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“GET THE GOVERNMENT OUT OF MY LIFE”
LETTERS
LETTERS JADA 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, doublespaced 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.
BOUNDED EDENTULOUS SPACES
The article by Dr. Daniel Shugars et al. concerning posterior bounded edentulous spaces (August JADA) was most welcome because it answered questions I’ve wondered about ever since I began practicing dentistry back in 1971. Periodically, I’ll see patients, usually in their forties or older, who have been missing posterior teeth for many years and are doing just fine dentally. In most cases, the dentition is stable, function and health are fine, and no progressive problems exist. The patient is usually seeking a second opinion and is very concerned because another dentist has recently advised him or her that the missing teeth need to be replaced to prevent serious (and inevitable) deterioration of the remaining dentition. Since things are stable and any problems that might have been prevented by replacement of the missing teeth have either not occurred (the usual case) or have already devel-
oped, the justification for replacing the missing teeth at that point has always been a mystery to me. Since more than a few dentists were telling their patients the same story, I always supposed I must have slept through that lecture in dental school and in the two-year general dentistry residency I completed later and in the lectures I sat in on as a staff member (five years) and director (five more) of one-year general dentistry residencies. Dr. Shugars et al. have done an excellent job of reviewing this important issue and pointing out the great paucity of any evidence showing that restoration of a BES improves the prognosis for adjacent teeth. Their list of issues the profession needs to address on this topic would apply to the evaluation of other clinical practices as well. I look forward to seeing subsequent articles by this group. John G. Warnick, D.D.S., M.S. Beavercreek, Ohio ‘GET THE GOVERNMENT OUT OF MY LIFE’
I was appalled to read your antitobacco diatribe masquerading as an editorial in September JADA (“ ‘Public Health Malpractice, Plain and Simple’ ”). That one of our “leaders” in the ADA would advocate using federal government intervention as a panacea for the “evils” of tobacco is a sad commentary on the state of our society and profession today. Whatever happened to personal responsibility? Doesn’t the one who decides to smoke cigarettes make a decision regarding the risks and
benefits? Please don’t try to tell me that the “evil tobacco empire” has brainwashed the public into believing that cigarettes are harmless. The Surgeon General’s health warning has been on a pack of cigarettes since I was a child (I am 42 years old, and that warning has been on the cigarette pack since the 1960s). I particularly liked your advocacy of the $1.10 tax per pack of cigarettes. Maybe we should put a $1.10 tax on a Big Mac and fries. We know that intake of saturated fats increases the risk of heart disease and myocardial infarction, so let’s “protect” the public against the health hazard of a high-fat diet by taxing these foods so as to be unaffordable. After all, we wouldn’t want people to have to use good judgment. Let’s just have the government protect us to save us the trouble of exercising reason. Maybe if the federal government didn’t get into the business of paying for health care, it wouldn’t care about the costs of cigarette smoking. Please get the federal government out of my life and everyone else’s. I do not smoke and I never intend to. I watch my diet and exercise because I want to, but I don’t want anyone to tell me I have to! Maybe you feel the need for the federal government to legislate your lifestyle, but I do not. Just get the government to stop subsidizing tobacco farmers and leave it at that. (It is absurd that the government subsidizes tobacco farming and then spends billions to keep people from smoking.) Just get the government to stop subsidizing careless lifestyles (by paying for health
JADA, Vol. 129, November 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
1521
LETTERS care for those not responsible enough to buy health insurance or control their overindulgent lifestyles) and we won’t have to worry about such pressing “public health malpractice” as cigarette smoking. As a dentist and oral and maxillofacial surgeon, I would not encourage anyone to smoke cigarettes or use tobacco in any form. However, I do not feel compelled to be an antismoking/tobacco crusader. People know the risks, and if they are stupid enough to make the wrong choice then let them suffer the consequences without blaming others for their folly. People such as you frighten me and make me wonder where reason has gone. Gregory W. Dimmich, D.M.D. via e-mail AEROSOL AND SPLATTER
The article, “Aerosol and Splatter Contamination From the Operative Site During Ultrasonic Scaling,” by Drs. Steve K. Harrel, James B. Barnes and Francisco RiveraHidalgo (September JADA), illustrates the potential for infectious aerosol contamination of our working environment. Their study and conclusions point out in detail the origin of the problem. As they note, the use of proper flows into the high-volume evacuation, or HVE, system is critical. However, in practice the single operator often has difficulty making efficient use of the HVE along with treatment instruments and resorts to the saliva ejector, which is very inefficient, as the authors state. I offer a further suggestion for aerosol control in the application of “laminar air” technology with1524
in the treatment room. My studies for NASA on the problem of environmental control and aerosol containment within space vehicles revealed the effectiveness of a laminar air flow to direct aerosols down and away from the crew/dental team and into a recovery collector, where the contamination was removed. The recirculation of aerosolladen air throughout a facility should not be encouraged. In a dental treatment room, the simple placement of a return air collector for the central air conditioning system at baseboard level in the vicinity of the foot of the dental chair achieves remarkable results in aerosol control. In most dental offices, the incoming conditioned air enters the room from the ceiling or high-mounted wall outlets near the head of the patient. Simply placing a return duct to direct the flow down and away from the operating team and patient creates an air flow that directs the aerosol away from the breathing zone of the operators. Obviously, balancing the air system to create this flow is a simple matter of damper adjustment in the HVAC system. Return air filtration, up to and including HEPA filtration, is recommended for maximum control. A qualified heating and air conditioning firm can easily and inexpensively convert most existing systems to provide laminar air within the treatment room. It is highly recommended that all new dental office construction incorporate this system. Congratulations, again, on an excellent article. John M. Young, D.D.S., M.Sc.
