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All in the family
LETTERS TO THE EDITOR
The JOURNAL devotes th is section to com m ent by readers on to p ics of cu rre n t in te re st to d e n tistry. The e d ito r reserves the rig h t to e d it a ll com m unications to f i t available space and requires th a t all letters be signed. Printed com m unications do not necessarily re fle c t th e opinion or o ffic ia l policy of the Association. Your p a rticip a tio n in th is section is invited.
On closed panels
The editorial in the October JADA, “ Let the closed panel compete,” should be thoughtfully considered for what it was—a proposal to ex plore the effectiveness of the closed panel approach in providing dental health care for certain segments of the American population. I must refute the totally unquali fied statement of Ira Rothfield (Dec JADA, page 1187) who wrote that “ there are too many inherent evils in closed panels to give them the seal of respectability.” In doing so, I speak for 31 dentists and 100 aux iliaries employed in a closed panel clinic, who are making a dedicated effort to provide complete dental care—of a high order of quality— for all eligible recipients. It is true that some prepaid plans have built-in inequities which make it easy for either the provid er or the underwriter to take unfair advantage. If that is the case, and evil practices emerge, they are the result of evil intentions of people. Closed panels are not evil, but evil people may be involved, just as they are involved in every profession, vocation, or trade. The status of any private office, clinic, or association, as determined
by its peers, depends on the profes sional integrity of its principals, its philosophy, and the qualifications of its staff. The closed panel has every right to be judged by the same stan dards. In defending the closed panel, I do so as the result of my five years as a staff vy member and more than three years as director. During that time, I have developed a great ap preciation for certain significant advantages: —the free and easy privilege of consulting with the staff, nine of whom are trained specialists, and —the fact that, in our clinic, in ternal peer review is automatically the order of the day. I know of no greater stimulus to individual excellence than to have one’s patients seen by his colleagues during and after treatment. These are the same advantages which ac crue to a full-time hospital staff physician. I do not suggest that the closed panel is always the best method of delivering comprehensive dental care. In many situations, an option al indemnity plan may better serve the needs of some consumers. I do firmly believe that a properly planned closed panel has a limitless potential for meeting the increasing demands from government, labor,
and the individual for good oral health. It is noteworthy that the Southern California Dental Association has been evaluating both existing and proposed prepaid dental plans in this area for some time, and has published periodic statements re garding their acceptability to the membership. This is as it should be. CHARLES S. JONES, DDS DIRECTOR RETAIL CLERKS UNION LOCAL 770 AND FOOD EMPLOYERS BENEFIT FUND DENTAL CLINIC
All in the family
I read with interest your article re garding the father-son team in Mas sachusetts and Wisconsin. In answer to your question about similar circumstances in other states, I offer the following infor mation. Fred E. Maxfield of Bangor was president of the Maine Dental Asso ciation in 1903; his son, Carl W. Maxfield, was president in 1932. Giles C. Grant of Portland was president in 1937; his son, Henry H. Grant of Portland, was president in 1958. Philip F. M. Gilley, Sr., of JADA, Vol. 84, March 1972 ■ 471
Southwest H arbor was president in 1938, and his son, Frank P. Gilley of Bangor served in that post in 1959. It is interesting to note that Dr. Gilley, Sr., succeeded Giles Grant, and the same was true of Henry G rant and Frank Gilley. Of additional interest is the fact that William Kierstead of Waterville was president in 1956, and his brother, Edward, also of Waterville, was president in 1964. Philip Gilley, Sr., and Frank Gil ley also served as members on the State Board of Dental Examiners, as did the Maxfields. William Kier stead is a former member of the state board, while his brother, Ed ward, is a current member. FR A N K P. G IL L E Y , DDS BA N G O R, ME
Unfair moratorium While I do not ordinarily subscribe to the conspiratorial view of human behavior, I must confess that I do find it somewhat sinister that E. A. Lusterman’s tendentious article on state boards (Jan JA D A ) should ap pear in the JA D A on the eve of the nationwide survey on licensing pro cedures. It is too late, of course, to submit a rejoinder before the survey is taken and so repair some of the damage done by this article, but surely a brief of equal length should be solicited from the National Coun cil for the Improvement of Dental Licensure. What an egregious example of unfairness to declare a moratorium on the subject of licensing in “ Let ters to the Editor,” but arrogantly publish the arguments “ in extenso” of a member of the New York State Board of Dentistry. D O N A L D N. SH A PIR O , DDS H U N T IN G T O N W OODS, M ICH A fanfared moratorium on “ Letters to the Editor” in regard to dental licensure is imposed on the grass roots members so that an objective survey of membership opinion can
