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Dentistry and the media
JADA LETTERS
TO
THE
EDITOR
JA D A devotes this section to co m m en t by readers o n topics of c u rre n t interest to dentistry. T h e editor reserves th e rig h t to e dit a ll c o m m u n ic atio n s to fit available space a n d requires th a t all letters be typed, double-spaced, an d signed. No m ore th a n ten references should be given w ith each letter. P rin ted c o m m u n icatio n s do not necessarily reflect the o p in io n o r official policy of the Association. Y our p a rtic ip a tio n in this section is invited.
Dentistry and the media □ I am d istressed a b o u t w h a t I believe has b een a p re p o n d e ra n c e of n e g a tiv ism to w ard d e n tistry in th e visu al m edia. In th is g e n e r a tio n of d e n tistry in w h ic h o u r tr a in in g has e m p h asized c o m p le te a n d a d e q u a te a n e s th e sia c o u p le d w ith a p o sitiv e, c a rin g , a n d p a in le ss delivery system , it is b o th u n w a r ra n te d a n d erro n e o u s to sad d le d en tistry w ith th e m e d ia im ag e of a rc h a ic p ra c tices. . . . I ci te a n ep iso d e of L A L a w (F eb 19, 1987) as a n e x a m p le of su p p o se d ly h ig h ly e d u cated atto rn e y s d isc u ssin g th e p a in f u l an d u n e n v ia b le p ro sp e c t of v is itin g a d en tist. T h e e m p h a s is is o n th e u n p le a s a n tn e s s of th is u p c o m in g v isit a n d n o t o n th e n e g li g en ce of th e p a tie n t in m a in ta in in g h is or h e r d e n ta l h e a lth . T h e y o u n g a tto rn e y is g reeted by a “ f lig h ty ” fem ale d e n tis t w hose re p re s e n ta tio n n o t o n ly serves to d e n ig ra te d e n tistry b u t also w o m en as p ro fessio n a l h e a lth care pro v id ers. In p a st episodes of St. E lsew h ere a n d the rec e n t S ta r T re k I V m ovie, references to d e n tistry have su g g ested th a t it is a “ second c h o ic e ” p ro fessio n to m e d ic in e in a so m e w h a t c o n d e sc e n d in g n a tu re . I a m in a firstch o ice , first-rate p ro fessio n th a t sees a dire n eed fo r a m o re p o sitiv e a p p ro a c h to w a rd th e g e n e ra l p u b lic . W hereas th e stu d io s h ire c o n s u lta n ts in th e m e d ic a l a n d leg al p ro fe ssio n s to assist th em in th e tech n ical d ire c tio n o f v a rio u s show s, it is b la ta n tly o b v io u s th a t n o d e n ta l p ro fe ssio n a l acts in th e sam e capacity. 578 ■ JA D A , V o l. 114, M ay 1987
In th e ep iso d e of L A L a w , th e d e n tist is w a v in g a sy rin g e in fro n t o f h e r p a tie n t. In m y years of tr a in in g a n d p ractice, I have n ever d o n e so o r w itn essed a n y d e n tist w av in g a syringe. In fact, a co n ce rte d effo rt is m ad e first to c o m fo rt th e p a tie n t a n d keep the syringe o u t of sight. A lth o u g h the d e n tal p ro fessio n p ro m o tes p re v e n tio n a n d h as seen a d ecrease in d e n tal disease in y o u n g e r p a tie n ts , it seem s n e g lig e n t o f th e n e tw o rk to p ro p a g a te lin g e rin g m e m o rie s of a d is ta n t era. In fact, y o u n g e r p a tie n ts are co o p e ra tiv e a n d view d e n tistry in a p o sitiv e lig h t. P a re n ts act as ad o lescen ts rein fo rced by th e m ed ia. W hen w ill we b rin g d e n tistry in to 1987 a n d p re s e n t d en tists as th e c a rin g , co m p e te n t, a n d sen sitiv e p ro fe ssio n a ls a n d h e a lth care p ro viders th a t they tru ly are? . . . H A L W O L FS O N , DDS N EW YORK, NY
