DENTAL DEGREES

L E T T E R S

How does one know that the clinical aberrations being called “fluorosis” by Dr. Eugenio Beltrán-Aguilar and colleagues in “Prevalence and Trends in Enamel Fluorosis in the United States from the 1930s to the 1980s” (February JADA) are being caused by exposure to fluoride? So many things could be doing it. And if it is exposure to fluoride, how do we know it isn’t the kind of fluoride being eaten and imbibed and assimilated—natural vs. sodium vs. the kind in municipal water supplies? How do we know it isn’t a combination of factors and fluoride is just one of the factors? Jan Wade Gilbert, D.M.D. Lawrence, N.Y.

In the 1986-1987 NIDCR survey, a group of trained examiners identified enamel fluorosis using, in addition to Dean’s criteria, the Russell’s criteria to differentiate fluorosis vs. nonfluorotic lesions. Therefore, in our analysis we relied on the diagnosis made by others, and although there is room for misclassification, we believe both studies used sound methodologies in their efforts to obtain unbiased data. We agree completely with Dr. Gilbert’s second comment. In fact, we discussed extensively that the fluorosis observed in 1986-1987 probably was produced by the combined exposure to fluoride from multiple sources, not just fluoride in the water. We are not saying that water fluoridation in the optimal range (0.7 to 1.2 parts per million fluoride ions) is the sole cause of the fluorosis prevalence and severity observed in 19861987. The wide availability of fluorides, especially in dietary supplements, processed foods and toothpaste, in addition to the fluoride levels in the water, puts children at a higher risk of enamel fluorosis. Eugenio D. BeltránAguilar, D.M.D. Atlanta

Author’s response: We compared published data collected during the 1930s by H. T. Dean1,2 and data from the 19861987 National Survey of School Children3,4 conducted by the National Institute of Dental Research, now the National Institute of Dental and Craniofacial Research, or NIDCR. Both of these data sets used the same diagnostic criteria to identify enamel fluorosis.

1. Dean HT. The investigation of physiological effects by the epidemiological method. In: Moulton FR, ed. Fluorine and dental health. Washington: American Association for the Advancement of Science; 1942:23-31. 2. Dean HT. Endemic fluorosis and its relation to dental caries. Public Health Rep 1938;53:1443-52. 3. U.S. Department of Health and Human Services. Oral health of United States children: The National Survey of Dental Caries in U.S. School Children: 1986-1987. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health; 1989. NIH publication 89-2247. 4. National Institute of Dental Research. Oral health of United States children: The National Survey of Oral Health in U.S. School Children: 1986-1987. Public use datafile docu-

LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, double-spaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.

J

FLUOROSIS

544

mentation and survey methodology, 1992. Bethesda, Md.: Epidemiology and Oral Disease Prevention Program of the National Institute of Dental Research.

DENTAL DEGREES

At the moment, we have two designations for degrees given to dentists: Doctor of Dental Surgery (D.D.S.) and Doctor of Dental Medicine (D.M.D.). Occasional editorials have been written about the advantages and disadvantages of one of the degrees over the other. I will not argue whether one is “better” than another, but will offer that in my own opinion it is a disservice to the profession and our patients to offer two degrees that are essentially identical. If there are really no differences, then one, not two degrees should be offered. To make things more complicated, our profession appears to be moving towards becoming “physicians” of the mouth. We are not just “tooth doctors” any more. Much has been written about the dental practitioner’s expertise in diagnosing and managing a range of diseases of the oral cavity and proximal structures. This is justifiably so. The plethora of descriptors utilized, however, makes one wonder if we are all on the same page. Designations of specialists, associations and journals have included the terms “dental,” “oral,” “orodental,” “orofacial,” “dentofacial,” “maxillofacial,” “oral and maxillofacial” and “craniofacial.” Even the designation “head and neck” has been considered. Is it any wonder some should be confused? While the following suggestion would not take care of all of the terminological morass, it would more accurately describe

JADA, Vol. 133, May 2002 Copyright ©2002 American Dental Association. All rights reserved.

