- Email: [email protected]
A matter of degree
J Oral Maxillofac
Surg
49:221.1991
A Matter of Degree accurately define the major activity of most dental practitioners. Thus, the term is antiquated as well as misleading. The DMD degree, on the other hand, not only currently better defines the role of the dentist, but also will be even more appropriate in the future as the decline in dental caries and periodontal diseases gradually changes the emphasis in dentistry from a more technically oriented to a more medically oriented profession. A review of the current dental curriculum clearly indicates that this trend is already occurring. Another benefit of using the DMD degree might be the effect it could have on the profession in terms of how dentists perceive themselves. By changing the degree designation to more clearly reflect the current scope of dentistry, the public may begin to more appropriately equate the education and training of the medical and dental professions, as indicated by the opinion poll. If this occurs, then perhaps the dentist’s self-image will improve. Not that there is any real basis for a feeling of inferiority, and even public opinion polls show that the dentist ranks high as an ethical and competent provider of an important aspect of health care, but perception often tends to be interpreted as reality, and dentists tend to be their own worst enemy in this respect. Changing to a unified degree will not be an easy task, no matter what decision is recommended by the Council on Dental Education. When this issue was last brought before the ADA House of Delegates, they did not support the idea and believed it was the prerogative of each school to decide which degree to award. Perhaps this time, with the recommendation arising from the House of Delegates rather than the Council, the decision will be different. But the ADA can only recommend the idea; it cannot make it a mandate. The American Association of Dental Schools can also take a position on the matter, but it too cannot make it compulsory. Ultimately, the decision will have to be made by the individual schools. However, if the schools do not decide to adopt a uniform degree, it has been suggested as an alternative to ask State Boards of Dentistry to amend their rules to permit either degree to be used without violation of any state regulations. Unification of the dental degree is an important and timely issue, but it will not be achieved without
In 1990, the American Dental Association House of Delegates approved a resolution calling for the Council on Dental Education to study the feasibility and advisability of all dental schools conferring a similar degree, either DDS or DMD, instead of the current practice of some schools awarding one and some the other. This proposal stems from the same argument raised almost 20 years ago when the ADA Council on Dental Education recommended that the DMD degree be used by all schools; namely, that the two degrees cause confusion for the public. There is no doubt that different designations for individuals with the same education and training can cause confusion. Because of the similarity between the MD and DMD degrees, patients often assume that those who possess the latter have some special expertise. This was confirmed in a survey done by the Department of Marketing in the College of Business Administration of the University of South Florida, which showed that 36% of those polled believed there was a difference between the medical training of those with DMD and those with DDS degrees, and that 45% also thought that dentists with a DMD degree go to school longer. When asked whom they would go to for a tooth extraction, 59% selected a dentist with a DDS degree, yet 40% said they would choose one with a DMD degree for removal of a cyst or tumor (compared to 35% for the DDS-degreed dentist and 25% who didn’t know or care), and 54% (compared to 18% and 28%, respectively) said they would choose a person with a DMD degree if they were considering cosmetic facial surgery. Obviously, there is a great deal of confusion in the mind of the public regarding the types of services provided by the bearers of these degrees, and the extent of their education, that could be resolved by conferring only one degree . If there is going to be a unified degree in dentistry, then the question is which one it should be. Historically, the DDS degree was the first to be awarded and it remains the one conferred by 30 of 50 dental schools. Although traditions are important, and should be continued whenever possible, there are logical reasons why continuation of the DDS degree may not be in the best interest of the profession. Certainly, one can argue that “dental surgery” does not now, and probably never did,
(continued
221
on page 323)
323
CURRENT LITERATURE
Laryngeal Obstruction and Obstructive Sleep Apnea Syn drome. Anonsen C. Laryngoscope 100:775, 1990 Snoring is found in 100% of ObStNCtiVe sleep apnea (OSA) patients, and is the most common cause of visitation to an otolaryngologists by these patients. Nighttime sleep disturbances may be caused by any number of airway obstructions, and are not necessarily associated with the oropharynx or hypopharynx as in OSA. In order to manage these patients correctly, the exact location of obstruction must be identified. A central versus a peripheral etiology must also be determined. This is usually done by polysomnography, which is thought of as the most helpful and informative initial test in evaluating these patients. This article reports the use of a voice-activated cassette tape recorder to assist in diagnosis of this condition, and reports two cases in which this tape prevented inappropriate surgery, and three cases in which a recording would have prevented surgery. The tape helped differentiate laryngeal sources of OSA from other types of OSA requiring surgery. It is suggested as another tool to be
used in the work up and evaluation from obstructive sleep apnea.-G.W. Reprint requests to Dr Anonsen: WA 98004.
of patients
suffering
HUELER
1201 116th Ave NE, Bellevue,
Sleep Apnea and the Upper Airway. Hoffstein V, Zamel N. Br .I Anesth 65:139, 1990 This review article presents current concepts of diagnosis and treatment of sleep apnea. Diagnostic methods are discussed, including acoustic reflection technique and magnetic resonance imaging. Pharmacologic treatments presented include respiratory stimulants, dopaminergic antagonists, and antidepressants. Surgical correction of sleep apnea is reviewed, including rationale for tracheostomy and uvulopalatopharyngoplasty (UPPP). The authors conclude by enumerating questions yet unanswered regarding sleep apnea and avenues for future research.J. DEMBO Reprintrequeststo Dr Zamel: Room 656, Mount Sinai Hospital, 600 University Ave, Toronto, Canada M5G 1X5.