University of Texas Dental School Department of General Dentistry San Antonio WHO’S IN CHARGE? YOU ARE
I very much enjoyed reading your editorial, “Who’s in Charge? You Are” (August JADA), and it stimulated some strong memories and questions. I, too, remember the ego-centered dental attitudes of the 1970s and remember the wars fought over whether dental assistants should be permitted to take alginate impressions for study models. We missed the boat then, and appear to be in serious danger of missing it again. Are we really worried about the hygienists’ lobby? Or should we be more worried about the wellfunded insurance lobby, which certainly has nothing to lose and much to gain from independent hygiene practice? No, I don’t think their lobby proves more harmful to the welfare of dental patients than the intrusion of third-party financial entities. Third-party financial entities have one objective: profit and low-cost dentistry. Where no value is placed on our services, price and profit are the only issues. Independent hygiene practice is not good for patients, and it’s certainly not good for dentistry. Maybe the reason hygienists feel the need to be so independent is that they are overtrained for what they can really do. If we were to establish the doctor as the controlling force in the office, with rights to train and evaluate personnel and who had the ultimate responsibility for every-
JADA, Vol. 129, November 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
LETTERS JADA 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, doublespaced 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.
BOUNDED EDENTULOUS SPACES
The article by Dr. Daniel Shugars et al. concerning posterior bounded edentulous spaces (August JADA) was most welcome because it answered questions I’ve wondered about ever since I began practicing dentistry back in 1971. Periodically, I’ll see patients, usually in their forties or older, who have been missing posterior teeth for many years and are doing just fine dentally. In most cases, the dentition is stable, function and health are fine, and no progressive problems exist. The patient is usually seeking a second opinion and is very concerned because another dentist has recently advised him or her that the missing teeth need to be replaced to prevent serious (and inevitable) deterioration of the remaining dentition. Since things are stable and any problems that might have been prevented by replacement of the missing teeth have either not occurred (the usual case) or have already devel-
oped, the justification for replacing the missing teeth at that point has always been a mystery to me. Since more than a few dentists were telling their patients the same story, I always supposed I must have slept through that lecture in dental school and in the two-year general dentistry residency I completed later and in the lectures I sat in on as a staff member (five years) and director (five more) of one-year general dentistry residencies. Dr. Shugars et al. have done an excellent job of reviewing this important issue and pointing out the great paucity of any evidence showing that restoration of a BES improves the prognosis for adjacent teeth. Their list of issues the profession needs to address on this topic would apply to the evaluation of other clinical practices as well. I look forward to seeing subsequent articles by this group. John G. Warnick, D.D.S., M.S. Beavercreek, Ohio ‘GET THE GOVERNMENT OUT OF MY LIFE’
I was appalled to read your antitobacco diatribe masquerading as an editorial in September JADA (“ ‘Public Health Malpractice, Plain and Simple’ ”). That one of our “leaders” in the ADA would advocate using federal government intervention as a panacea for the “evils” of tobacco is a sad commentary on the state of our society and profession today. Whatever happened to personal responsibility? Doesn’t the one who decides to smoke cigarettes make a decision regarding the risks and
benefits? Please don’t try to tell me that the “evil tobacco empire” has brainwashed the public into believing that cigarettes are harmless. The Surgeon General’s health warning has been on a pack of cigarettes since I was a child (I am 42 years old, and that warning has been on the cigarette pack since the 1960s). I particularly liked your advocacy of the $1.10 tax per pack of cigarettes. Maybe we should put a $1.10 tax on a Big Mac and fries. We know that intake of saturated fats increases the risk of heart disease and myocardial infarction, so let’s “protect” the public against the health hazard of a high-fat diet by taxing these foods so as to be unaffordable. After all, we wouldn’t want people to have to use good judgment. Let’s just have the government protect us to save us the trouble of exercising reason. Maybe if the federal government didn’t get into the business of paying for health care, it wouldn’t care about the costs of cigarette smoking. Please get the federal government out of my life and everyone else’s. I do not smoke and I never intend to. I watch my diet and exercise because I want to, but I don’t want anyone to tell me I have to! Maybe you feel the need for the federal government to legislate your lifestyle, but I do not. Just get the government to stop subsidizing tobacco farmers and leave it at that. (It is absurd that the government subsidizes tobacco farming and then spends billions to keep people from smoking.) Just get the government to stop subsidizing careless lifestyles (by paying for health
JADA, Vol. 129, November 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.