be taken. Implicitly, let the mem bers make up their own minds with out being further propagandized (one way or the other). One, two, three—turnabout, and presto—the propaganda. A strongly pro-licensure article by Dr. Lusterman in the same JA D A issue as the moratorium. We now have a very controversial subject being reduced to a mono logue. The membership-at-large has been editorially deprived by the moratorium of agreeing or dis agreeing. Oh, come now. You really can’t have your cake and eat it. STA N LEY L. KOLKER, DDS R A N TO U L, ILL Your “ Editor’s N ote” in the Janu ary JA D A states that no debate on licensure would be covered because of the upcoming survey. I would submit that the article, “ A critical réévaluation of state boards for den tistry” (Jan JA D A ), is the longest “ letter to the editor” I have ever read. I question your sense of fair play in printing an article which was more opinion and ideas than factual and one very defensive of the pres ent system. If T H E JO U R N A L mir rors the supposed neutrality of the A D A on this issue, I feel this article also could have been published after the survey. K EN T A. HO V E, DDS, MSD M IN N EA PO LIS
Comments on ‘Guidelines’ A few comments on the “ Guidelines for Dentistry’s Position in a Nation al Health Program,” which appeared in the Dec JA D A (page 1225). Priorities: Dental services on chil dren are a worthless exercise in fu tility unless parents are included in a full preventive program. I am not limiting myself to flossing and brushing. Plaque control is one thing and prevention is many things. Preventive procedures: Let us stop confusing the word “ prevention’’ with our obsession for better oral
hygiene. L et’s call a spade a spade; how to clean your mouth better is an important factor in prevention of oral disease, but it’s only one factor. In six points you mention preven tion many times, yet you list only good oral hygiene and fluoridation as the measures required. And what do you do with an edentulous indi vidual who cannot tolerate his den tures? End result of “ prevention.” Let us grow up and look at the patient and not at the disease. Why is he or she disease prone? Not that I have the statistics at hand, but more people with diabetes or with cardiovascular incidents are eden tulous than healthy people. Is floss going to prevent diabetes, too? A N A TO L T. C H A R I, DDS NEW PO RT BEACH, C A LIF
N ew mode o f therapy The use of corticosteroids as a sys temic therapeutic aid in dentistry is rare. However, the dentist frequent ly will treat patients who are receiv ing cortisone medically, and this presents problems over a long peri od due to the abolition of the classi cal early signs and symptoms of in flammation. The administration of corticoster oids depresses the patient’s own adrenal gland and causes atrophy of same. Thus, if the patient’s corti costeroid is stopped, he or she could go into shock following general anes thesia or oral surgery. This would be due to a “ therapeutic Addison’s disease.” Strangely enough, slight trauma causes more difficulty than major surgery because of the small re sponse evoked from the adrenal gland; in other words, it is more dangerous. This has been true to date, but modern science is so pro gressive that this is no longer true. What I am about to say will not be found in any textbook. All of us have a diurnal cycle of body functions. Among these is a cycle of cortisone formation. The highest production occurs when we
LETTERS TO THE EDITOR I JADA, Vol. 84, March 1972 ■ 473
The JOURNAL devotes th is section to com m ent by readers on to p ics of cu rre n t in te re st to d e n tistry. The e d ito r reserves the rig h t to e d it a ll com m unications to f i t available space and requires th a t all letters be signed. Printed com m unications do not necessarily re fle c t th e opinion or o ffic ia l policy of the Association. Your p a rticip a tio n in th is section is invited.
On closed panels
The editorial in the October JADA, “ Let the closed panel compete,” should be thoughtfully considered for what it was—a proposal to ex plore the effectiveness of the closed panel approach in providing dental health care for certain segments of the American population. I must refute the totally unquali fied statement of Ira Rothfield (Dec JADA, page 1187) who wrote that “ there are too many inherent evils in closed panels to give them the seal of respectability.” In doing so, I speak for 31 dentists and 100 aux iliaries employed in a closed panel clinic, who are making a dedicated effort to provide complete dental care—of a high order of quality— for all eligible recipients. It is true that some prepaid plans have built-in inequities which make it easy for either the provid er or the underwriter to take unfair advantage. If that is the case, and evil practices emerge, they are the result of evil intentions of people. Closed panels are not evil, but evil people may be involved, just as they are involved in every profession, vocation, or trade. The status of any private office, clinic, or association, as determined
by its peers, depends on the profes sional integrity of its principals, its philosophy, and the qualifications of its staff. The closed panel has every right to be judged by the same stan dards. In defending the closed panel, I do so as the result of my five years as a staff vy member and more than three years as director. During that time, I have developed a great ap preciation for certain significant advantages: —the free and easy privilege of consulting with the staff, nine of whom are trained specialists, and —the fact that, in our clinic, in ternal peer review is automatically the order of the day. I know of no greater stimulus to individual excellence than to have one’s patients seen by his colleagues during and after treatment. These are the same advantages which ac crue to a full-time hospital staff physician. I do not suggest that the closed panel is always the best method of delivering comprehensive dental care. In many situations, an option al indemnity plan may better serve the needs of some consumers. I do firmly believe that a properly planned closed panel has a limitless potential for meeting the increasing demands from government, labor,
and the individual for good oral health. It is noteworthy that the Southern California Dental Association has been evaluating both existing and proposed prepaid dental plans in this area for some time, and has published periodic statements re garding their acceptability to the membership. This is as it should be. CHARLES S. JONES, DDS DIRECTOR RETAIL CLERKS UNION LOCAL 770 AND FOOD EMPLOYERS BENEFIT FUND DENTAL CLINIC
