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Cyanoacrylate warning
C er rito s a ir d isa s te r
L e t te r s to E d it o r
the
ap p ro p riate analogue to h u m a n p eriodon titis th a n does the monkey, there are p ro b lems in h eren t in the study by B eaum ont a n d o th ers.3 T h e a u th o rs’ conclusions h ard ly seem justified in lig h t of the sm all n u m b er of anim als and the short d uration of the lesion (20 days). Also, they present no evidence to suggest that the m icroflora ex istin g in the “sulci” of these anim als w ould have caused continued loss of at tach m en t or was capable of su stain in g a t tach m en t loss in the absence of physical trau m a (ligature); no evidence suggests th a t these were progressive lesions in the sense th a t chro n ic lesions of ad u lt p e ri o d ontitis are. Little p erfect research is ever done. T h e difficulties involved in research , especially clinical research, m ake it extrem ely im p o r ta n t th a t th e results o btain ed be cautiously ev a lu a ted . T h e p u b lish ed lite ra tu re o f p eriodontics has seldom p rovided d e fin i tive answ ers to clinical situations. T h e re a re at least as m any perio d o n tists who c o u l d r a t i o n a l l y d i s a g r e e w ith D r. R a m ljo rd ’s conclusions as w ould agree. O u r clinical ex p e rien c e indicates the conclusions draw n do n o t coincide p e r fectly w ith clinical practice. New concepts are continually being advanced an d co n clusions d raw n from past research will be m odified. We should re m e m b e r th a t re search, at best, provides a nev er-en d in g p ath tow ard th e final tru th . . . . We strongly dispute Dr. R am fjord’s co n ten tio n th a t surgical pocket elim in a tio n is n o t justifiable. MARK V. T H O M A S, DMD W ILLIAM J. M ORGAN, DMD R IC H M O N D , VA 1. M agnusson, I., and others. A long junctional epithelium — a locus minoris resistiae in plaque infec tion? J Clin Periodontol 10:333-340, 1983. 2. B eaum ont, R.H.; O ’Leary, T.J.; and Kafrawy, A .H . Relative resistance o f long junctional epithelial a d h e sio n s an d c o n n e c tiv e tissu e atta ch m en ts to plaque-induced inflam m ation. J Periodontol 55:213223, 1984. 3. Barrington, E.P. An overview o f periodontal sur gical procedures. J Periodontol 52:518-528, 1981. 4. Page, R.C., and Schroeder, H.E. Periodontitis in m an and other animals: a com parative review. Basel, Karger, 1982. 5. K ennedy, J.E., and Poison, A.M . Experim ental m a r g in a l p e r io d o n titis in s q u ir r e l m o n k e y s. J Periodontol 44:140-144, 1973. 6. G oldm an, H.M . An observation o f an unusual repair o f an osseous defect. J Periodontol 45:746, 1974.
12 ■ JADA, Vol. 115, July 1987
□ As a d en tist an d a pilot, I am co n cern ed with th e public im age o f both fields o f e n d e a v o r . A f te r r e a d i n g th e a r tic le “Forensic dentistry in th e C erritos air dis aster,” by Drs. G erald Vale, Jo se p h A nselm o, an d Betty H o ffm an (May), I was struck by th e p h rasin g used in describing the m idair collision. T h e a u th o rs stated that th e airlin er “. . .was struck by a small private plane . . . ” T his u n fo rtu n a te choice o f w ords n o t only inaccurately p o rtray s w hat h a p p e n e d , b ut gives all light aircraft an d g eneral aviation an u n d eserv ed bad rep u ta tio n . T o say th e sm aller, slower air c ra ft “stru ck ” th e airlin er is akin to saying “th e car was struck by th e p e d e stria n .” T his also tend s to lead people to place blam e o n th e small aircraft. T his blam e has n ot been established as yet by th e N ational T r a n s p o r ta tio n Safety B o a rd (N T S B ), an d m ay never be. A b etter choice o f w ords m ight have been, “the aircraft collided with a small private p lan e.” T h e re w ere sets o f eyes in both cockpits responsible fo r seeing an d avoiding o th e r air traffic. O n a very clear day such as A ug 31, 1986, th e p eo p le b e h in d those eyes, in both cockpits, obviously failed. . . .