L E T T E R S

the scope of our profession and move us from two degrees to one. As such, I would like to offer the term “Doctor of Stomatology” (S.D.) to be utilized in the coming years as our degree. The term “stomatology” is now being utilized in many circles and several dental school departments or divisions come under this heading. I believe they are on to something, that the term encompasses the whole of the mouth and does not limit itself to teeth. It would be of great merit to see the American Dental Association take the lead on this issue. I realize that the ADA has no governing authority over schools of dentistry to enact such a change. Any suggestions, however, if taken in the spirit of the common good, would likely be considered. S. Bryan Whitaker, D.D.S. Fayetteville, Ark. COMMUNICATION PROBLEMS

I read Dr. Jeffcoat’s February JADA editorial (“A Matter of Life and Death”) and was very moved. I share her concern and have felt that this subject needed attention. I first experienced the problem with communication with physicians years ago when my patients’ blood pressure medications began causing gingival hyperplasia. When I was able to get through to the physicians, several blew me off and did not seem to care. I suspected then that they did not understand much about the oral cavity. My most recent encounter with the lack of communication between the dental and medical professions occurred when a medical resident came to me to diagnose a tongue lesion in the

resident’s own mouth. When I told the resident that clinically it appeared to be hairy leukoplakia, the resident did not know anything about the significance of that diagnosis. I then was surprised to learn that a couple of my physician friends also were unfamiliar with that diagnosis. Dr. Jeffcoat’s article is timely and well written. Karen McCaffery, D.M.D. Birmingham, Ala. PROFESSIONALISM

It is difficult to disagree with Dr. Marjorie Jeffcoat’s February editorial, “A Matter of Life and Death.” It’s the “motherhood and apple pie” stuff that dentists love to hear if, for no other reason, to reinforce and convince us at the grassroots level that dentistry is an important and serious endeavor. It’s drummed into our heads in dental school that we are not second-class citizens to our physician colleagues. To receive the title of “Dr.”, we’d better darned well earn and deserve it. We come out of dental school with a handpiece in one hand and stethoscope in the other. Then, somewhere along the way, the influences of selfpromotion, hucksterism and commercialism get their grip on us in the name of marketing and, to a greater or lesser degree, the professionalism slips away. Every practicing dentist has to filter what he or she wants to project as his or her image. The pressures of private practice are too great to reject all forms of communication with the public. But do the refrigerator magnets of Mr. Happy Tooth, the sleazy ads and the cartoon recall cards really project our

image? We wonder why our physician colleagues (no less our patients!) don’t take us seriously. Would a neurosurgeon have a picture of a brain on his business card? Let’s stop with the “Smile Centers” and “we cater to cowards” promotions. This sends a message in conflict with what we really are and how we want to be perceived. Throughout my 30 years in practice, I have contended that to be treated like professionals, we must act like professionals. The rest should eventually fall into place. Ellis R. Disick, D.M.D. White Plains, N.Y. DENTAL PRODUCT LABELING

Have you ever treated patients in a clinic or even your own office and not known or not recorded what dental products you were using? Have you ever wondered what you would then do if a patient had a reaction to one of these unknown products, or if a product you might have used was recalled by the manufacturer (it does happen!)? If the brand name of the dental product were not in the written record and an incident occurred some months or years in the future, it would be nearly impossible to go back to document the situation with certainty, enough to satisfy a plaintiff’s litigator and a jury. I see two major problems in the way dentists use modern clinical materials: dunit dose products are rarely labeled to show what they are (such as dental amalgam prepackaged capsules); ddentists usually don’t record the brand name of the products they use. Improper written notes often doom legal cases be-

JADA, Vol. 133, May 2002 Copyright ©2002 American Dental Association. All rights reserved.

545