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A Note on Smoke
___________________ J A D A _______________ UKKKKÊÊÊÊÊÊÊÊÊKÊÊÊÊKKÊÊÊtÊÊÊÊÊÊtÊÊÊÊÊÊÊÊÊ L E T T E R S
TO
T H E
E D I T O R
JA D A devotes this section to com m ent by readers on topics of current interest to dentistry. T he editor reserves the right to edit all com m unications to fit available space and requires that all letters be typed, double-spaced, and signed. N o more than ten references should be given with each letter. Printed com m u nications do not necessarily reflect the op in ion or official policy o f the Association. Your participation in this section is invited.
enable bo th parties to fully discuss the fundam ental com ponents of the rela tio n ship. P u ttin g an oral agreem ent in w ritin g lessens the chance of a fu tu re disagreem ent or m isunderstanding. M oreover, a w ritten agreem ent carries a perceived degree of im portance stressing the seriousness of the relatio n sh ip being undertaken, w hether th e re la tio n sh ip is th a t of em ployee, independen t co ntractor, or tim e-share/ solo g ro u p .”
G et it in w r itin g □ I am w ritin g to w arn other young d e n tis ts w h o m ay be e n te r in g in to e m p lo y e e o r in d e p e n d e n t c o n tra c to r relationships. I began em ploym ent in a m all-based dental office as an indep en d en t contractor w ith o u t a contract or restrictive covenant. At the tim e, I th o u g h t this arrangem ent m ig h t have been to my advantage should the relatio n sh ip end. H owever, w hen I was fired w ithout notice or ju stification, I discovered that my p o s itio n w as fa r less th a n o p tim a l. F ortunately, I w orked a t an o th er office ab o u t 15 hours a week an d I was able to increase my tim e there. It took VA m onths to get back to full-tim e em ploym ent, and my fam ily’s finances were stressed to the lim it. In addition, the first office refused to c o m p e n sa te m e fo r th e services I perform ed an d I now find myself in the m iddle of w hat prom ises to be a long legal battle. I have learned th a t it is foolish to be w ith o u t a contract. If there is a restrictive covenant, it is usually reasonable, or else unenforceable. A contract sho u ld include d efin ition of em ploym ent status, determ i n atio n of com pensation, a n d notice of term in atio n required. M ITC H ELL COHEN, DMD M ARLTON, NJ.
□ E d ito r’s note: T h is concern is discussed in the book B u ild in g Successful Associateships p u blished by the ADA C ouncil on D ental Practice. In the chapter on contrac tual considerations, the recom m endations are: “ A w ritten contract betw een all parties considering an associate relationship is preferable for a variety of practical and professional reasons. W ritten agreem ents 10 ■ JADA, Vol. 121, July 1990
A n o te o n sm o k e
patien ts avoid an d disco n tin u e the use of tobacco: others are m ak in g significant co n trib u tio n s in d ental ed ucation an d research, an d by in flu en cin g p u b lic policy. N atio n al Cancer In stitu te recom m ended intervention m ethods for d ental practice are brief, sim p le, a n d effective. S uch preventive a n d cessation services im prove the q u ality of d ental practice as w ell as p atien ts’ lives. R O B ER T M ECKLENBURG, DDM, MPH N A TIO N A L CANCER IN ST IT U T E C O N SU L T A N T
T M J arth ro sco p y □ H elp in g patients avoid o r discontinue use of tobacco produces im m ediate an d long-term benefits to everyone, in clu d in g dentists. A lth o u g h m ost dentists recognize the im portance of tobacco use as it relates to health an d p u b lic policy, m any do n o t recognize its relatio n to dental practice. T h is is disturbing, because approxim ately one-fourth of dental patien ts use tobacco. D entists are obliged to help p atients avoid an d disco n tin u e activities th a t can dam age oral health. It is scientifically incontrovertible th a t b o th sm oking an d sm okeless tobacco are associated w ith leukoplakia, o ral cancer, precancerous lesions, certain p erio d o n tal conditions, oral tissue changes, an d esthetic co n d i tions. In addition, tobacco use is associated w ith poorer prognoses a n d longer recovery tim es after certain d ental therapies, such