Dental missionary work

a turning back o f the clock in the area of legislative public protection inviting back problem s much more serious than any it m ay solve. JOHN F. DE VOE, DDS ELIZABETH, NJ

Dentistry oversimplified m I ju st finished reading the article by Richard M. Jacobs in the 1977 January issue of T h e Journal (page 14) about consequences of expandedduty auxiliaries. I fully agree w ith the context of this article. I feel that your everyday general practitioner should be asked his feelings about the use of these auxiliaries. All we have so far is some dentists in W ashington (who have never m ade it in private practice) and som e graduate dental school student w orking on a governm ent grant say­ ing th at this is good for us and is the w ay w e should go. T he way we are h eaded we are letting anyone with a little knowledge perform dental tasks th a t everyone at one time thought should be perform ed only by skilled d entists after many years of school. W hat these people are doing is over­ simplifying dentistry. We are concerned about “ dentu rism .” This expanded-duty thing is an o th er form of “ denturism .” We are delegating duties once perform ed by dentists only. EUGENE E. STOLL, DDS NORTH OLMSTED, OHIO

*A “ denturist” is a person who is educa­ tionally unqualified and not licensed, for the necessary protection of the public, to practice dentistry in any form on the public. “ Denturism” is the unqualified as well as the illegal practice of dentistry in any form on the public.

Appreciates help m Because of the current fund drive, now seem s to be an appropriate time to thank both the A m erican D ental A ssociation Relief F und and its local counterpart, the A rizona State D ental A ssociation Relief Fund. T he help

extended to my family during these past 3'A m onths was deeply appre­ ciated. D ue to a long-standing injury, I was totally disabled from active practice and subsequently advised th at my m edical insurance com pany was not willing to make any coverage for the surgery and oth er medical expenses. T he bills and th e inability to work w ere quite devastating. This letter is w ritten both as a “ thank you” and as a request to do­ nate to this m ost valid of funds. This fund is not only for the older dentist in his last year of practice, but it is fo r all those “ o th er guys” who least expect this type of problem . I have a busy, active practice and am 29 years o f age, and before the surgery I was apparently in good health. T he Relief F und was literally a finnancial G od-send. Please rem em ber your donation as a valid and valued service to all of o u r dental colleagues. RICHARD A. DE MARK, DDS PRESCOTT, ARIZ

Student clinics complimented m A t the A D A annual meeting in L as V egas, I was privileged to see tw o unusual and clinically signifi­ cant student table clinics. I would like to take this means to bring these to the attention of the readers. T he tw o table clinics were “ Ster­ ilization of handpieces to prevent hepatitis virus transm ission” by Brant B radford o f the U niversity of Colo­ rado School of D entistry and “ T ech­ niques of local anesthesia” by Bruce K. H all of the U niversity of Louis­ ville School of D entistry. T he clinic on hepatitis protection is a clinically realistic review of dental hepatitis risks and a now, today cap­ ability that every dental office can em ploy to sterilize handpieces and other cross-contam ination sources. E xcellent, tim ely, and necessary. T he clinic on techniques of local anesthesia involves an excellent pre­ sentation of the hazards and employs a manikin developed for training in safety techniques. This simple de­ scription does not do justice to the

excellence o f the clinic, but it would be a striking “ featu rette” because of the manikin. C ertainly, from a clinical point of view , these tw o student table clinics w ere the best I viewed at the meeting. H opefully you’ll be able to bring th ese good w orks before the m em ber­ ship of “ w et finger” dentists who can profit from the knowledge and render an even better, safer service to their patients. OSCAR MALMIN, DDS AKRON, OHIO

Respect is earned

■ A fter reading T h e Journal for some 20 years as student and practitioner, I finally feel constrained to write. I believe entirely too m uch tim e and effort are w asted by T h e Journal and the m em bers o f th e profession fretting about “ im age.” D ental caries, peri­ odontal disease, and the m yriad un­ solved problem s of our profession cry for a solution; w hether a person is a D D S or D M D does not. A nd the hue and cry over cartoons that may or m ay not depict our pro­ fession in an unfavorable light depend on point of view. T hey don’t, of them ­ selves, make us more or less com pe­ tent practitioners. I hope we, as den­ tists, never lose the ability to laugh at ourselves. In every cartoon, there is a m ite of truth. T hose offended “ doth p ro test too much, me th in k s.” It is my belief th at upgrading of our profession (if, in fact, upgrading is needed) will com e only from the dem ­ onstrated com petence of the mem­ bers of the profession. We don’t as­ sum e a m antle of sacred respectabil­ ity by changing the initials behind our nam e. R espect for the dental role in health care delivery is earned, not granted. T. G. MATTHEWS, DDS KERRVILLE, TEX

Dental missionary work

■ T he experiences of D r. C arlos Sal­ daña reported in the N ovem ber J A D A (page 956) are very interesting to me

