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Pearls, grooves, and projections
LETTERS
TO
THE
E D IT O R
of a localized periodontitis around m a x illa ry or m a n d ib u la r m olars (e n a m e l p e a rls o r e n a m e l p r o jections) or on the m axillary incisors (radicular lingual groove). DAVID C. VANDERSALL, DDS, MS INDIANAPOLIS 1. Swann, R.H., and Hurt, W.C. Cervical enamel projections as an etiologic factor in fur cation involvement. JADA 93(2):342-345,1976. 2. August, D.S. The radicular lingual groove: an overlooked differential diagnosis. JADA 96(6):1037-1039, 1978.
P e a rls, g rooves, a n d p ro je c tio n s
L ig h tin g u p
□ T he c lin ic a l re p o rt, “ Enam el pearls as a co n trib u tin g factor in p e rio d o n ta l b re a k d o w n ,” by Dr. G o ld s te in (The Jo urna l, A u g u st) brought to m ind other abnormalities of enamel form ation and deposition that are frequently associated w ith localized periodontitis. They are cer vic a l enamel projections 1 and the radicular ling ua l groove .2 Whether the e tiologic relationship of these enamel form ations to periodontitis is due to the tenuous attachment of the junctional epithelium to enamel, or to the altered configuration of the ad ja c e n t a lv e o la r bone is u nclea r. Nevertheless, the diagnostician must be aware o f th e ir occurrence and th e ir potential for harming the perio dontium . Unfortunately, as Goldstein points out, these varieties of enamel deposi tio n are rarely diagnosed u n til the p e rio d o n ta l b re a k d o w n has oc curred. Even then, because o f th eir deceptive nature and m icroscopic appearance, as w e ll as th e ir rare oc currence, they are often overlooked as a contributing factor in the break down. As a result, they are excluded from the treatm ent plan, and the periodontal destruction is allowed to progress. G oldstein’s report b ea utifu lly i l lustrates the im portance of early id e n tific a tio n and management of the enamel pearl (Illustration) in the com prehensive treatm ent o f a lo ca lize d p e rio d o n titis . Perhaps i f sim ilar reports are brought to the at tention of readers, the dental practi tioner w ill become more cognizant of the presence and the potential dan gers of these enamel malformations. This is especially im portant i f one is attem pting to determine the etiology
□ Price and Shaw (The Journal, June) have w ritten a tim ely article on “ Illu m in a tio n of the Dental Operato ry.” E quivalent sphere illu m in a tio n (ESI), contrast rendition factor (CRF), and lig h tin g effectiveness fa cto r (LEF) are reference terms that are used to indicate the quality of light. However, these factors have never b e e n e v a lu a t e d f o r d e n t a l operatories. Currently, the only re ference available is the Illu m in a tin g Engineering Society (IES) Lighting H andbook w h ic h evaluates office
7 9 4 ■ J A D A , V o l. 9 9 , N o v e m b e r 1 9 7 9
tasks. A n example of an office task w ou ld be the contrast of a pencil line or b allpo in t pen line on a piece of pa per. A com parison of th is nature seems in c o n s is te n t w ith the de mands that are placed upon a practi tioner to distinguish the many fine and varied details that occur in teeth and tooth-related structures. The authors suggest that a batwing d is trib u tio n of lig h t (Illu s tra tio n ) w i ll reduce the brightness w hen v ie w e d fr o m b e lo w , th e r e b y m in im izin g patient discomfort. It is my belief that it is a measure of the in tensity (candelas) of the lig h t at the view ing angle that is the determ i nant. I w ould also like to see more re search inform ation concerning the need for 300 ftc in a standard dental operatory. I th in k that this is m uch too high. I fin d a level of 150 to 2 00 ftc in the area around the patient’s head sufficient. I use H igh Value Perfor m an ce lu m in a ire s w h ic h have parabolic shaped anodized a lu m i n um refle cting surfaces w ith tw o 40-W fluorescent bulbs in tandem. T his fixtu re does not require the use of a lens or a defractor to lessen the ef fect of glare and veiling reflections.