o f oral use o f this chem ical should m ake th e p r a c t i t i o n e r w a ry . S p e c ific a lly , cyanoacrylates, w hen ex p o sed to air, will p ro d u ce a gas. T his is a p o te n t allergen th a t can cause serious resp irato ry distress. T h e use o f this p articu la r chem ical in the m outh w ould seem to be an u n w arran ted risk. As th e a u th o rs e n d o rse in tra o ra l use o f cyanoacrylate, they sh o u ld have clearly o u tlin ed at least th e very m inim al p rec au tions fo r its in trao ral use: fo r exam ple, a specific m edical history focusing on p rev i ous sensitivity to cyanoacrylates; ru b b er dam isolation; an d p ro tectio n o f th e air way by use o f hig h -sp eed suction. In ad d itio n , th e d en tist a n d staff should avoid in halation of th e gaseous b y-product o f this chem ical reaction. M ICHAEL L. GOR D O N , DMD C IN C IN N A T I
X -ra y f ilm d u p lic a tio n
□ A p ro b lem w h ereb y th e id en tify in g bubble on d en tal X -ray film can no longer be relied o n to d eterm in e th e left o r rig h t sides o f th e p a tie n t’s m o u th is o ccu rrin g because E astm an K odak Co is m ark etin g d u p licatin g film in periapical film size with a raised d o t. A lth o u g h th e m a n u fa c tu re r’s T H O R N T O N A. D A R C , DDS rec o m m en d e d p ro c e d u re is to place the PRESIDENT-ELECT em ulsion side o f th e d u p licatin g film in FLYING D E N T IST S’ A SSO C IA T IO N contact with th e film to be copied, a d u p li □ Comment: T h e lan g u ag e used by th e a u cate can still be m ade if th e copy film is th o rs was based on in fo rm atio n re p o rte d reversed. N orm ally, th e reversal o f d u plicating in The Los Angeles Times w hich stated: “at least th ree eyewitnesses said they saw th e film in sh eet fo rm , a com m on d ark ro o m sm aller plane crash into th e tail section o f e rro r, does n o t cause a pro b lem because th e je t lin e r .. . .” T h e source o f this in fo r th e d en tist m ust specifically m ark left a n d rig h t afte r th e film is dup licated . H ow m ation was referen ced in th e article.1 Lest th e re be any d o u b t, th e a u th o rs do ever, with raised dots on reg u la r size 2 n o t claim to have eith er th e necessary in d u p licatin g film , dentists can accidentally fo rm atio n o r expertise to d eterm in e fault believe th a t th e film is an original, not in this disaster n o r was this o u r intent. realizing th a t it is reversed. Aside from th e difficulty o f review ing A long w ith D r. D’Arc, we await th e re p o rt p erso n al in ju ry cases w ith this e rro r, a d d i o f th e N TSB on this m atter. tional ram ifications include body identifi GERALD L. VALE, DDS, MDS JOSEPH A. ANSELM O, DDS cation an d , m ore significantly, potential B ETTY L. H O FFM AN, D DS, MSEd m alpractice liability. T h e d en tist who is on th e bubble to d eterm in e left 1. T h e Los A ngeles T im es, Sept l,p p 1 ,5 ,2 0 ,1 relying 986. an d rig h t sides could accidentally tre a t the w rong side o f th e m o u th . C y a n o a c r y la te w a r n in g U ntil this pro b lem is resolved, the use o f c o n v e n tio n a l s h e e t d u p lic a t in g film sh o u ld be en co u rag ed . □ T h e a r tic le in th e A p ril J o u r n a l, HASKELL A SKIN, DDS “C yanoacrylate — a new tre a tm e n t fo r hy BRICK T O W N , NJ persensitive d en tin a n d ce m e n tu m ,” by Drs. B ahram Javid, R ah m at A. B ark h o r- □ Comment: D u p lic atin g film is single d e r, an d S uryakant V. B hinda failed to em ulsion film, an d in trao ral rad io g rap h ic inform th e re a d e r th a t cyanoacrylate can film is dou b le em u lsio n film. A lthough cause a serious allergic reaction. T h e risks d uplicates o f rad io g rap h s can be m ade
L e t te r s to E d it o r
the