(Continued from page 221)
a concerted
effort on the part of many individuals at the ADA level, at the AADS level, with the various dental schools, and perhaps with State Boards. If you too believe that this is an important issue, it is
not too soon to make your opinion heard in the appropriate arenas. DANIEL M. LASKIN
Surg
49:221.1991
A Matter of Degree accurately define the major activity of most dental practitioners. Thus, the term is antiquated as well as misleading. The DMD degree, on the other hand, not only currently better defines the role of the dentist, but also will be even more appropriate in the future as the decline in dental caries and periodontal diseases gradually changes the emphasis in dentistry from a more technically oriented to a more medically oriented profession. A review of the current dental curriculum clearly indicates that this trend is already occurring. Another benefit of using the DMD degree might be the effect it could have on the profession in terms of how dentists perceive themselves. By changing the degree designation to more clearly reflect the current scope of dentistry, the public may begin to more appropriately equate the education and training of the medical and dental professions, as indicated by the opinion poll. If this occurs, then perhaps the dentist’s self-image will improve. Not that there is any real basis for a feeling of inferiority, and even public opinion polls show that the dentist ranks high as an ethical and competent provider of an important aspect of health care, but perception often tends to be interpreted as reality, and dentists tend to be their own worst enemy in this respect. Changing to a unified degree will not be an easy task, no matter what decision is recommended by the Council on Dental Education. When this issue was last brought before the ADA House of Delegates, they did not support the idea and believed it was the prerogative of each school to decide which degree to award. Perhaps this time, with the recommendation arising from the House of Delegates rather than the Council, the decision will be different. But the ADA can only recommend the idea; it cannot make it a mandate. The American Association of Dental Schools can also take a position on the matter, but it too cannot make it compulsory. Ultimately, the decision will have to be made by the individual schools. However, if the schools do not decide to adopt a uniform degree, it has been suggested as an alternative to ask State Boards of Dentistry to amend their rules to permit either degree to be used without violation of any state regulations. Unification of the dental degree is an important and timely issue, but it will not be achieved without
In 1990, the American Dental Association House of Delegates approved a resolution calling for the Council on Dental Education to study the feasibility and advisability of all dental schools conferring a similar degree, either DDS or DMD, instead of the current practice of some schools awarding one and some the other. This proposal stems from the same argument raised almost 20 years ago when the ADA Council on Dental Education recommended that the DMD degree be used by all schools; namely, that the two degrees cause confusion for the public. There is no doubt that different designations for individuals with the same education and training can cause confusion. Because of the similarity between the MD and DMD degrees, patients often assume that those who possess the latter have some special expertise. This was confirmed in a survey done by the Department of Marketing in the College of Business Administration of the University of South Florida, which showed that 36% of those polled believed there was a difference between the medical training of those with DMD and those with DDS degrees, and that 45% also thought that dentists with a DMD degree go to school longer. When asked whom they would go to for a tooth extraction, 59% selected a dentist with a DDS degree, yet 40% said they would choose one with a DMD degree for removal of a cyst or tumor (compared to 35% for the DDS-degreed dentist and 25% who didn’t know or care), and 54% (compared to 18% and 28%, respectively) said they would choose a person with a DMD degree if they were considering cosmetic facial surgery. Obviously, there is a great deal of confusion in the mind of the public regarding the types of services provided by the bearers of these degrees, and the extent of their education, that could be resolved by conferring only one degree . If there is going to be a unified degree in dentistry, then the question is which one it should be. Historically, the DDS degree was the first to be awarded and it remains the one conferred by 30 of 50 dental schools. Although traditions are important, and should be continued whenever possible, there are logical reasons why continuation of the DDS degree may not be in the best interest of the profession. Certainly, one can argue that “dental surgery” does not now, and probably never did,
(continued
221
on page 323)
323
CURRENT LITERATURE
Laryngeal Obstruction and Obstructive Sleep Apnea Syn drome. Anonsen C. Laryngoscope 100:775, 1990 Snoring is found in 100% of ObStNCtiVe sleep apnea (OSA) patients, and is the most common cause of visitation to an otolaryngologists by these patients. Nighttime sleep disturbances may be caused by any number of airway obstructions, and are not necessarily associated with the oropharynx or hypopharynx as in OSA. In order to manage these patients correctly, the exact location of obstruction must be identified. A central versus a peripheral etiology must also be determined. This is usually done by polysomnography, which is thought of as the most helpful and informative initial test in evaluating these patients. This article reports the use of a voice-activated cassette tape recorder to assist in diagnosis of this condition, and reports two cases in which this tape prevented inappropriate surgery, and three cases in which a recording would have prevented surgery. The tape helped differentiate laryngeal sources of OSA from other types of OSA requiring surgery. It is suggested as another tool to be
used in the work up and evaluation from obstructive sleep apnea.-G.W. Reprint requests to Dr Anonsen: WA 98004.
of patients
suffering
HUELER
1201 116th Ave NE, Bellevue,
Sleep Apnea and the Upper Airway. Hoffstein V, Zamel N. Br .I Anesth 65:139, 1990 This review article presents current concepts of diagnosis and treatment of sleep apnea. Diagnostic methods are discussed, including acoustic reflection technique and magnetic resonance imaging. Pharmacologic treatments presented include respiratory stimulants, dopaminergic antagonists, and antidepressants. Surgical correction of sleep apnea is reviewed, including rationale for tracheostomy and uvulopalatopharyngoplasty (UPPP). The authors conclude by enumerating questions yet unanswered regarding sleep apnea and avenues for future research.J. DEMBO Reprintrequeststo Dr Zamel: Room 656, Mount Sinai Hospital, 600 University Ave, Toronto, Canada M5G 1X5.
(Continued from page 221)
a concerted
effort on the part of many individuals at the ADA level, at the AADS level, with the various dental schools, and perhaps with State Boards. If you too believe that this is an important issue, it is
not too soon to make your opinion heard in the appropriate arenas. DANIEL M. LASKIN