All in the family
I read with interest your article re garding the father-son team in Mas sachusetts and Wisconsin. In answer to your question about similar circumstances in other states, I offer the following infor mation. Fred E. Maxfield of Bangor was president of the Maine Dental Asso ciation in 1903; his son, Carl W. Maxfield, was president in 1932. Giles C. Grant of Portland was president in 1937; his son, Henry H. Grant of Portland, was president in 1958. Philip F. M. Gilley, Sr., of JADA, Vol. 84, March 1972 ■ 471
Southwest H arbor was president in 1938, and his son, Frank P. Gilley of Bangor served in that post in 1959. It is interesting to note that Dr. Gilley, Sr., succeeded Giles Grant, and the same was true of Henry G rant and Frank Gilley. Of additional interest is the fact that William Kierstead of Waterville was president in 1956, and his brother, Edward, also of Waterville, was president in 1964. Philip Gilley, Sr., and Frank Gil ley also served as members on the State Board of Dental Examiners, as did the Maxfields. William Kier stead is a former member of the state board, while his brother, Ed ward, is a current member. FR A N K P. G IL L E Y , DDS BA N G O R, ME
Unfair moratorium While I do not ordinarily subscribe to the conspiratorial view of human behavior, I must confess that I do find it somewhat sinister that E. A. Lusterman’s tendentious article on state boards (Jan JA D A ) should ap pear in the JA D A on the eve of the nationwide survey on licensing pro cedures. It is too late, of course, to submit a rejoinder before the survey is taken and so repair some of the damage done by this article, but surely a brief of equal length should be solicited from the National Coun cil for the Improvement of Dental Licensure. What an egregious example of unfairness to declare a moratorium on the subject of licensing in “ Let ters to the Editor,” but arrogantly publish the arguments “ in extenso” of a member of the New York State Board of Dentistry. D O N A L D N. SH A PIR O , DDS H U N T IN G T O N W OODS, M ICH A fanfared moratorium on “ Letters to the Editor” in regard to dental licensure is imposed on the grass roots members so that an objective survey of membership opinion can
be taken. Implicitly, let the mem bers make up their own minds with out being further propagandized (one way or the other). One, two, three—turnabout, and presto—the propaganda. A strongly pro-licensure article by Dr. Lusterman in the same JA D A issue as the moratorium. We now have a very controversial subject being reduced to a mono logue. The membership-at-large has been editorially deprived by the moratorium of agreeing or dis agreeing. Oh, come now. You really can’t have your cake and eat it. STA N LEY L. KOLKER, DDS R A N TO U L, ILL Your “ Editor’s N ote” in the Janu ary JA D A states that no debate on licensure would be covered because of the upcoming survey. I would submit that the article, “ A critical réévaluation of state boards for den tistry” (Jan JA D A ), is the longest “ letter to the editor” I have ever read. I question your sense of fair play in printing an article which was more opinion and ideas than factual and one very defensive of the pres ent system. If T H E JO U R N A L mir rors the supposed neutrality of the A D A on this issue, I feel this article also could have been published after the survey. K EN T A. HO V E, DDS, MSD M IN N EA PO LIS
Comments on ‘Guidelines’ A few comments on the “ Guidelines for Dentistry’s Position in a Nation al Health Program,” which appeared in the Dec JA D A (page 1225). Priorities: Dental services on chil dren are a worthless exercise in fu tility unless parents are included in a full preventive program. I am not limiting myself to flossing and brushing. Plaque control is one thing and prevention is many things. Preventive procedures: Let us stop confusing the word “ prevention’’ with our obsession for better oral
hygiene. L et’s call a spade a spade; how to clean your mouth better is an important factor in prevention of oral disease, but it’s only one factor. In six points you mention preven tion many times, yet you list only good oral hygiene and fluoridation as the measures required. And what do you do with an edentulous indi vidual who cannot tolerate his den tures? End result of “ prevention.” Let us grow up and look at the patient and not at the disease. Why is he or she disease prone? Not that I have the statistics at hand, but more people with diabetes or with cardiovascular incidents are eden tulous than healthy people. Is floss going to prevent diabetes, too? A N A TO L T. C H A R I, DDS NEW PO RT BEACH, C A LIF
N ew mode o f therapy The use of corticosteroids as a sys temic therapeutic aid in dentistry is rare. However, the dentist frequent ly will treat patients who are receiv ing cortisone medically, and this presents problems over a long peri od due to the abolition of the classi cal early signs and symptoms of in flammation. The administration of corticoster oids depresses the patient’s own adrenal gland and causes atrophy of same. Thus, if the patient’s corti costeroid is stopped, he or she could go into shock following general anes thesia or oral surgery. This would be due to a “ therapeutic Addison’s disease.” Strangely enough, slight trauma causes more difficulty than major surgery because of the small re sponse evoked from the adrenal gland; in other words, it is more dangerous. This has been true to date, but modern science is so pro gressive that this is no longer true. What I am about to say will not be found in any textbook. All of us have a diurnal cycle of body functions. Among these is a cycle of cortisone formation. The highest production occurs when we
LETTERS TO THE EDITOR I JADA, Vol. 84, March 1972 ■ 473