as periodontal treatm ent services. As h ealth professionals, dentists are obliged to help people avoid an d reduce their risk of developing general medical conditions. T im ely assistance can u lti m ately result in fewer requests for services to tre a t red u ced re sp ira to ry capacity, cardiovascular disease, reduced resp o n siveness to m edication, addictive behav iors, an d the possibility of developing acute m edical crises. As good citizens, dentists are obliged to w arn people ab o u t activities th a t could le ad to d isa ste r. T o k n o w th e risk s involved, yet rem ain silent w hen treating these patients falls sh o rt of basic standards of responsibility to the public. S om e d e n tists r o u tin e ly h e lp th e ir
□ I was displeased to see the m in im al rep o rtin g o n te m p o ro m an d ib u lar jo in t (TM J) arthroscopy in your them e issue (March). In regard to diagnosis an d treatm ent of T M disorders, arthroscopic surgery has m ade h u g e strides in the past 5 to 10 years. It is the o nly m odality th at enables us to remove all speculation concerning jo in t p a th o lo g y . A rth ro sc o p y p ro v id es th e ability to directly look at the T M J an d define its p ath o lo g ical condition. . . . I co n sid er th is te c h n iq u e th e m ost im p o rta n t one to com e alo n g to treat T M J problem s. JOSEPH P. McCAIN, DMD MIAMI
□ E ditor’s note: We m ust reiterate that w hen we offer a com prehensive look at a p articu la r topic of dentistry, n o t all aspects are addressed to the total satisfac tio n of all readers. O n th e lig h te r sid e □ Y our M arch issue was long due an d for m ost p a rt excellent. In spite of the trem endous strides the ADA has m ade in try in g to separate the discom forts of T M D (the disorder) from the m ere biological entity of T M J (the jo in t) , th e f o llo w in g d itty is w o rth rep ublishing: W hat D o Y o u Say A b o u t T M J Show m e a d en tist w ith n o th in g to say A nd I ’ll show you a m an w ho talks T M J.
TO
T H E
E D I T O R
JA D A devotes this section to com m ent by readers on topics of current interest to dentistry. T he editor reserves the right to edit all com m unications to fit available space and requires that all letters be typed, double-spaced, and signed. N o more than ten references should be given with each letter. Printed com m u nications do not necessarily reflect the op in ion or official policy o f the Association. Your participation in this section is invited.
enable bo th parties to fully discuss the fundam ental com ponents of the rela tio n ship. P u ttin g an oral agreem ent in w ritin g lessens the chance of a fu tu re disagreem ent or m isunderstanding. M oreover, a w ritten agreem ent carries a perceived degree of im portance stressing the seriousness of the relatio n sh ip being undertaken, w hether th e re la tio n sh ip is th a t of em ployee, independen t co ntractor, or tim e-share/ solo g ro u p .”
G et it in w r itin g □ I am w ritin g to w arn other young d e n tis ts w h o m ay be e n te r in g in to e m p lo y e e o r in d e p e n d e n t c o n tra c to r relationships. I began em ploym ent in a m all-based dental office as an indep en d en t contractor w ith o u t a contract or restrictive covenant. At the tim e, I th o u g h t this arrangem ent m ig h t have been to my advantage should the relatio n sh ip end. H owever, w hen I was fired w ithout notice or ju stification, I discovered that my p o s itio n w as fa r less th a n o p tim a l. F ortunately, I w orked a t an o th er office ab o u t 15 hours a week an d I was able to increase my tim e there. It took VA m onths to get back to full-tim e em ploym ent, and my fam ily’s finances were stressed to the lim it. In addition, the first office refused to c o m p e n sa te m e fo r th e services I perform ed an d I now find myself in the m iddle of w hat prom ises to be a long legal battle. I have learned th a t it is foolish to be w ith o u t a contract. If there is a restrictive covenant, it is usually reasonable, or else unenforceable. A contract sho u ld include d efin ition of em ploym ent status, determ i n atio n of com pensation, a n d notice of term in atio n required. M ITC H ELL COHEN, DMD M ARLTON, NJ.