PDL injections □ It is p le a s in g to see a n a rtic le su c h as th a t by Drs. J o s e p h D ’Souza a n d R ic h a rd W alto n , a n d Mr. L aw ren ce P eterso n , “ P e ri o d o n ta l lig a m e n t in je c tio n : a n e v a lu a tio n o f th e e x te n t of a n esth e sia a n d p o stin je c tio n d isc o m fo rt” (M arch), th a t stresses c a u tio n a n d c ritic a l e v a lu a tio n of new te c h n iq u e s th a t g a in ra p id w id e sp re a d favor p a rtia lly becau se o f effective m a rk e tin g , in itia l c lin ic a l success, a n d th e c o n sta n t search for b etter m o u setrap s. In a d d itio n to th e ideas m e n tio n e d by the a u th o rs, th e c o m m o n m isc o n c e p tio n p ro m u lg a te d by several o th e r w rite rs th a t the p e rio d o n ta l lig a m e n t (P D L ) te c h n iq u e is safer because less v o lu m e o f a n e sth e tic is used is sim p ly n o t tru e .1'2 A lth o u g h the dose o f th e a g e n t is a n im p o rta n t facto r in p ro d u c in g to x ic a n d alle rg ic p h e n o m e n a , p a tie n t age, w e ig h t, g en d er, presence of disease, genetics, m e n ta l a ttitu d e , e n v iro n m en t, a n d v a sc u la rity of th e in je c te d site m u s t a ll be co n sid ered , in a d d itio n to the a c tu a l m illig ra m dose o f d ru g .3 As far as th e a u th o r s ’ fin d in g th a t lim ite d
sp re a d o f P D L in je c tio n s is d iffic u lt to su b sta n tia te , a t lea st o n e study clearly su p p o rts th e ir c o n c e rn .4 T h e d ra m a tic sp read of s o lu tio n sh o w n in th is stu d y is n o t s u r p ris in g in c o n sid e rin g th a t in je c tio n p ressures th ro u g h 3 0 -g au g e n eedles are 1,000 tim es g re a te r th a n th ro u g h 2 5 -g au g e n eedles if la m in a r flow is m a in ta in e d .5 T h u s , w h a t we have is a n ew c lin ic a l te c h n iq u e th a t h as been sh o w n to be in itia lly favored by som e a u th o rs. It m ay be effective w ith relativ e lo w d o sag e of ag en ts b u t m ay in v o lv e m u ltip le h ig h -p re ssu re in fu sio n s o f a h ig h ly c o n c e n tra te d a g e n t in to a v a scu lar bed in a v aried p a tie n t p o p u la tio n . C o n ce rn a n d fu rth e r research are w a r ra n te d b efo re P D L te c h n iq u e s becom e w idely accep ted as e q u a l in safety to m o re c o n v e n tio n a l te c h n iq u e s w ith a s p ira tin g syringes. D A N IE L L. O R R II, DDS. MS U N IV ER SITY O F NEVADA 1. S aadoun, A .P., and M alam ed, S.F. Intraseptal anesthesia in p erio d o n ta l surgery. JAD A 111 (2):249256, 1985. 2. M arin, M.K. In traseptal anesthesia in the general d e ntal practice. C om pend C o ntin Educ D ent 8:202-209, 1987. 3. M alam ed, S.F. H a ndbook of local anesthesia. St. Louis, C. V. M osby Co, 1980, p p 211-224. 4. R aw son, R .D ., and O rr, D .L. II V ascular penetra tion follow ing in tralig a m e n ta l injection. J O ral M axillofac S urg 43(8):600-604, 1985. 5. O rr, D.L. II T h e broken needle: re p o rt of case. JADA 107(4):603-604, 1983.
Serum chemistries □ T h e a rtic le , “ S eru m c h e m istries for d e n tists” b y Drs. T h o m a s S h o p p e r a n d C h a rle s B oozer (F ebruary), o v e rsim p lified th e c u rre n t sta tu s o f la b o ra to ry m edicine. “ S h o tg u n ” a p p ro a c h e s to sc re e n in g for disease h av e been d eb ate d sin ce th e 1960s. T h e p rev alen ce of th is ty p e of screening w as th e re s u lt p rim a rily of se q u e n tia l a n a lyzers th a t h a v e n o o th e r m o d e b u t to p e r fo rm a ll c h e m ic a l a n a ly sis o n th e serum sam p led. E vid ence to s u p p o r t th e idea th a t
TO
THE
EDITOR
JA D A devotes this section to co m m en t by readers o n topics of c u rre n t interest to dentistry. T h e editor reserves th e rig h t to e dit a ll c o m m u n ic atio n s to fit available space a n d requires th a t all letters be typed, double-spaced, an d signed. No m ore th a n ten references should be given w ith each letter. P rin ted c o m m u n icatio n s do not necessarily reflect the o p in io n o r official policy of the Association. Y our p a rtic ip a tio n in this section is invited.
