L E T T E R S
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T H E JO U R N A L d e v o te s th i s s e c tio n to c o m m e n t b y re a d e r s o n to p ic s o f c u r r e n t in t e r e s t to d e n tis tr y . T h e e d i to r re s e r v e s th e r i g h t to e d it a ll c o m m u n ic a tio n s to f it a v a ila b le s p a c e a n d r e q u ir e s th a t a ll le tte r s b e s ig n e d . P r in te d c o m m u n ic a tio n s d o n o t n e c e s s a r ily r e f le c t t h e o p in i o n o r o ffic ia l p o li c y o f th e A s s o c ia tio n . Y o u r p a r t ic i p a tio n in th i s s e c t io n is in v ite d .
A ntiplaque agents □ I w o u ld like to v oice a co m p lain t ab o u t th e rep o rtin g in v arious d ental jo u rn a ls of th e e ffe c ts o f m o u th w a s h e s lik e c h l o r h e x i d i n e a n d alex id in e. I have read ab o u t th e th e r ap e u tic effects of th e se a g e n ts for ap p ro x im ately eight years b u t have b een u n ab le to p u rc h a se or p rescribe th em for m y patien ts. W hy are th ese n o t available to th e p rac titio n e r for p ro fessio n al use? If it is because th e re are side effects th a t co u ld p re v e n t th e ir rec eiv in g Food an d D rug A d m in istra tio n ap p ro v a l, th e n th e a m o u n t o f tim e being sp e n t by differen t researchers is w asted a n d th e sp ace d ev o ted to a rticle s ab o u t th em s h o u ld be d e voted to som eth in g th a t w e can use, n o t so m eth in g w e m ay n ev er be able to use. S A M U E L A . L E IS H E A R , D M D P O C O M O K E C IT Y , M D
C o m m en t: In fo rm a tio n c o n c e rn in g c h lo rh e x id in e an d a lex id in e has ap p eared in foreign jo u rn als an d in US d en tal research an d abstracts jo u r nals. T he rin sin g ag en ts ap p e ar to h av e a p o te n tia l p rac tica l b enefit in th e p ractice of d e n tistry an d th e re fore are of in te re st to th e profession. It is o u r u n d e rsta n d in g th a t p ro d u cts
co n tain in g eith er or b o th of th ese in g redients have b een su b m itte d to th e FDA. O ne o f th e m a jo r p ro b le m s th u s far is th a t c h lo rh e x id in e a n d a lex id in e can cau se stain in g , som e tim es severe, of te e th an d oral soft tissue.
Fluoridation and bacterial endocarditis □ T he q u estio n raise d by Drs. Ber m an a n d Jaffin (The Journal, M arch), a b o u t w h e th e r f lu o r id a tio n i n d i re c tly p re v e n ts b a c te ria l e n d o c a r ditis, is of fu n d am e n tal im p o rtan ce because of its co n n e ctio n w ith th e q u estio n of “ focal d ise ase ,” form erly k now n as foacl in fection. Tw o p ap ers w ere p u b lish e d at th e end of th e “ in tro d u c to ry ” p h ase of w ater flu o rid atio n . In “W ater-borne flu o rid es a n d m o rta lity ,” 1 H agan a n d others co m p ared m o rta lity rates of 16 U S c i tie s w h e r e f lu o r i d e le v e ls w ere elevated, w ith m o rtality rates in 16 com parab le cities w h ere th e fluoride levels w ere low . T otal m o r tality a n d death s from card iac d is e a se , c a r c in o m a , in tr a c r a n ia l le sions, n e p h ritis, an d cirrh o sis of th e liver in th e tw o co m m u n ities d id not sh o w s ta tis tic a lly s ig n ific a n t d if ferences. In “M edical asp ects of ex