ap p ro p riate analogue to h u m a n p eriodon titis th a n does the monkey, there are p ro b lems in h eren t in the study by B eaum ont a n d o th ers.3 T h e a u th o rs’ conclusions h ard ly seem justified in lig h t of the sm all n u m b er of anim als and the short d uration of the lesion (20 days). Also, they present no evidence to suggest that the m icroflora ex istin g in the “sulci” of these anim als w ould have caused continued loss of at tach m en t or was capable of su stain in g a t tach m en t loss in the absence of physical trau m a (ligature); no evidence suggests th a t these were progressive lesions in the sense th a t chro n ic lesions of ad u lt p e ri o d ontitis are. Little p erfect research is ever done. T h e difficulties involved in research , especially clinical research, m ake it extrem ely im p o r ta n t th a t th e results o btain ed be cautiously ev a lu a ted . T h e p u b lish ed lite ra tu re o f p eriodontics has seldom p rovided d e fin i tive answ ers to clinical situations. T h e re a re at least as m any perio d o n tists who c o u l d r a t i o n a l l y d i s a g r e e w ith D r. R a m ljo rd ’s conclusions as w ould agree. O u r clinical ex p e rien c e indicates the conclusions draw n do n o t coincide p e r fectly w ith clinical practice. New concepts are continually being advanced an d co n clusions d raw n from past research will be m odified. We should re m e m b e r th a t re search, at best, provides a nev er-en d in g p ath tow ard th e final tru th . . . . We strongly dispute Dr. R am fjord’s co n ten tio n th a t surgical pocket elim in a tio n is n o t justifiable. MARK V. T H O M A S, DMD W ILLIAM J. M ORGAN, DMD R IC H M O N D , VA 1. M agnusson, I., and others. A long junctional epithelium — a locus minoris resistiae in plaque infec tion? J Clin Periodontol 10:333-340, 1983. 2. B eaum ont, R.H.; O ’Leary, T.J.; and Kafrawy, A .H . Relative resistance o f long junctional epithelial a d h e sio n s an d c o n n e c tiv e tissu e atta ch m en ts to plaque-induced inflam m ation. J Periodontol 55:213223, 1984. 3. Barrington, E.P. An overview o f periodontal sur gical procedures. J Periodontol 52:518-528, 1981. 4. Page, R.C., and Schroeder, H.E. Periodontitis in m an and other animals: a com parative review. Basel, Karger, 1982. 5. K ennedy, J.E., and Poison, A.M . Experim ental m a r g in a l p e r io d o n titis in s q u ir r e l m o n k e y s. J Periodontol 44:140-144, 1973. 6. G oldm an, H.M . An observation o f an unusual repair o f an osseous defect. J Periodontol 45:746, 1974.
12 ■ JADA, Vol. 115, July 1987
□ As a d en tist an d a pilot, I am co n cern ed with th e public im age o f both fields o f e n d e a v o r . A f te r r e a d i n g th e a r tic le “Forensic dentistry in th e C erritos air dis aster,” by Drs. G erald Vale, Jo se p h A nselm o, an d Betty H o ffm an (May), I was struck by th e p h rasin g used in describing the m idair collision. T h e a u th o rs stated that th e airlin er “. . .was struck by a small private plane . . . ” T his u n fo rtu n a te choice o f w ords n o t only inaccurately p o rtray s w hat h a p p e n e d , b ut gives all light aircraft an d g eneral aviation an u n d eserv ed bad rep u ta tio n . T o say th e sm aller, slower air c ra ft “stru ck ” th e airlin er is akin to saying “th e car was struck by th e p e d e stria n .” T his also tend s to lead people to place blam e o n th e small aircraft. T his blam e has n ot been established as yet by th e N ational T r a n s p o r ta tio n Safety B o a rd (N T S B ), an d m ay never be. A b etter choice o f w ords m ight have been, “the aircraft collided with a small private p lan e.” T h e re w ere sets o f eyes in both cockpits responsible fo r seeing an d avoiding o th e r air traffic. O n a very clear day such as A ug 31, 1986, th e p eo p le b e h in d those eyes, in both cockpits, obviously failed. . . .