LETTERS TO THE EDITOR / JADA, Vol. 94, March 1977 ■ 427

because they parallel mine rather closely. I also m ade a trip to H onduras in July 1975. O ne can hardly becom e an expert in the short tim e each o f us stayed, but his im pressions are the same as mine. I also feel that sugar cane is the culprit in causing so much decay. On my next trip I too hope to take som e audiovisual aids in preventive den­ tistry and hygiene. It may not be very practical to carry a projector and bat­ teries on a mule into the mountains w here I w ent, but perhaps pictures draw n or pasted on paper with short m essages tacked on the walls might be helpful. I t m ay be that the passion for sugar cane is generally listed to H onduras. I was told o f a pastor from C osta Rica w ho lost his position with a H onduran church as a result of excessive abra­ siveness on this subject. H e told them , “ Solam ente los burros com en la caña (only burros eat sugar cane).” I hope ou r health m essages can be a little more tactful (“ the surgeon general has determ ined that eating sugar cane is injurious to the te e th ” ). I w as intrigued by D r. Saldaña’s m ethod of chiseling out decay. I was tem pted to do the sam e in cases w here all four upper incisors had large areas o f decay on mesial and distal. Would a p retty little 12-year-old girl look better w ith four spiked incisors or none a t all? If she w alked the 30 miles to Choluteca all she could afford or get would be extractions. I am haunted by my decision to extract, but dubious of the alternatives. T he response of the readers w ould be helpful. T he people there are not different from those here in many respects. T hey w aited in line for hours, then w hen they sat dow n they w anted total treatm ent, regardless of tim e lim ita­ tions. I w ould ask, “ W here does it hurt the w orst?” “ A quí, aquí, aquí, aquí, aquí, y aq u í,” they w ould say pointing to all four quadrants plus the anteriors. “ But w here is it m ost severe?” “ A quí, aquí, aquí, aquí, aquí, y aq u í.” “ I cannot do all th at to d ay .” “ P orqué?” “ W hy?” Again I would explain and ask w here I could help them most.

“ A quí, aquí, etc, and so fo rth .” D r. Saldaña’s technique of using his knee for a headrest is ingenious. I am sure it would w ork well for a young man, but my advanced years would preclude such a m ethod for any length of time. A chair of som e sort is really a necessity. I was fortunate th at a local dentist accom panied our party and brought his portable chair. It was a lifesaver for me. I feel th at any dental society which has m em bers who devote periods of time for benevolent w ork in rem ote areas would do well to purchase these chairs to be checked out for such use. Y ou will notice in the picture that D r. Saldaña is wearing plastic dis­ posable gloves. T hese gloves are not a convenience, but a necessity. W here there is no running w ater blood will not easily w ash off th e hands. O ne who w orks in such areas will do well to take along a large supply. T his type of treatm ent is primitive. T eeth that could be saved easily in our offices here are sacrificed there. A s indicated, the conscience suffers some twinges by the necessary com ­ prom ise and outright abdication to expediency. O ur concern in the prac­ tice of dentistry in our offices for aes­ thetics and function has little place. T he prim ary concern is for pain and infection. Recently my pastor stopped me to relay a m essage from the people we visited. T hey said, “ We are glad you came, we don’t hurt an y m o re.” SAM P. PATTERSON, DDS SAN ANTONIO, TEX

S h a r e d responsibility m I t was with much interest that I read D r. W areham ’s com m ents on M a r a t h o n M a n in th e D ecem ber issue of T h e Journal. In it, he places responsibility for our image on the various dental societies, stating that a watchdog com m ittee is required so that dentistry may be portrayed to the public in a m ore favorable light. I thoroughly disagree with this en­ tire concept. I agree that a w atch­ dog com m ittee is required, b ut it is D r. W areham , myself, and every den­ tist w ho m ust be the forefront of this

428 ■ LETTERS TO THE EDITOR / JADA, Vol. 94, March 1977

com m ittee. It is not enough for me to sit back and let som eone else do the w ork for me. I t is I alone w ho am responsible for the p atien ts’ attitudes and beliefs that are handed down from adult to child through the genera­ tions that spaw n m aterial such as th at seen in th e M a r a t h o n M a n . My patients have told me about these scenes in the movie, b ut not from a fear th a t th ey will be subjected to the same indignities at the hands o f their own dentist (me), but from the view­ point of literary license. It is my responsibility to m yself and my patients to m ake my own be­ havior in my office such that none of my patients need fear coming to me. My patients are goodwill am bassadors of dentistry, and of me in particular, because they know I care w hat hap­ pens to them . I have learned this through experience and also by be­ coming very m uch aw are of myself, understanding myself, thereby being able to help my patients, who are my friends and com panions in our quest for optim al dental health. R esponsibility is the key to all of this. In the D ecem ber 13, 1976, issue of the A D A N e w s , there is an article on suicide and divorce among den­ tists. D r. Shankle says in this article “ A cause can be found in the con­ tradiction th at exists betw een the den­ tist’s quest for perfection and a failure of patients to appreciate his efforts.” Believing and understanding that I cannot m ake a patient do anything that he does not w ant to do, I insist that my patient take full responsi­ bility for his own health. I bring him to the brink o f the insight allowing his own mind to give him his own insight. T herefore, inasm uch as I do not feel responsible for my p atien t’s health, for th at is his right even if he does not w ant to brush his teeth , I do not have this contradiction that D r. Shankle speaks aboout. Furtherm ore, I take my own responsibility by doing everything th at I can do to have my office such a place th at my patient will b e com fortable at all tim es, and enjoy his visit with me. I hope that all the dentists who feel that the A D A should take responsi­ bility for their patients think about this for awhile. I enjoy m yself with my patient. I have a great deal of fun dur­