cessiv e flu o rid e in a w ate r su p p ly ,” 2 L eone a n d others re p o rte d a sig n ifi ca n tly h ig h e r in c id e n c e of c a rd io v a sc u la r d ise a se in a lo w -flu o rid e c o m m u n ity th a n in one w ith h ig h flu o rid e levels. B ecause of th e scale o f th e stu d ies, th e fin d in g s w ere of no p rac tica l value. A t ab o u t th e sam e tim e, a stu d y of tw o p o p u la tio n s in H u n g ary w as re p o rte d by B arth a.3 In th e co m m u n ity w ith h ig h flu o rid e le v els, th e ex p ec te d low p rev alen ce of caries w as d e m o n s tr a te d in s c h o o lc h i ld r e n ag ed 6 to 14 years. In a d u lt w o m en w h o h a d liv ed all th e ir liv es in th e to w n , caries p rev a len c e w as c o n s id erab ly low er th a n in a co m p arab le g ro u p in th e flu o rid e-d efic ien t tow n. T he m o rtality rates in th e se co m m u n itie s w ere e x a m in e d w ith re s p e c t to c a rd io v a sc u la r a n d re n a l diseases. T h ese d iseases w ere c h o s e n as p o s s ib le c o n s e q u e n c e s of “ fo cal in f e c tio n ” th a t m ig h t h av e b een d u e to d en tal d isease. In a d d i tio n , fo r th e sa k e of c o m p a ris o n , m o r ta lity r a te s fo r tu b e r c u lo s is , a c u te in fe c tio u s d ise a s e s , a n d all o th e r cau ses w ere ex am in ed . . . . A s ta tis tic a lly s ig n ific a n t d iffe re n c e w a s d e m o n s tr a te d in d e a th ra te s from card io v asc u la r an d ren al d is eases, w ith th e h ig h e r in c id e n c e in th e flu o rid e-d eficien t tow n. J A D A , V o l. 9 9 , S e p te m b e r 1 9 7 9 ■ 4 3 3
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If th is difference h ad been d u e u n eq u iv o cally to th e h ig h e r in c id en ce of focal diseases, a low er m ean age at d ea th sh o u ld have b een found in the flu o rid e-d efic ien t co m m u n ity . T his w as not th e case. T h e difference w as a c tu a lly d u e to m ore deaths am ong th o se over 40 years in th e fluorideric h c o m m u n ity . N o u n e q u iv o c a l c o n c lu sio n s co u ld be d raw n from th is stu d y w h ich covered five-year p erio d s b etw e en 1901 a n d 1915 and b etw een 1921 an d 1940. B artha a ttrib u te d th e am biguous resu lts to th e q u estio n a b le reliability of th e p rim e cause of d eath as given in th e registers by lay coroners for m a n y y ears before m edical p ra c ti tio n e rs began to m ake th e d eath cer tificates, an d to th e lack of data on th e f lu o rid e le v e ls in c o m m u n ity w ate r su p p lie s w h e n w ell w ater w as used. P. A D L E R , M D D E B R E C E N , H U N G A R Y
1.
H a g a n , T .L .; P a s te rn a c k ,
G .C . W a t e r - b o r n e lic
H e a lth 2.
f lu o r id e s
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a n d
S c h o lz ,
m o r ta lity . P u b
R e p 6 9 ( 5 ):4 5 0 -4 5 4 , 1 9 5 4 .
Le on e,
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N .C ., a n d flu o r id e
o th e rs .
in
M e d ic a l a s p e c ts
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H e a lth R e p 6 9 ( 1 0 ):9 2 5 - 9 3 6 , 1 9 5 4 . 3.
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O d o n to g e n e
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M o r ta lita ts s ta tis tik .
Z a h n a r z t l R u n d s c h a u 6 5 ( 1 3 ):3 1 1 -3 1 5 , 1 9 5 6 .