Dentistry and the media □ I am d istressed a b o u t w h a t I believe has b een a p re p o n d e ra n c e of n e g a tiv ism to w ard d e n tistry in th e visu al m edia. In th is g e n e r a tio n of d e n tistry in w h ic h o u r tr a in in g has e m p h asized c o m p le te a n d a d e q u a te a n e s th e sia c o u p le d w ith a p o sitiv e, c a rin g , a n d p a in le ss delivery system , it is b o th u n w a r ra n te d a n d erro n e o u s to sad d le d en tistry w ith th e m e d ia im ag e of a rc h a ic p ra c tices. . . . I ci te a n ep iso d e of L A L a w (F eb 19, 1987) as a n e x a m p le of su p p o se d ly h ig h ly e d u cated atto rn e y s d isc u ssin g th e p a in f u l an d u n e n v ia b le p ro sp e c t of v is itin g a d en tist. T h e e m p h a s is is o n th e u n p le a s a n tn e s s of th is u p c o m in g v isit a n d n o t o n th e n e g li g en ce of th e p a tie n t in m a in ta in in g h is or h e r d e n ta l h e a lth . T h e y o u n g a tto rn e y is g reeted by a “ f lig h ty ” fem ale d e n tis t w hose re p re s e n ta tio n n o t o n ly serves to d e n ig ra te d e n tistry b u t also w o m en as p ro fessio n a l h e a lth care pro v id ers. In p a st episodes of St. E lsew h ere a n d the rec e n t S ta r T re k I V m ovie, references to d e n tistry have su g g ested th a t it is a “ second c h o ic e ” p ro fessio n to m e d ic in e in a so m e w h a t c o n d e sc e n d in g n a tu re . I a m in a firstch o ice , first-rate p ro fessio n th a t sees a dire n eed fo r a m o re p o sitiv e a p p ro a c h to w a rd th e g e n e ra l p u b lic . W hereas th e stu d io s h ire c o n s u lta n ts in th e m e d ic a l a n d leg al p ro fe ssio n s to assist th em in th e tech n ical d ire c tio n o f v a rio u s show s, it is b la ta n tly o b v io u s th a t n o d e n ta l p ro fe ssio n a l acts in th e sam e capacity. 578 ■ JA D A , V o l. 114, M ay 1987
In th e ep iso d e of L A L a w , th e d e n tist is w a v in g a sy rin g e in fro n t o f h e r p a tie n t. In m y years of tr a in in g a n d p ractice, I have n ever d o n e so o r w itn essed a n y d e n tist w av in g a syringe. In fact, a co n ce rte d effo rt is m ad e first to c o m fo rt th e p a tie n t a n d keep the syringe o u t of sight. A lth o u g h the d e n tal p ro fessio n p ro m o tes p re v e n tio n a n d h as seen a d ecrease in d e n tal disease in y o u n g e r p a tie n ts , it seem s n e g lig e n t o f th e n e tw o rk to p ro p a g a te lin g e rin g m e m o rie s of a d is ta n t era. In fact, y o u n g e r p a tie n ts are co o p e ra tiv e a n d view d e n tistry in a p o sitiv e lig h t. P a re n ts act as ad o lescen ts rein fo rced by th e m ed ia. W hen w ill we b rin g d e n tistry in to 1987 a n d p re s e n t d en tists as th e c a rin g , co m p e te n t, a n d sen sitiv e p ro fe ssio n a ls a n d h e a lth care p ro viders th a t they tru ly are? . . . H A L W O L FS O N , DDS N EW YORK, NY