□ E d ito r’s note: T h is concern is discussed in the book B u ild in g Successful Associateships p u blished by the ADA C ouncil on D ental Practice. In the chapter on contrac tual considerations, the recom m endations are: “ A w ritten contract betw een all parties considering an associate relationship is preferable for a variety of practical and professional reasons. W ritten agreem ents 10 ■ JADA, Vol. 121, July 1990
A n o te o n sm o k e
patien ts avoid an d disco n tin u e the use of tobacco: others are m ak in g significant co n trib u tio n s in d ental ed ucation an d research, an d by in flu en cin g p u b lic policy. N atio n al Cancer In stitu te recom m ended intervention m ethods for d ental practice are brief, sim p le, a n d effective. S uch preventive a n d cessation services im prove the q u ality of d ental practice as w ell as p atien ts’ lives. R O B ER T M ECKLENBURG, DDM, MPH N A TIO N A L CANCER IN ST IT U T E C O N SU L T A N T
T M J arth ro sco p y □ H elp in g patients avoid o r discontinue use of tobacco produces im m ediate an d long-term benefits to everyone, in clu d in g dentists. A lth o u g h m ost dentists recognize the im portance of tobacco use as it relates to health an d p u b lic policy, m any do n o t recognize its relatio n to dental practice. T h is is disturbing, because approxim ately one-fourth of dental patien ts use tobacco. D entists are obliged to help p atients avoid an d disco n tin u e activities th a t can dam age oral health. It is scientifically incontrovertible th a t b o th sm oking an d sm okeless tobacco are associated w ith leukoplakia, o ral cancer, precancerous lesions, certain p erio d o n tal conditions, oral tissue changes, an d esthetic co n d i tions. In addition, tobacco use is associated w ith poorer prognoses a n d longer recovery tim es after certain d ental therapies, such as periodontal treatm ent services. As h ealth professionals, dentists are obliged to help people avoid an d reduce their risk of developing general medical conditions. T im ely assistance can u lti m ately result in fewer requests for services to tre a t red u ced re sp ira to ry capacity, cardiovascular disease, reduced resp o n siveness to m edication, addictive behav iors, an d the possibility of developing acute m edical crises. As good citizens, dentists are obliged to w arn people ab o u t activities th a t could le ad to d isa ste r. T o k n o w th e risk s involved, yet rem ain silent w hen treating these patients falls sh o rt of basic standards of responsibility to the public. S om e d e n tists r o u tin e ly h e lp th e ir
□ I was displeased to see the m in im al rep o rtin g o n te m p o ro m an d ib u lar jo in t (TM J) arthroscopy in your them e issue (March). In regard to diagnosis an d treatm ent of T M disorders, arthroscopic surgery has m ade h u g e strides in the past 5 to 10 years. It is the o nly m odality th at enables us to remove all speculation concerning jo in t p a th o lo g y . A rth ro sc o p y p ro v id es th e ability to directly look at the T M J an d define its p ath o lo g ical condition. . . . I co n sid er th is te c h n iq u e th e m ost im p o rta n t one to com e alo n g to treat T M J problem s. JOSEPH P. McCAIN, DMD MIAMI
□ E ditor’s note: We m ust reiterate that w hen we offer a com prehensive look at a p articu la r topic of dentistry, n o t all aspects are addressed to the total satisfac tio n of all readers. O n th e lig h te r sid e □ Y our M arch issue was long due an d for m ost p a rt excellent. In spite of the trem endous strides the ADA has m ade in try in g to separate the discom forts of T M D (the disorder) from the m ere biological entity of T M J (the jo in t) , th e f o llo w in g d itty is w o rth rep ublishing: W hat D o Y o u Say A b o u t T M J Show m e a d en tist w ith n o th in g to say A nd I ’ll show you a m an w ho talks T M J.