o f oral use o f this chem ical should m ake th e p r a c t i t i o n e r w a ry . S p e c ific a lly , cyanoacrylates, w hen ex p o sed to air, will p ro d u ce a gas. T his is a p o te n t allergen th a t can cause serious resp irato ry distress. T h e use o f this p articu la r chem ical in the m outh w ould seem to be an u n w arran ted risk. As th e a u th o rs e n d o rse in tra o ra l use o f cyanoacrylate, they sh o u ld have clearly o u tlin ed at least th e very m inim al p rec au tions fo r its in trao ral use: fo r exam ple, a specific m edical history focusing on p rev i ous sensitivity to cyanoacrylates; ru b b er dam isolation; an d p ro tectio n o f th e air way by use o f hig h -sp eed suction. In ad d itio n , th e d en tist a n d staff should avoid in halation of th e gaseous b y-product o f this chem ical reaction. M ICHAEL L. GOR D O N , DMD C IN C IN N A T I
X -ra y f ilm d u p lic a tio n
□ A p ro b lem w h ereb y th e id en tify in g bubble on d en tal X -ray film can no longer be relied o n to d eterm in e th e left o r rig h t sides o f th e p a tie n t’s m o u th is o ccu rrin g because E astm an K odak Co is m ark etin g d u p licatin g film in periapical film size with a raised d o t. A lth o u g h th e m a n u fa c tu re r’s T H O R N T O N A. D A R C , DDS rec o m m en d e d p ro c e d u re is to place the PRESIDENT-ELECT em ulsion side o f th e d u p licatin g film in FLYING D E N T IST S’ A SSO C IA T IO N contact with th e film to be copied, a d u p li □ Comment: T h e lan g u ag e used by th e a u cate can still be m ade if th e copy film is th o rs was based on in fo rm atio n re p o rte d reversed. N orm ally, th e reversal o f d u plicating in The Los Angeles Times w hich stated: “at least th ree eyewitnesses said they saw th e film in sh eet fo rm , a com m on d ark ro o m sm aller plane crash into th e tail section o f e rro r, does n o t cause a pro b lem because th e je t lin e r .. . .” T h e source o f this in fo r th e d en tist m ust specifically m ark left a n d rig h t afte r th e film is dup licated . H ow m ation was referen ced in th e article.1 Lest th e re be any d o u b t, th e a u th o rs do ever, with raised dots on reg u la r size 2 n o t claim to have eith er th e necessary in d u p licatin g film , dentists can accidentally fo rm atio n o r expertise to d eterm in e fault believe th a t th e film is an original, not in this disaster n o r was this o u r intent. realizing th a t it is reversed. Aside from th e difficulty o f review ing A long w ith D r. D’Arc, we await th e re p o rt p erso n al in ju ry cases w ith this e rro r, a d d i o f th e N TSB on this m atter. tional ram ifications include body identifi GERALD L. VALE, DDS, MDS JOSEPH A. ANSELM O, DDS cation an d , m ore significantly, potential B ETTY L. H O FFM AN, D DS, MSEd m alpractice liability. T h e d en tist who is on th e bubble to d eterm in e left 1. T h e Los A ngeles T im es, Sept l,p p 1 ,5 ,2 0 ,1 relying 986. an d rig h t sides could accidentally tre a t the w rong side o f th e m o u th . C y a n o a c r y la te w a r n in g U ntil this pro b lem is resolved, the use o f c o n v e n tio n a l s h e e t d u p lic a t in g film sh o u ld be en co u rag ed . □ T h e a r tic le in th e A p ril J o u r n a l, HASKELL A SKIN, DDS “C yanoacrylate — a new tre a tm e n t fo r hy BRICK T O W N , NJ persensitive d en tin a n d ce m e n tu m ,” by Drs. B ahram Javid, R ah m at A. B ark h o r- □ Comment: D u p lic atin g film is single d e r, an d S uryakant V. B hinda failed to em ulsion film, an d in trao ral rad io g rap h ic inform th e re a d e r th a t cyanoacrylate can film is dou b le em u lsio n film. A lthough cause a serious allergic reaction. T h e risks d uplicates o f rad io g rap h s can be m ade