1521
LETTERS care for those not responsible enough to buy health insurance or control their overindulgent lifestyles) and we won’t have to worry about such pressing “public health malpractice” as cigarette smoking. As a dentist and oral and maxillofacial surgeon, I would not encourage anyone to smoke cigarettes or use tobacco in any form. However, I do not feel compelled to be an antismoking/tobacco crusader. People know the risks, and if they are stupid enough to make the wrong choice then let them suffer the consequences without blaming others for their folly. People such as you frighten me and make me wonder where reason has gone. Gregory W. Dimmich, D.M.D. via e-mail AEROSOL AND SPLATTER
The article, “Aerosol and Splatter Contamination From the Operative Site During Ultrasonic Scaling,” by Drs. Steve K. Harrel, James B. Barnes and Francisco RiveraHidalgo (September JADA), illustrates the potential for infectious aerosol contamination of our working environment. Their study and conclusions point out in detail the origin of the problem. As they note, the use of proper flows into the high-volume evacuation, or HVE, system is critical. However, in practice the single operator often has difficulty making efficient use of the HVE along with treatment instruments and resorts to the saliva ejector, which is very inefficient, as the authors state. I offer a further suggestion for aerosol control in the application of “laminar air” technology with1524
in the treatment room. My studies for NASA on the problem of environmental control and aerosol containment within space vehicles revealed the effectiveness of a laminar air flow to direct aerosols down and away from the crew/dental team and into a recovery collector, where the contamination was removed. The recirculation of aerosolladen air throughout a facility should not be encouraged. In a dental treatment room, the simple placement of a return air collector for the central air conditioning system at baseboard level in the vicinity of the foot of the dental chair achieves remarkable results in aerosol control. In most dental offices, the incoming conditioned air enters the room from the ceiling or high-mounted wall outlets near the head of the patient. Simply placing a return duct to direct the flow down and away from the operating team and patient creates an air flow that directs the aerosol away from the breathing zone of the operators. Obviously, balancing the air system to create this flow is a simple matter of damper adjustment in the HVAC system. Return air filtration, up to and including HEPA filtration, is recommended for maximum control. A qualified heating and air conditioning firm can easily and inexpensively convert most existing systems to provide laminar air within the treatment room. It is highly recommended that all new dental office construction incorporate this system. Congratulations, again, on an excellent article. John M. Young, D.D.S., M.Sc.
University of Texas Dental School Department of General Dentistry San Antonio WHO’S IN CHARGE? YOU ARE
I very much enjoyed reading your editorial, “Who’s in Charge? You Are” (August JADA), and it stimulated some strong memories and questions. I, too, remember the ego-centered dental attitudes of the 1970s and remember the wars fought over whether dental assistants should be permitted to take alginate impressions for study models. We missed the boat then, and appear to be in serious danger of missing it again. Are we really worried about the hygienists’ lobby? Or should we be more worried about the wellfunded insurance lobby, which certainly has nothing to lose and much to gain from independent hygiene practice? No, I don’t think their lobby proves more harmful to the welfare of dental patients than the intrusion of third-party financial entities. Third-party financial entities have one objective: profit and low-cost dentistry. Where no value is placed on our services, price and profit are the only issues. Independent hygiene practice is not good for patients, and it’s certainly not good for dentistry. Maybe the reason hygienists feel the need to be so independent is that they are overtrained for what they can really do. If we were to establish the doctor as the controlling force in the office, with rights to train and evaluate personnel and who had the ultimate responsibility for every-
JADA, Vol. 129, November 1998 Copyright ©1998-2001 American Dental Association. All rights reserved.