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Antiplaque agents
L E T T E R S
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T H E
E D IT O R
T H E JO U R N A L d e v o te s th i s s e c tio n to c o m m e n t b y re a d e r s o n to p ic s o f c u r r e n t in t e r e s t to d e n tis tr y . T h e e d i to r re s e r v e s th e r i g h t to e d it a ll c o m m u n ic a tio n s to f it a v a ila b le s p a c e a n d r e q u ir e s th a t a ll le tte r s b e s ig n e d . P r in te d c o m m u n ic a tio n s d o n o t n e c e s s a r ily r e f le c t t h e o p in i o n o r o ffic ia l p o li c y o f th e A s s o c ia tio n . Y o u r p a r t ic i p a tio n in th i s s e c t io n is in v ite d .
A ntiplaque agents □ I w o u ld like to v oice a co m p lain t ab o u t th e rep o rtin g in v arious d ental jo u rn a ls of th e e ffe c ts o f m o u th w a s h e s lik e c h l o r h e x i d i n e a n d alex id in e. I have read ab o u t th e th e r ap e u tic effects of th e se a g e n ts for ap p ro x im ately eight years b u t have b een u n ab le to p u rc h a se or p rescribe th em for m y patien ts. W hy are th ese n o t available to th e p rac titio n e r for p ro fessio n al use? If it is because th e re are side effects th a t co u ld p re v e n t th e ir rec eiv in g Food an d D rug A d m in istra tio n ap p ro v a l, th e n th e a m o u n t o f tim e being sp e n t by differen t researchers is w asted a n d th e sp ace d ev o ted to a rticle s ab o u t th em s h o u ld be d e voted to som eth in g th a t w e can use, n o t so m eth in g w e m ay n ev er be able to use. S A M U E L A . L E IS H E A R , D M D P O C O M O K E C IT Y , M D
C o m m en t: In fo rm a tio n c o n c e rn in g c h lo rh e x id in e an d a lex id in e has ap p eared in foreign jo u rn als an d in US d en tal research an d abstracts jo u r nals. T he rin sin g ag en ts ap p e ar to h av e a p o te n tia l p rac tica l b enefit in th e p ractice of d e n tistry an d th e re fore are of in te re st to th e profession. It is o u r u n d e rsta n d in g th a t p ro d u cts
co n tain in g eith er or b o th of th ese in g redients have b een su b m itte d to th e FDA. O ne o f th e m a jo r p ro b le m s th u s far is th a t c h lo rh e x id in e a n d a lex id in e can cau se stain in g , som e tim es severe, of te e th an d oral soft tissue.
Fluoridation and bacterial endocarditis □ T he q u estio n raise d by Drs. Ber m an a n d Jaffin (The Journal, M arch), a b o u t w h e th e r f lu o r id a tio n i n d i re c tly p re v e n ts b a c te ria l e n d o c a r ditis, is of fu n d am e n tal im p o rtan ce because of its co n n e ctio n w ith th e q u estio n of “ focal d ise ase ,” form erly k now n as foacl in fection. Tw o p ap ers w ere p u b lish e d at th e end of th e “ in tro d u c to ry ” p h ase of w ater flu o rid atio n . In “W ater-borne flu o rid es a n d m o rta lity ,” 1 H agan a n d others co m p ared m o rta lity rates of 16 U S c i tie s w h e r e f lu o r i d e le v e ls w ere elevated, w ith m o rtality rates in 16 com parab le cities w h ere th e fluoride levels w ere low . T otal m o r tality a n d death s from card iac d is e a se , c a r c in o m a , in tr a c r a n ia l le sions, n e p h ritis, an d cirrh o sis of th e liver in th e tw o co m m u n ities d id not sh o w s ta tis tic a lly s ig n ific a n t d if ferences. In “M edical asp ects of ex
cessiv e flu o rid e in a w ate r su p p ly ,” 2 L eone a n d others re p o rte d a sig n ifi ca n tly h ig h e r in c id e n c e of c a rd io v a sc u la r d ise a se in a lo w -flu o rid e c o m m u n ity th a n in one w ith h ig h flu o rid e levels. B ecause of th e scale o f th e stu d ies, th e fin d in g s w ere of no p rac tica l value. A t ab o u t th e sam e tim e, a stu d y of tw o p o p u la tio n s in H u n g ary w as re p o rte d by B arth a.3 In th e co m m u n ity w ith h ig h flu o rid e le v els, th e ex p ec te d low p rev alen ce of caries w as d e m o n s tr a te d in s c h o o lc h i ld r e n ag ed 6 to 14 years. In a d u lt w o m en w h o h a d liv ed all th e ir liv es in th e to w n , caries p rev a len c e w as c o n s id erab ly low er th a n in a co m p arab le g ro u p in th e flu o rid e-d efic ien t tow n. T he m o rtality rates in th e se co m m u n itie s w ere e x a m in e d w ith re s p e c t to c a rd io v a sc u la r a n d re n a l diseases. T h ese d iseases w ere c h o s e n as p o s s ib le c o n s e q u e n c e s of “ fo cal in f e c tio n ” th a t m ig h t h av e b een d u e to d en tal d isease. In a d d i tio n , fo r th e sa k e of c o m p a ris o n , m o r ta lity r a te s fo r tu b e r c u lo s is , a c u te in fe c tio u s d ise a s e s , a n d all o th e r cau ses w ere ex am in ed . . . . A s ta tis tic a lly s ig n ific a n t d iffe re n c e w a s d e m o n s tr a te d in d e a th ra te s from card io v asc u la r an d ren al d is eases, w ith th e h ig h e r in c id e n c e in th e flu o rid e-d eficien t tow n. J A D A , V o l. 9 9 , S e p te m b e r 1 9 7 9 ■ 4 3 3
T O
T H E
E D IT O R
T H E JO U R N A L d e v o te s th i s s e c tio n to c o m m e n t b y re a d e r s o n to p ic s o f c u r r e n t in t e r e s t to d e n tis tr y . T h e e d i to r re s e r v e s th e r i g h t to e d it a ll c o m m u n ic a tio n s to f it a v a ila b le s p a c e a n d r e q u ir e s th a t a ll le tte r s b e s ig n e d . P r in te d c o m m u n ic a tio n s d o n o t n e c e s s a r ily r e f le c t t h e o p in i o n o r o ffic ia l p o li c y o f th e A s s o c ia tio n . Y o u r p a r t ic i p a tio n in th i s s e c t io n is in v ite d .
