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Delegating Duties
and McDonald’s in popular culture? After all, America does have the most sophisticated advertising and marketing in the world. We can sell Coke to Mongolian yogurt eaters, so why not health to fast food junkies? What would it mean to the world, given that what America does first, the rest of the world inevitably picks up later? One example of what I have in mind is the vastly improved dental caries incidence in the western world that is the result of cooperation among profes sionals (dentists and scientists), governments (water fluorida tion), industry (toothpaste, toothbrush and mouthwash makers) and our popular culture’s standards of dental beauty and fresh breath (the way to be, which is healthy). Leena Sederlof, D.D.S., M.S. W ashington, D.C.
dentistry, on compliance with the bloodborne pathogens standard. In this video, the application of rubber dam was shown three times in the dental setting. Dental dam is also specifically stated in the OSHA regulations as an optional device, combined with the use of high-volume evacuation, to minimize circulation of bloodborne pathogens. The procedure of the appli cation of dental dam is taught at every dental university in the United States. It is simple for the dentist to use and offers many benefits to their practice. Why doesn’t the ADA support dental dam as a vital part of infection control procedures as it does gloves, masks, gowns, handpiece sterilization, etc.? Thomas E. Chapman President and Chief E xecutive Officer The H ygenic Corp. Akron, Ohio
WHY NO DENTAL. DAM?
I just finished reading the “OSHA Compliance Check List” for the dental office prepared by the ADA and distributed to its members [through the Jan. 18 ADA News], The subject of the OSHA Check List was compliance with the OSHA bloodborne pathogens standard. In general, [the Check List] is informative and useful to the dentist. We wonder why dental dam was not recommended in this publication to reduce the circulation of bloodborne pathogens, as studies prove a 98 percent reduction when used. Coincidentally, this very same week, I had an oppor tunity to review the video produced by OSHA and intended to assist professionals in various fields, including 16
JADA, Vol. 124, April 1993
E d ito r’s note: Mr. Chap- » man, the ADA does support the use of dental dam. ADA informational materials on infection control contain frequent references to the use and advantages of dental dam as a barrier to the spread of microorganisms. The lack of inclusion of dental dam in the ADA/OSHA Compliance Check List was neither an oversight nor a slight to dental dam’s effective ness. The OSHA Check List was designed specifically to address only the federal agency’s requirements. Dental dam is not among those requirements. The effectiveness of dental dam in reducing the spread of bloodborne pathogens has been well documented in this Journal. A product that can
provide a barrier that is 98 percent effective should find greater use by the dental practitioner. By including dental dam in its infection control publications, the ADA has demonstrated its support for this product. DELEGATING DUTIES
Dr. Gordon Christensen’s article, “The Cracked Tooth Syndrome” (February), gives me cause to feel uneasy. As a practicing dentist, I have been confronted with the seemingly impossible task of diagnosing the true cause of periodic and intermittent tooth pain. I have been confronted with the problem for over 30 years, and continue to expect similar diagnostic confronta tions on a daily basis for as long as I continue to practice. I couldn’t agree more with Dr. Christensen’s observation that diagnosing the severity of a cracked tooth is nearly impossible. Likewise, I couldn’t disagree more with his direction that “it is advisable to instruct assistants and dental hygienists in the use of diagnostic tools for the purpose of identifying a tooth with a cracked cusp.” It is purely the dentist’s professional responsibility to perform the full gamut of appropriate diagnostic tests to determine the cause of a perceived problem, and there after to make the logical treatment recommendations for its resolution. Delegating to an auxiliary the performance of a task that plays a role in making a differential diagnosis is an abrogation of the doctor’s professional responsibility. Certain state dental practice acts prohibit the making of a diagnosis by an auxiliary, as
well as the planning of treatment for the correction of a problem that has just been diagnosed. It is true that many cracks that are seen in teeth are superficial. It is also a fact that many of these teeth with super ficial cracks are asymptomatic. Clinical experience and observation have proven to me that a tooth with a visible crack, whether it be in the coronal portion or in the root, will exhibit sensitivity as reported by the patient, and the diagnosis is fairly simple. It is the appropriate corrective treatment recommendation that is most vexing. With all due respect to the manufacturers of enamel, dentin and amalgam bonding materials—and I use or have used all the ones mentioned in the article—a visible crack signals to me that I had better not trust the fate of a critical abutment tooth or any tooth to the presumption that “what I can see is all there is.” There is nothing profession ally inappropriate in saying to your patient, “I can’t tell you exactly what is causing your discomfort at this time. Let’s watch and observe the progress.” Or would you rather say, “Let’s ask the dental assistant.” Lawrence J. Singer, D.D.S. Wallingford, Conn. E d ito r’s note: The views expressed in Dr. Christensen’s column are his own and do not necessarily reflect ADA policy or opinion. ADA policy identifies a range of functions or procedures that dentists must not delegate to dental auxiliaries. Delegating these activities is barred, the 18
JADA, Vol. 124, April 1993
ADA says, because “effective and safe performance of them depends on making judgments that require the synthesis and application of knowledge acquired in professional dental education.” Among those functions the ADA says should not be delegated are “complete or limited examination, diagnosis and treatment planning.” LOOKING FORWARD TO RETIREMENT
I greatly enjoyed your February 1993 editorial, “Life after dentistry.” Perhaps a future article may be devoted to the challenges and opportunities facing dentists who are in good mental and physical health and will shortly retire or have recently done so. I, for one, look forward to retiring in the next 12 months and would certainly enjoy reading about this timely topic. Also, I am impressed with the quality of JADA and congratulate you and your staff on a very fine journal. Thor Bakland, D.D.S. Loma Linda, C alif PLANNING AND DISCIPLINE
Yes, there is life after dentistry. Complete, fulfilling, exciting. But, it takes planning and discipline before the event. Perhaps I can help your colleague wrestle his retirement problem to the mat. At least, here’s some food for thought during his dental-dinner pie-ala-modes: ™ Start a retirement program the first day of practice. If you’re past the first day, use a CPA to work out a plan. It works no matter when the retirement date.
