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GLOVES AND AIDS
L E T T E R S
LETTERS JADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. 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. PROFESSIONALISM
Thank you for publishing Dr. Gordon Christensen’s “The Credibility of Dentists” (August JADA). Dr. Christensen expresses precisely the opinion of so many of us who have witnessed the decline of professionalism during the last 25 or 30 years. Even though “the views expressed are those of the author and do not necessarily reflect the opinions or official policies of the American Dental Association,” it is to be fervently hoped that they do, indeed, reflect the views of our organization. Robert E. Horseman, D.D.S. Whittier, Calif. FOLLOW THE MONEY
I applaud Dr. Meskin’s editorial “Do No Harm” (September JADA). I would like to suggest that one of the reasons that amalgam is getting bashed is that there is money in it. As crude as the dictum “follow the money” is, I have to look no further than our dental journals that invoke the various authors’ versions of economically driven “science” as they promote their version of improved materials and techniques. It helps, of
course, when hysteria (frequently media-driven) is the state-of-mind that is generated. Reason and logic are, of course, the casualties of these tactics. Alan Goldstein, D.M.D. New York City ON TARGET
Thank you for Dr. Meskin’s editorial “Do No Harm” (September JADA). His persistence is refreshing, and his assessment of the amalgam controversy is right on target. Max Martin Jr., D.D.S. Lincoln, Neb. RUBBER GLOVE DISPOSAL
It used to be said that the two sure things were death and taxes. Perhaps nowadays we can add world terrorism and rubber gloves. Dr. Gordon Christensen prepared an excellent article discussing the pros and cons of glove use (“Operating Gloves: The Good and the Bad,” October JADA). One very important factor that was not covered, however, was the environmental impact of the widespread use of gloves by the dental profession. Some time ago I saw something printed on this and, if it was accurate, the numbers were awesome as to the large amount of agricultural land needed to plant sufficient rubber trees to produce this many gloves. Then the problem on the other end is the very large volume of waste produced that will require suitable landfill locations or other means of disposal. If you also consider all other health care professions, the problem could at least double. Perhaps the author could address this for a future issue. W.V. Williamson, D.D.S., M.S.
Casares, Nicaragua GLOVES AND AIDS
Dr. Christensen’s October article on operating gloves resurrected one of the greatest nonscientific, nontechnological and nonbeneficial changes in the history of dentistry. In fact, it drove many excellent dentists out of the profession because of allergies to latex. And sadly, the whole barrier phenomenon was a fraud and a charade, foisted upon the health professions by the Occupational Safety and Health Administration, which was running out of ways to scare people and justify its existence—and found the Acer case the perfect ploy. The facts are these: U.S. dentists performed for decades, and without gloves, more than 1 billion dental procedures each year in the course of more than 500 million dental visits, with no human immunodeficiency virus transmissions reported! We are left with one health care worker (Dr. David Acer) who defies staggering odds and infects a few people. And finally the Centers for Disease Control and Prevention is admitting, after its investigations, to the incontestable anomaly of the case. As a profession, we need to be deeply concerned when public health policy is set, not by scientists, but by political operatives and special interests with axes to grind and agendas to fulfill, all supported by the journalistic rhetorical fashion of the moment, elevating another chimerical danger. All of which exploits the lemming behavior of a vast majority of people, including acquiescing health professionals. Because of these sensational, nonscientific charges spewed
1 4 JADA, Vol. 133, January 2002 Copyright ©2002 American Dental Association. All rights reserved.