A ntiplaque agents □ I w o u ld like to v oice a co m p lain t ab o u t th e rep o rtin g in v arious d ental jo u rn a ls of th e e ffe c ts o f m o u th w a s h e s lik e c h l o r h e x i d i n e a n d alex id in e. I have read ab o u t th e th e r ap e u tic effects of th e se a g e n ts for ap p ro x im ately eight years b u t have b een u n ab le to p u rc h a se or p rescribe th em for m y patien ts. W hy are th ese n o t available to th e p rac titio n e r for p ro fessio n al use? If it is because th e re are side effects th a t co u ld p re v e n t th e ir rec eiv in g Food an d D rug A d m in istra tio n ap p ro v a l, th e n th e a m o u n t o f tim e being sp e n t by differen t researchers is w asted a n d th e sp ace d ev o ted to a rticle s ab o u t th em s h o u ld be d e voted to som eth in g th a t w e can use, n o t so m eth in g w e m ay n ev er be able to use. S A M U E L A . L E IS H E A R , D M D P O C O M O K E C IT Y , M D
C o m m en t: In fo rm a tio n c o n c e rn in g c h lo rh e x id in e an d a lex id in e has ap p eared in foreign jo u rn als an d in US d en tal research an d abstracts jo u r nals. T he rin sin g ag en ts ap p e ar to h av e a p o te n tia l p rac tica l b enefit in th e p ractice of d e n tistry an d th e re fore are of in te re st to th e profession. It is o u r u n d e rsta n d in g th a t p ro d u cts
co n tain in g eith er or b o th of th ese in g redients have b een su b m itte d to th e FDA. O ne o f th e m a jo r p ro b le m s th u s far is th a t c h lo rh e x id in e a n d a lex id in e can cau se stain in g , som e tim es severe, of te e th an d oral soft tissue.
Fluoridation and bacterial endocarditis □ T he q u estio n raise d by Drs. Ber m an a n d Jaffin (The Journal, M arch), a b o u t w h e th e r f lu o r id a tio n i n d i re c tly p re v e n ts b a c te ria l e n d o c a r ditis, is of fu n d am e n tal im p o rtan ce because of its co n n e ctio n w ith th e q u estio n of “ focal d ise ase ,” form erly k now n as foacl in fection. Tw o p ap ers w ere p u b lish e d at th e end of th e “ in tro d u c to ry ” p h ase of w ater flu o rid atio n . In “W ater-borne flu o rid es a n d m o rta lity ,” 1 H agan a n d others co m p ared m o rta lity rates of 16 U S c i tie s w h e r e f lu o r i d e le v e ls w ere elevated, w ith m o rtality rates in 16 com parab le cities w h ere th e fluoride levels w ere low . T otal m o r tality a n d death s from card iac d is e a se , c a r c in o m a , in tr a c r a n ia l le sions, n e p h ritis, an d cirrh o sis of th e liver in th e tw o co m m u n ities d id not sh o w s ta tis tic a lly s ig n ific a n t d if ferences. In “M edical asp ects of ex
cessiv e flu o rid e in a w ate r su p p ly ,” 2 L eone a n d others re p o rte d a sig n ifi ca n tly h ig h e r in c id e n c e of c a rd io v a sc u la r d ise a se in a lo w -flu o rid e c o m m u n ity th a n in one w ith h ig h flu o rid e levels. B ecause of th e scale o f th e stu d ies, th e fin d in g s w ere of no p rac tica l value. A t ab o u t th e sam e tim e, a stu d y of tw o p o p u la tio n s in H u n g ary w as re p o rte d by B arth a.3 In th e co m m u n ity w ith h ig h flu o rid e le v els, th e ex p ec te d low p rev alen ce of caries w as d e m o n s tr a te d in s c h o o lc h i ld r e n ag ed 6 to 14 years. In a d u lt w o m en w h o h a d liv ed all th e ir liv es in th e to w n , caries p rev a len c e w as c o n s id erab ly low er th a n in a co m p arab le g ro u p in th e flu o rid e-d efic ien t tow n. T he m o rtality rates in th e se co m m u n itie s w ere e x a m in e d w ith re s p e c t to c a rd io v a sc u la r a n d re n a l diseases. T h ese d iseases w ere c h o s e n as p o s s ib le c o n s e q u e n c e s of “ fo cal in f e c tio n ” th a t m ig h t h av e b een d u e to d en tal d isease. In a d d i tio n , fo r th e sa k e of c o m p a ris o n , m o r ta lity r a te s fo r tu b e r c u lo s is , a c u te in fe c tio u s d ise a s e s , a n d all o th e r cau ses w ere ex am in ed . . . . A s ta tis tic a lly s ig n ific a n t d iffe re n c e w a s d e m o n s tr a te d in d e a th ra te s from card io v asc u la r an d ren al d is eases, w ith th e h ig h e r in c id e n c e in th e flu o rid e-d eficien t tow n. J A D A , V o l. 9 9 , S e p te m b e r 1 9 7 9 ■ 4 3 3