other quote, which I may take out of context and comment on, concerns the gathering of statistics regarding how often “specific procedures” are “rejected by insurance plans.” If we are not to fall into the same web of insurance intrigue
JADA, Vol. 134, June 2003 Copyright ©2003 American Dental Association. All rights reserved.