L E T T E R S
out by the media, the dentist/ AIDS thing was just another paradigm (along with alar, asbestos, lead, mercury and others) of the hypochondria that grips an affluent society frightened by shadows on the wall. Robert D. Hemholdt, D.D.S., P.A. Ft. Lauderdale, Fla. A SPECIALIST’S COMPLAINT
Two things have happened that prompt me to write. The first was Dr. Meskin’s editorial regarding strength in numbers as a reason to belong to the ADA (“Strength in Numbers,” November JADA). Immediately after reading this editorial, I examined a new patient, complete with study models and cephalometric and panoramic X-rays from a general dentist nearby. As a licensed orthodontic specialist in Missouri, I recognize that any dentist is legally entitled to perform any aspect of dentistry in which he or she feels qualified. This is irrespective of the amount of training received in that venue, whether it is a weekend course or a fullfledged residency. I am not arguing against that right to practice because I don’t want another “turf war” dispute. What I am incensed about is that for the umpteenth time I’ve had a patient’s parent report that the general dentist planning orthodontic treatment spent half his time denigrating orthodontic specialists, their training and backgrounds, and their treatment plans and results. Who is teaching them these concepts and why? Now I don’t claim to achieve great results 100 percent of the time and neither do most prac-
titioners with whom I am acquainted. However, it really irks me that individuals who don’t have 1 percent of the training time and educational background in a specialty field that I have can make pronouncements about how orthodontists don’t have a clue about what they are doing and are furthermore doing it all wrong! And this from someone who sends impressions and X-rays to a laboratory that provides a diagnosis and treatment plan! (Naturally, a disclaimer is included saying that the outline provided is for “informational purposes” only and that only a licensed dentist can provide an actual treatment plan.) Invariably the treatment plan begins with some sort of “jaw expansion” appliance because the orthodontist would extract teeth. Can this be true every time? Let me ask if any of you think the lab would recommend an initial expansion appliance for every patient if it didn’t get paid for making it— that is, if the lab got the same remuneration without it? What ties all this together for me is that, on the one hand, I have the ADA telling me why I should retain my membership; at the same time, its members are telling patients I don’t know what I’m doing. I believe in live and let live. If you, as a general dentist, have a special interest in orthodontics and wish to learn more about it and incorporate it into your practice, fine and dandy. However, I don’t believe you serve the best interests of your patients, the public or your profession to waste time in unsubstantiated denigration of a proud specialty. So let’s just get
on with the work at hand and I hope you do it well. But give the devil his due and don’t set aside the superior training afforded to a specialist. James M. Jolly, D.M.D., M.S. Hannibal, Mo. A PHYSICIAN RESPONDS
On behalf of the family physicians practicing in North Carolina, I am responding to Dr. Meskin’s editorial “Look Who’s Practicing Dentistry” (October JADA). We are grateful for the opportunity to make an impact on the number of high-risk children suffering from early childhood caries. Caries is one of the diseases we see most often in our offices, and one of the most frustrating to resolve. As physicians, we are not interested in diagnosing or treating the dental problems of our patients. In a perfect world, we would recognize when a problem exists and successfully refer the patient to a dentist. My colleagues and I can tell frustrating stories of trying to refer children with dental problems and infections, to no avail. Something must be done, and family physicians are attempting to address the prevention aspect by offering the oral screening and fluoride varnish procedure in our offices. I would point out that we are highly trained medical providers, and performing oral screening is a procedure many of us already provide for our patients when we examine the throat and pharynx. We also see these high-risk children in our offices eight to 20 times before they are 3 years old. Since we are already familiar with oral anatomy and have ac-
JADA, Vol. 133, January 2002 Copyright ©2002 American Dental Association. All rights reserved.
15
LETTERS JADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. 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. PROFESSIONALISM
Thank you for publishing Dr. Gordon Christensen’s “The Credibility of Dentists” (August JADA). Dr. Christensen expresses precisely the opinion of so many of us who have witnessed the decline of professionalism during the last 25 or 30 years. Even though “the views expressed are those of the author and do not necessarily reflect the opinions or official policies of the American Dental Association,” it is to be fervently hoped that they do, indeed, reflect the views of our organization. Robert E. Horseman, D.D.S. Whittier, Calif. FOLLOW THE MONEY
I applaud Dr. Meskin’s editorial “Do No Harm” (September JADA). I would like to suggest that one of the reasons that amalgam is getting bashed is that there is money in it. As crude as the dictum “follow the money” is, I have to look no further than our dental journals that invoke the various authors’ versions of economically driven “science” as they promote their version of improved materials and techniques. It helps, of
course, when hysteria (frequently media-driven) is the state-of-mind that is generated. Reason and logic are, of course, the casualties of these tactics. Alan Goldstein, D.M.D. New York City ON TARGET
Thank you for Dr. Meskin’s editorial “Do No Harm” (September JADA). His persistence is refreshing, and his assessment of the amalgam controversy is right on target. Max Martin Jr., D.D.S. Lincoln, Neb. RUBBER GLOVE DISPOSAL
It used to be said that the two sure things were death and taxes. Perhaps nowadays we can add world terrorism and rubber gloves. Dr. Gordon Christensen prepared an excellent article discussing the pros and cons of glove use (“Operating Gloves: The Good and the Bad,” October JADA). One very important factor that was not covered, however, was the environmental impact of the widespread use of gloves by the dental profession. Some time ago I saw something printed on this and, if it was accurate, the numbers were awesome as to the large amount of agricultural land needed to plant sufficient rubber trees to produce this many gloves. Then the problem on the other end is the very large volume of waste produced that will require suitable landfill locations or other means of disposal. If you also consider all other health care professions, the problem could at least double. Perhaps the author could address this for a future issue. W.V. Williamson, D.D.S., M.S.