™ Pay off your debts and increase retirement payments as soon as possible. ■■ Build a loving relationship with spouse and kids. It’s a real dividend in retirement. ™ Dentists serve people. Re tired dentists can do the same. Here’s how to enjoy retirement: ™ Do some building, painting (art and siding), woodworking. A dentist’s hands are trained for detail. ■" Join Kiwanis, Lions, Rotary. A dentist’s mind is set on service to kids, youth, teens and up. ™ Serve on hospital boards, church boards, city councils. A dentist develops people, organizational and health care skills. Swim, climb, golf, travel. Don’t quit what you’ve started. I spent 38 years creating smiles in a dental office. Now I create smiles on fifth graders with “Brought Up Grades” awards, on a crippled colleague during a lunch together, on family during special day celebrations and on myself when bow hunting. Please tell your colleague, “Plan for it. You’ll enjoy it.” Richard H. Hagerman D.D.S. Wendell, Idaho A TIMELY REPORT
The article, “Restoring Sensation After Trigeminal Nerve Injury: A Review of Current Management” (December 1992), by Drs. Colin and Donoff is important and timely. I have performed more than 300 microsurgical operations to repair peripheral branches of the trigeminal never injured during dental or surgical procedures such as removal of impacted teeth, osteotomies,
dentistry, on compliance with the bloodborne pathogens standard. In this video, the application of rubber dam was shown three times in the dental setting. Dental dam is also specifically stated in the OSHA regulations as an optional device, combined with the use of high-volume evacuation, to minimize circulation of bloodborne pathogens. The procedure of the appli cation of dental dam is taught at every dental university in the United States. It is simple for the dentist to use and offers many benefits to their practice. Why doesn’t the ADA support dental dam as a vital part of infection control procedures as it does gloves, masks, gowns, handpiece sterilization, etc.? Thomas E. Chapman President and Chief E xecutive Officer The H ygenic Corp. Akron, Ohio
WHY NO DENTAL. DAM?
