- Email: [email protected]
Effects of restorative materials
J'AD)A LETTERS
TO
THE
EDITOR
JA D A devotes this section to com m ent by readers o n topics of c u rre n t interest to dentistry. T h e e ditor reserves the rig h t to edit all c o m m u n ic atio n s to fit a vailable space a n d requires th a t all letters be typed, double-spaced, and signed. N o m ore th a n ten references sh ould be given w ith each letter. P rinted co 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.
Early detection
Emphasis topics □ T h e cover and 13 pages of E m phasis in the Ju n e issue were devoted to office design an d ergonom ics. T h e article was well w rit ten a n d touched on econom y of m otion, color, light, a n d w ork sim plification. However, as T h e Journal is the prem ier jo u rn a l of o u r profession, cover stories sh o u ld address issues of vital concern that have an im p act on dentistry: dental re search, infectious disease, liability, dw in d lin g enrollm ent, closure of dental schools, legislative activity, caries prevention, p eri o d o n tal health, jo in t com m ission activi ties, restorative dentistry, relevant p ublic h e a lth co n c ern s, a n d h o s p ita l p r iv i leges. . . . O u r profession should take pride in the significance and q u ality of the m aterial p u b lish ed an d the w ork of an ou tstan d in g staff. L et’s stay on track. B U R T O N S. W ASSERM AN, DDS B O O T H M EM O R IA L M ED ICA L C E N T E R F L U S H IN G , NY
□ E ditorial com m ent: T raditio n ally , the J u n e E m p h asis has centered on a nonclinical aspect of dental practice, including d ental education (1981), procom petition (1982), dental hygiene (1983), associateships (1984), office eq u ip m en t (1985), and office design (1986). A lthough some of the topics may seem less significant th an others fea tured in E m phasis, they are chosen to meet specific m em ber needs. T hese needs are determ ined from m em bers’ com m ents. Some of the topics Dr. W asserm an suggests have already been fea tured in E m phasis an d others are scheduled for future issues. 126 ■ JADA, Vol. 113, August 1986
□ T h e clinical rep o rt by Dr. Stephen C ohen and others on the oral prodrom al signs of a central nervous system m alig n an t neoplasm —glioblastom a m ultiform e (May) was an interesting presentation of an u n u su a l case. However, I believe th a t one p o in t was n o t adequately em phasized. In any case in w hich a patien t has a history of paresth esia—regardless of o th er sym p tom s—of a branch of the trigem inal nerve, a diagnosis of m etastatic m a lig n an t disease or the presence of an occult prim ary m alignancy, sh o u ld be placed h ig h on the c lin ic ia n ’s list of diagnoses. T h is is p artic ularly true if the p atien t is at an increased risk for m a lig n a n t disease o r has a history of treatm ent. I am fam iliar w ith a n u m b er of cases, p rim a rily inv o lv in g carcin o m a of the breast, of m a x illo facial m etastases in w hich the p atien ts’ in itial sym ptom s in cluded paresthesia. O ften these patien ts are seen by a n um b er of p ractitioners and undergo unnecessary treatm ent before a diagnosis is made. T h e im portance of ru lin g o u t neoplastic disease w hen evaluating these p atients ca n not be overestim ated for early detection of any type of m alignancy. R O B E R T D. FOSS, DDS V IR G IN IA BEACH, VA
Effects of restorative materials □ T h e article, “A visible light-cured poste rio r com posite resin: results of a 3-year clinical evalu atio n ,” by Dr. Boksm an and others (May) contained some farsighted a n d revelatory statements. T h e authors stated that “ totally w ear-resistant m aterials are undesirable. M aterials th a t show a wear rate identical to enam el m ust be considered as id eal.” T h e au th o rs fu rth er p o in ted o u t research that showed the 18-month wear rate o f h u m a n enam el is 82 /xm (55 /xm per year). It is tim e for the dental profession to consider the physiological effects of restor ative m aterials th at show a m ean w ear rate