PDL injections □ It is p le a s in g to see a n a rtic le su c h as th a t by Drs. J o s e p h D ’Souza a n d R ic h a rd W alto n , a n d Mr. L aw ren ce P eterso n , “ P e ri o d o n ta l lig a m e n t in je c tio n : a n e v a lu a tio n o f th e e x te n t of a n esth e sia a n d p o stin je c tio n d isc o m fo rt” (M arch), th a t stresses c a u tio n a n d c ritic a l e v a lu a tio n of new te c h n iq u e s th a t g a in ra p id w id e sp re a d favor p a rtia lly becau se o f effective m a rk e tin g , in itia l c lin ic a l success, a n d th e c o n sta n t search for b etter m o u setrap s. In a d d itio n to th e ideas m e n tio n e d by the a u th o rs, th e c o m m o n m isc o n c e p tio n p ro m u lg a te d by several o th e r w rite rs th a t the p e rio d o n ta l lig a m e n t (P D L ) te c h n iq u e is safer because less v o lu m e o f a n e sth e tic is used is sim p ly n o t tru e .1'2 A lth o u g h the dose o f th e a g e n t is a n im p o rta n t facto r in p ro d u c in g to x ic a n d alle rg ic p h e n o m e n a , p a tie n t age, w e ig h t, g en d er, presence of disease, genetics, m e n ta l a ttitu d e , e n v iro n m en t, a n d v a sc u la rity of th e in je c te d site m u s t a ll be co n sid ered , in a d d itio n to the a c tu a l m illig ra m dose o f d ru g .3 As far as th e a u th o r s ’ fin d in g th a t lim ite d
sp re a d o f P D L in je c tio n s is d iffic u lt to su b sta n tia te , a t lea st o n e study clearly su p p o rts th e ir c o n c e rn .4 T h e d ra m a tic sp read of s o lu tio n sh o w n in th is stu d y is n o t s u r p ris in g in c o n sid e rin g th a t in je c tio n p ressures th ro u g h 3 0 -g au g e n eedles are 1,000 tim es g re a te r th a n th ro u g h 2 5 -g au g e n eedles if la m in a r flow is m a in ta in e d .5 T h u s , w h a t we have is a n ew c lin ic a l te c h n iq u e th a t h as been sh o w n to be in itia lly favored by som e a u th o rs. It m ay be effective w ith relativ e lo w d o sag e of ag en ts b u t m ay in v o lv e m u ltip le h ig h -p re ssu re in fu sio n s o f a h ig h ly c o n c e n tra te d a g e n t in to a v a scu lar bed in a v aried p a tie n t p o p u la tio n . C o n ce rn a n d fu rth e r research are w a r ra n te d b efo re P D L te c h n iq u e s becom e w idely accep ted as e q u a l in safety to m o re c o n v e n tio n a l te c h n iq u e s w ith a s p ira tin g syringes. D A N IE L L. O R R II, DDS. MS U N IV ER SITY O F NEVADA 1. S aadoun, A .P., and M alam ed, S.F. Intraseptal anesthesia in p erio d o n ta l surgery. JAD A 111 (2):249256, 1985. 2. M arin, M.K. In traseptal anesthesia in the general d e ntal practice. C om pend C o ntin Educ D ent 8:202-209, 1987. 3. M alam ed, S.F. H a ndbook of local anesthesia. St. Louis, C. V. M osby Co, 1980, p p 211-224. 4. R aw son, R .D ., and O rr, D .L. II V ascular penetra tion follow ing in tralig a m e n ta l injection. J O ral M axillofac S urg 43(8):600-604, 1985. 5. O rr, D.L. II T h e broken needle: re p o rt of case. JADA 107(4):603-604, 1983.
Serum chemistries □ T h e a rtic le , “ S eru m c h e m istries for d e n tists” b y Drs. T h o m a s S h o p p e r a n d C h a rle s B oozer (F ebruary), o v e rsim p lified th e c u rre n t sta tu s o f la b o ra to ry m edicine. “ S h o tg u n ” a p p ro a c h e s to sc re e n in g for disease h av e been d eb ate d sin ce th e 1960s. T h e p rev alen ce of th is ty p e of screening w as th e re s u lt p rim a rily of se q u e n tia l a n a lyzers th a t h a v e n o o th e r m o d e b u t to p e r fo rm a ll c h e m ic a l a n a ly sis o n th e serum sam p led. E vid ence to s u p p o r t th e idea th a t