I just finished reading the “OSHA Compliance Check List” for the dental office prepared by the ADA and distributed to its members [through the Jan. 18 ADA News], The subject of the OSHA Check List was compliance with the OSHA bloodborne pathogens standard. In general, [the Check List] is informative and useful to the dentist. We wonder why dental dam was not recommended in this publication to reduce the circulation of bloodborne pathogens, as studies prove a 98 percent reduction when used. Coincidentally, this very same week, I had an oppor tunity to review the video produced by OSHA and intended to assist professionals in various fields, including 16
JADA, Vol. 124, April 1993
E d ito r’s note: Mr. Chap- » man, the ADA does support the use of dental dam. ADA informational materials on infection control contain frequent references to the use and advantages of dental dam as a barrier to the spread of microorganisms. The lack of inclusion of dental dam in the ADA/OSHA Compliance Check List was neither an oversight nor a slight to dental dam’s effective ness. The OSHA Check List was designed specifically to address only the federal agency’s requirements. Dental dam is not among those requirements. The effectiveness of dental dam in reducing the spread of bloodborne pathogens has been well documented in this Journal. A product that can
provide a barrier that is 98 percent effective should find greater use by the dental practitioner. By including dental dam in its infection control publications, the ADA has demonstrated its support for this product. DELEGATING DUTIES
Dr. Gordon Christensen’s article, “The Cracked Tooth Syndrome” (February), gives me cause to feel uneasy. As a practicing dentist, I have been confronted with the seemingly impossible task of diagnosing the true cause of periodic and intermittent tooth pain. I have been confronted with the problem for over 30 years, and continue to expect similar diagnostic confronta tions on a daily basis for as long as I continue to practice. I couldn’t agree more with Dr. Christensen’s observation that diagnosing the severity of a cracked tooth is nearly impossible. Likewise, I couldn’t disagree more with his direction that “it is advisable to instruct assistants and dental hygienists in the use of diagnostic tools for the purpose of identifying a tooth with a cracked cusp.” It is purely the dentist’s professional responsibility to perform the full gamut of appropriate diagnostic tests to determine the cause of a perceived problem, and there after to make the logical treatment recommendations for its resolution. Delegating to an auxiliary the performance of a task that plays a role in making a differential diagnosis is an abrogation of the doctor’s professional responsibility. Certain state dental practice acts prohibit the making of a diagnosis by an auxiliary, as
well as the planning of treatment for the correction of a problem that has just been diagnosed. It is true that many cracks that are seen in teeth are superficial. It is also a fact that many of these teeth with super ficial cracks are asymptomatic. Clinical experience and observation have proven to me that a tooth with a visible crack, whether it be in the coronal portion or in the root, will exhibit sensitivity as reported by the patient, and the diagnosis is fairly simple. It is the appropriate corrective treatment recommendation that is most vexing. With all due respect to the manufacturers of enamel, dentin and amalgam bonding materials—and I use or have used all the ones mentioned in the article—a visible crack signals to me that I had better not trust the fate of a critical abutment tooth or any tooth to the presumption that “what I can see is all there is.” There is nothing profession ally inappropriate in saying to your patient, “I can’t tell you exactly what is causing your discomfort at this time. Let’s watch and observe the progress.” Or would you rather say, “Let’s ask the dental assistant.” Lawrence J. Singer, D.D.S. Wallingford, Conn. E d ito r’s note: The views expressed in Dr. Christensen’s column are his own and do not necessarily reflect ADA policy or opinion. ADA policy identifies a range of functions or procedures that dentists must not delegate to dental auxiliaries. Delegating these activities is barred, the 18
JADA, Vol. 124, April 1993
ADA says, because “effective and safe performance of them depends on making judgments that require the synthesis and application of knowledge acquired in professional dental education.” Among those functions the ADA says should not be delegated are “complete or limited examination, diagnosis and treatment planning.” LOOKING FORWARD TO RETIREMENT
I greatly enjoyed your February 1993 editorial, “Life after dentistry.” Perhaps a future article may be devoted to the challenges and opportunities facing dentists who are in good mental and physical health and will shortly retire or have recently done so. I, for one, look forward to retiring in the next 12 months and would certainly enjoy reading about this timely topic. Also, I am impressed with the quality of JADA and congratulate you and your staff on a very fine journal. Thor Bakland, D.D.S. Loma Linda, C alif PLANNING AND DISCIPLINE
Yes, there is life after dentistry. Complete, fulfilling, exciting. But, it takes planning and discipline before the event. Perhaps I can help your colleague wrestle his retirement problem to the mat. At least, here’s some food for thought during his dental-dinner pie-ala-modes: ™ Start a retirement program the first day of practice. If you’re past the first day, use a CPA to work out a plan. It works no matter when the retirement date.
™ Pay off your debts and increase retirement payments as soon as possible. ■■ Build a loving relationship with spouse and kids. It’s a real dividend in retirement. ™ Dentists serve people. Re tired dentists can do the same. Here’s how to enjoy retirement: ™ Do some building, painting (art and siding), woodworking. A dentist’s hands are trained for detail. ■" Join Kiwanis, Lions, Rotary. A dentist’s mind is set on service to kids, youth, teens and up. ™ Serve on hospital boards, church boards, city councils. A dentist develops people, organizational and health care skills. Swim, climb, golf, travel. Don’t quit what you’ve started. I spent 38 years creating smiles in a dental office. Now I create smiles on fifth graders with “Brought Up Grades” awards, on a crippled colleague during a lunch together, on family during special day celebrations and on myself when bow hunting. Please tell your colleague, “Plan for it. You’ll enjoy it.” Richard H. Hagerman D.D.S. Wendell, Idaho A TIMELY REPORT
The article, “Restoring Sensation After Trigeminal Nerve Injury: A Review of Current Management” (December 1992), by Drs. Colin and Donoff is important and timely. I have performed more than 300 microsurgical operations to repair peripheral branches of the trigeminal never injured during dental or surgical procedures such as removal of impacted teeth, osteotomies,