sig n ifican tly lower th an th at of h u m an enam el. Is it possible that these m aterials contribute to tem porom andibular dysfunc tion, m yofascial pain, an d destruction of the p erio d o n tal structures? Perhaps harder m aterial (than h u m an enamel) is n o t necessarily better. M IC H A E L F. ZIFF, DDS O R L A N D O , FL
^ j,
fi
Infection control and reality
* □ T h e E m phasis article, “Infection co n trol in the dental office: a realistic ap p ro ac h ” (April), was a tim ely an d useful ad d itio n to the grow ing literature on this subj ect, and, for the m ost part, was w h at its title suggested: realistic. However, Dr. Peter H u rst stated th a t “d ental p e rso n n e l. . .sh o u ld . . .b e able to identify h ig h -risk p atien ts.” H e then sug gested th a t because dentists w ith “no m eanin g fu l tra in in g . . . in infection co n trol . . . ” w ould be unable to take the necessary precautions to “protect them selves, th eir staffs, and their other patients from . . . disease,” a n atio n al system of m u ltip le, hospital- or university-based cen ters sh o u ld be established to treat h ig h -risk dental patients. Dr. H u rs t’s suggestion contradicted the p o in t th at all of his cocontributors tried to em phasize, nam ely th at it is unrealistic to th in k th a t dental personnel can identify all high-risk patients, no m atter how th o r ou g h a m edical history they obtain. If den tal personnel cannot identify their h ighrisk p atien ts, they can n o t be expected to refer such p atients to the type of specialized health care facilities that Dr. H u rst envisions. W hether such facilities are needed for know n high-risk patients is debatable. B ut if the developm ent of such facilities is encouraged, it sh o u ld be done in conjunctio n w ith a m ajor educational effort so th at dental personnel recognize that all p atien ts m ust be created as if they are potentially infectious. R O B E R T E. ISMAN, DDS, M PH , C H IE F O FFIC E O F D E N T A L H E A L T H SA C R A M EN TO , CA
’
1
>
,
’
*
, ,
.
J '
TO
THE
EDITOR
JA D A devotes this section to com m ent by readers o n topics of c u rre n t interest to dentistry. T h e e ditor reserves the rig h t to edit all c o m m u n ic atio n s to fit a vailable space a n d requires th a t all letters be typed, double-spaced, and signed. N o m ore th a n ten references sh ould be given w ith each letter. P rinted co 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.
Early detection
Emphasis topics □ T h e cover and 13 pages of E m phasis in the Ju n e issue were devoted to office design an d ergonom ics. T h e article was well w rit ten a n d touched on econom y of m otion, color, light, a n d w ork sim plification. However, as T h e Journal is the prem ier jo u rn a l of o u r profession, cover stories sh o u ld address issues of vital concern that have an im p act on dentistry: dental re search, infectious disease, liability, dw in d lin g enrollm ent, closure of dental schools, legislative activity, caries prevention, p eri o d o n tal health, jo in t com m ission activi ties, restorative dentistry, relevant p ublic h e a lth co n c ern s, a n d h o s p ita l p r iv i leges. . . . O u r profession should take pride in the significance and q u ality of the m aterial p u b lish ed an d the w ork of an ou tstan d in g staff. L et’s stay on track. B U R T O N S. W ASSERM AN, DDS B O O T H M EM O R IA L M ED ICA L C E N T E R F L U S H IN G , NY
□ E ditorial com m ent: T raditio n ally , the J u n e E m p h asis has centered on a nonclinical aspect of dental practice, including d ental education (1981), procom petition (1982), dental hygiene (1983), associateships (1984), office eq u ip m en t (1985), and office design (1986). A lthough some of the topics may seem less significant th an others fea tured in E m phasis, they are chosen to meet specific m em ber needs. T hese needs are determ ined from m em bers’ com m ents. Some of the topics Dr. W asserm an suggests have already been fea tured in E m phasis an d others are scheduled for future issues. 126 ■ JADA, Vol. 113, August 1986