The professions under siege □ Its a long tim e since I have read s u c h an in te llig e n t a n d c o g e n tly w ritte n p ie c e as “ T h e pro fessio n s u n d e r sie g e” (The Journal, A pril) or one so ap t w o rld w id e. . . . D O N A L D D. D ERRICK , D DS LO N DO N
□ T h e le tte r by Dr. H arv ey (The Journal, July) gave an excellent d efi n itio n o f a p r o fe s s io n . To th is I w o u ld like to ad d another: “ If th e re is su c h a th in g as a p ro fession, as a c o n c ep t d istin ct from a v o c a tio n , it m u s t c o n s is t in th e id eals w h ich its m em bers m aintain, th e d ig n ity of character w h ich they b rin g to th e p e rfo rm a n c e of th e ir d u tie s , a n d th e a u s te r ity of th e ir self-im posed eth ical sta n d a rd s” (W. A. S chum aker, E ditor, Law N otes). It m ig h t be of in te rest to n o te th at 434
■ J A D A , V o l. 9 9 , S e p te m b e r 197 9
today, w h ile m em bers of o u r p ro fes sion m ay still m a in ta in th eir ideals a n d m ay still perform th e ir d u tie s w ith d ig n ity of character, they u n fo rtu n ately are now d ep riv e d of th e a u sterity of th e ir self-im posed e th i cal sta n d a rd s by g o v ern m en tal ac tion. O nly th e b attle w as lost, not the w ar. Let us co n tin u e w ith our h igh ideals an d perform our d u ties w ith d ig n ity of ch aracter. O nly th u s w ill th e p ro fe s s io n su rv iv e , if e th ic a l sta n d a rd s are m a in ta in ed on an in d iv id u a l basis. M IL T O N
S. T R A V IN , D D S B R O O K L Y N
State could learn from NHS □ A lth o u g h th e B ritish N a tio n a l H ealth S ervice h as m any defects in i t s d e n t a l c a r e p r o v i s i o n s , D r. N eib u rg e r (The Journal, M ay) d id n o t ad v a n ce th e p o in t of h is le tte r by referring to it. T he p ro v isio n of em erg en cy ser vices an d treatm en t is clearly laid o ut in th e NHS reg u latio n s. A n a p p ro p ria te co m p u ter form is available fo r s e n d in g fo r a u th o r iz a tio n of p a y m e n t fo r s u c h tr e a tm e n t, fo r w h ic h n o p a y m e n t w o u ld b e r e fused. T he fees for em ergency trea t m en t are p u b lis h e d an d are k ep t in th e d en tal office. I am n o t fu lly acq u ain ted w ith th e p rogram of th e Illin o is D epartm ent of P u b lic A id , b ut w ith re g a rd to em ergency treatm en t, as ex p lain ed by Dr. N eiburger, th e state does not a p p e a r to have learn ed from th e d e n tal service p ro v id ed in G reat B ritain. T here are a n u m b er of good p o in ts in th e p ro v isio n of d en tal care w ith in th e N ation al H ealth Service, b u t they are n o t th e p o in t of d isc u ssio n here.
c h ild r e n , u s in g th e P re c is io n i n stru m e n t, w as describ ed in a 1962 p u b licatio n . A ctually, th e 1962 article featu red a ten-film series u sin g # 0 ch ild film . In O ctober 1967, Paul E lcan an d I p u b lis h e d “ A p recisio n te c h n ic to re d u c e ra d ia tio n ” in D ental Survey. T h is p ap e r featu red a six-film fullm o u th e x a m in a tio n fo r th e p r e sch o o l child. A d u lt sta n d a rd # 2 film w a s u s e d w ith a P r e c is io n film h o ld e r (the Elcan) d esig n ed for o c c l u s a l v ie w s w ith f u ll i n tr a o r a l sh ield in g . T he series described in m y July le tte r is a n ew co m b in atio n u sin g tw o sta n d ard # 2 a d u lt film s for th e a n te r io r te e th a n d fo u r # 0 c h ild film s for th e p o sterio r te eth (Illus tration). F. M . M E D W E D E F F , D D S N A S H V IL L E , T E N N
D . R. M IN C H O M , B D S. L D S , R CS P A R K R O Y A L , UK
State boards Pedodontic survey □ M y co m m en t (The Journal, July) o n th e a rtic le by W hite a n d Rose (The Jo u rn al, A pril) w as in co rrectly e d ite d to in d icate th a t m y six-film fu ll-m o u th in trao ral ex am in atio n for
□ A p p lau se, applause! F in ally w e fin d som eone w ith th e nerv e to c h a l len g e an in stitu tio n th at is n o t o nly o u td ated , b ut obsolete (The Journal, J u ly ) .. . . I co u ld n ot agree m o re w ith T ain to r, B iesterfeld, and Jam es, m y m en to rs from N ebraska. If th e b o ard s