Casares, Nicaragua GLOVES AND AIDS
Dr. Christensen’s October article on operating gloves resurrected one of the greatest nonscientific, nontechnological and nonbeneficial changes in the history of dentistry. In fact, it drove many excellent dentists out of the profession because of allergies to latex. And sadly, the whole barrier phenomenon was a fraud and a charade, foisted upon the health professions by the Occupational Safety and Health Administration, which was running out of ways to scare people and justify its existence—and found the Acer case the perfect ploy. The facts are these: U.S. dentists performed for decades, and without gloves, more than 1 billion dental procedures each year in the course of more than 500 million dental visits, with no human immunodeficiency virus transmissions reported! We are left with one health care worker (Dr. David Acer) who defies staggering odds and infects a few people. And finally the Centers for Disease Control and Prevention is admitting, after its investigations, to the incontestable anomaly of the case. As a profession, we need to be deeply concerned when public health policy is set, not by scientists, but by political operatives and special interests with axes to grind and agendas to fulfill, all supported by the journalistic rhetorical fashion of the moment, elevating another chimerical danger. All of which exploits the lemming behavior of a vast majority of people, including acquiescing health professionals. Because of these sensational, nonscientific charges spewed
1 4 JADA, Vol. 133, January 2002 Copyright ©2002 American Dental Association. All rights reserved.
L E T T E R S
out by the media, the dentist/ AIDS thing was just another paradigm (along with alar, asbestos, lead, mercury and others) of the hypochondria that grips an affluent society frightened by shadows on the wall. Robert D. Hemholdt, D.D.S., P.A. Ft. Lauderdale, Fla. A SPECIALIST’S COMPLAINT
Two things have happened that prompt me to write. The first was Dr. Meskin’s editorial regarding strength in numbers as a reason to belong to the ADA (“Strength in Numbers,” November JADA). Immediately after reading this editorial, I examined a new patient, complete with study models and cephalometric and panoramic X-rays from a general dentist nearby. As a licensed orthodontic specialist in Missouri, I recognize that any dentist is legally entitled to perform any aspect of dentistry in which he or she feels qualified. This is irrespective of the amount of training received in that venue, whether it is a weekend course or a fullfledged residency. I am not arguing against that right to practice because I don’t want another “turf war” dispute. What I am incensed about is that for the umpteenth time I’ve had a patient’s parent report that the general dentist planning orthodontic treatment spent half his time denigrating orthodontic specialists, their training and backgrounds, and their treatment plans and results. Who is teaching them these concepts and why? Now I don’t claim to achieve great results 100 percent of the time and neither do most prac-
titioners with whom I am acquainted. However, it really irks me that individuals who don’t have 1 percent of the training time and educational background in a specialty field that I have can make pronouncements about how orthodontists don’t have a clue about what they are doing and are furthermore doing it all wrong! And this from someone who sends impressions and X-rays to a laboratory that provides a diagnosis and treatment plan! (Naturally, a disclaimer is included saying that the outline provided is for “informational purposes” only and that only a licensed dentist can provide an actual treatment plan.) Invariably the treatment plan begins with some sort of “jaw expansion” appliance because the orthodontist would extract teeth. Can this be true every time? Let me ask if any of you think the lab would recommend an initial expansion appliance for every patient if it didn’t get paid for making it— that is, if the lab got the same remuneration without it? What ties all this together for me is that, on the one hand, I have the ADA telling me why I should retain my membership; at the same time, its members are telling patients I don’t know what I’m doing. I believe in live and let live. If you, as a general dentist, have a special interest in orthodontics and wish to learn more about it and incorporate it into your practice, fine and dandy. However, I don’t believe you serve the best interests of your patients, the public or your profession to waste time in unsubstantiated denigration of a proud specialty. So let’s just get
on with the work at hand and I hope you do it well. But give the devil his due and don’t set aside the superior training afforded to a specialist. James M. Jolly, D.M.D., M.S. Hannibal, Mo. A PHYSICIAN RESPONDS
On behalf of the family physicians practicing in North Carolina, I am responding to Dr. Meskin’s editorial “Look Who’s Practicing Dentistry” (October JADA). We are grateful for the opportunity to make an impact on the number of high-risk children suffering from early childhood caries. Caries is one of the diseases we see most often in our offices, and one of the most frustrating to resolve. As physicians, we are not interested in diagnosing or treating the dental problems of our patients. In a perfect world, we would recognize when a problem exists and successfully refer the patient to a dentist. My colleagues and I can tell frustrating stories of trying to refer children with dental problems and infections, to no avail. Something must be done, and family physicians are attempting to address the prevention aspect by offering the oral screening and fluoride varnish procedure in our offices. I would point out that we are highly trained medical providers, and performing oral screening is a procedure many of us already provide for our patients when we examine the throat and pharynx. We also see these high-risk children in our offices eight to 20 times before they are 3 years old. Since we are already familiar with oral anatomy and have ac-
JADA, Vol. 133, January 2002 Copyright ©2002 American Dental Association. All rights reserved.
15