□ T h e clinical rep o rt by Dr. Stephen C ohen and others on the oral prodrom al signs of a central nervous system m alig n an t neoplasm —glioblastom a m ultiform e (May) was an interesting presentation of an u n u su a l case. However, I believe th a t one p o in t was n o t adequately em phasized. In any case in w hich a patien t has a history of paresth esia—regardless of o th er sym p tom s—of a branch of the trigem inal nerve, a diagnosis of m etastatic m a lig n an t disease or the presence of an occult prim ary m alignancy, sh o u ld be placed h ig h on the c lin ic ia n ’s list of diagnoses. T h is is p artic ularly true if the p atien t is at an increased risk for m a lig n a n t disease o r has a history of treatm ent. I am fam iliar w ith a n u m b er of cases, p rim a rily inv o lv in g carcin o m a of the breast, of m a x illo facial m etastases in w hich the p atien ts’ in itial sym ptom s in cluded paresthesia. O ften these patien ts are seen by a n um b er of p ractitioners and undergo unnecessary treatm ent before a diagnosis is made. T h e im portance of ru lin g o u t neoplastic disease w hen evaluating these p atients ca n not be overestim ated for early detection of any type of m alignancy. R O B E R T D. FOSS, DDS V IR G IN IA BEACH, VA
Effects of restorative materials □ T h e article, “A visible light-cured poste rio r com posite resin: results of a 3-year clinical evalu atio n ,” by Dr. Boksm an and others (May) contained some farsighted a n d revelatory statements. T h e authors stated that “ totally w ear-resistant m aterials are undesirable. M aterials th a t show a wear rate identical to enam el m ust be considered as id eal.” T h e au th o rs fu rth er p o in ted o u t research that showed the 18-month wear rate o f h u m a n enam el is 82 /xm (55 /xm per year). It is tim e for the dental profession to consider the physiological effects of restor ative m aterials th at show a m ean w ear rate
sig n ifican tly lower th an th at of h u m an enam el. Is it possible that these m aterials contribute to tem porom andibular dysfunc tion, m yofascial pain, an d destruction of the p erio d o n tal structures? Perhaps harder m aterial (than h u m an enamel) is n o t necessarily better. M IC H A E L F. ZIFF, DDS O R L A N D O , FL
^ j,
fi
Infection control and reality
* □ T h e E m phasis article, “Infection co n trol in the dental office: a realistic ap p ro ac h ” (April), was a tim ely an d useful ad d itio n to the grow ing literature on this subj ect, and, for the m ost part, was w h at its title suggested: realistic. However, Dr. Peter H u rst stated th a t “d ental p e rso n n e l. . .sh o u ld . . .b e able to identify h ig h -risk p atien ts.” H e then sug gested th a t because dentists w ith “no m eanin g fu l tra in in g . . . in infection co n trol . . . ” w ould be unable to take the necessary precautions to “protect them selves, th eir staffs, and their other patients from . . . disease,” a n atio n al system of m u ltip le, hospital- or university-based cen ters sh o u ld be established to treat h ig h -risk dental patients. Dr. H u rs t’s suggestion contradicted the p o in t th at all of his cocontributors tried to em phasize, nam ely th at it is unrealistic to th in k th a t dental personnel can identify all high-risk patients, no m atter how th o r ou g h a m edical history they obtain. If den tal personnel cannot identify their h ighrisk p atien ts, they can n o t be expected to refer such p atients to the type of specialized health care facilities that Dr. H u rst envisions. W hether such facilities are needed for know n high-risk patients is debatable. B ut if the developm ent of such facilities is encouraged, it sh o u ld be done in conjunctio n w ith a m ajor educational effort so th at dental personnel recognize that all p atien ts m ust be created as if they are potentially infectious. R O B E R T E. ISMAN, DDS, M PH , C H IE F O FFIC E O F D E N T A L H E A L T H SA C R A M EN TO , CA
’
1
>
,
’
*
, ,
.
J '