TO
THE
E D IT O R
of a localized periodontitis around m a x illa ry or m a n d ib u la r m olars (e n a m e l p e a rls o r e n a m e l p r o jections) or on the m axillary incisors (radicular lingual groove). DAVID C. VANDERSALL, DDS, MS INDIANAPOLIS 1. Swann, R.H., and Hurt, W.C. Cervical enamel projections as an etiologic factor in fur cation involvement. JADA 93(2):342-345,1976. 2. August, D.S. The radicular lingual groove: an overlooked differential diagnosis. JADA 96(6):1037-1039, 1978.
P e a rls, g rooves, a n d p ro je c tio n s
L ig h tin g u p
□ T he c lin ic a l re p o rt, “ Enam el pearls as a co n trib u tin g factor in p e rio d o n ta l b re a k d o w n ,” by Dr. G o ld s te in (The Jo urna l, A u g u st) brought to m ind other abnormalities of enamel form ation and deposition that are frequently associated w ith localized periodontitis. They are cer vic a l enamel projections 1 and the radicular ling ua l groove .2 Whether the e tiologic relationship of these enamel form ations to periodontitis is due to the tenuous attachment of the junctional epithelium to enamel, or to the altered configuration of the ad ja c e n t a lv e o la r bone is u nclea r. Nevertheless, the diagnostician must be aware o f th e ir occurrence and th e ir potential for harming the perio dontium . Unfortunately, as Goldstein points out, these varieties of enamel deposi tio n are rarely diagnosed u n til the p e rio d o n ta l b re a k d o w n has oc curred. Even then, because o f th eir deceptive nature and m icroscopic appearance, as w e ll as th e ir rare oc currence, they are often overlooked as a contributing factor in the break down. As a result, they are excluded from the treatm ent plan, and the periodontal destruction is allowed to progress. G oldstein’s report b ea utifu lly i l lustrates the im portance of early id e n tific a tio n and management of the enamel pearl (Illustration) in the com prehensive treatm ent o f a lo ca lize d p e rio d o n titis . Perhaps i f sim ilar reports are brought to the at tention of readers, the dental practi tioner w ill become more cognizant of the presence and the potential dan gers of these enamel malformations. This is especially im portant i f one is attem pting to determine the etiology
□ Price and Shaw (The Journal, June) have w ritten a tim ely article on “ Illu m in a tio n of the Dental Operato ry.” E quivalent sphere illu m in a tio n (ESI), contrast rendition factor (CRF), and lig h tin g effectiveness fa cto r (LEF) are reference terms that are used to indicate the quality of light. However, these factors have never b e e n e v a lu a t e d f o r d e n t a l operatories. Currently, the only re ference available is the Illu m in a tin g Engineering Society (IES) Lighting H andbook w h ic h evaluates office
7 9 4 ■ J A D A , V o l. 9 9 , N o v e m b e r 1 9 7 9
tasks. A n example of an office task w ou ld be the contrast of a pencil line or b allpo in t pen line on a piece of pa per. A com parison of th is nature seems in c o n s is te n t w ith the de mands that are placed upon a practi tioner to distinguish the many fine and varied details that occur in teeth and tooth-related structures. The authors suggest that a batwing d is trib u tio n of lig h t (Illu s tra tio n ) w i ll reduce the brightness w hen v ie w e d fr o m b e lo w , th e r e b y m in im izin g patient discomfort. It is my belief that it is a measure of the in tensity (candelas) of the lig h t at the view ing angle that is the determ i nant. I w ould also like to see more re search inform ation concerning the need for 300 ftc in a standard dental operatory. I th in k that this is m uch too high. I fin d a level of 150 to 2 00 ftc in the area around the patient’s head sufficient. I use H igh Value Perfor m an ce lu m in a ire s w h ic h have parabolic shaped anodized a lu m i n um refle cting surfaces w ith tw o 40-W fluorescent bulbs in tandem. T his fixtu re does not require the use of a lens or a defractor to lessen the ef fect of glare and veiling reflections.