- Email: [email protected]
Keep it civil
with glycoproteins that form the saliva-based, pellicle coating of the teeth, which may provide attachment sites for oral bacteria. Interactions may also involve nonpellicle–forming glycoproteins that can agglutinate oral bacteria and prevent attachment. Individual differences were noted between the properties of bacterial binding to pellicle proteins and the bacterial agglutination by non-pellicle forming proteins. Bacterial binding shows a positive correlation of cariogenic bacteria binding with caries history. Bacterial agglutination strength shows a negative correlation with caries history. Peanut agglutinin (PNA) lectin binding correlated with caries-resistant and caries-susceptible children, so elevated galactose β1,3 galactosamine on salivary glycoproteins may contribute to a protective effect against caries. None of the lectin affinities was individually strong enough to predict accurately individual caries histories or risk levels.
Clinical Significance.—Understanding the susceptibility of individuals to caries permits focusing preventive measures. Rather than studying specific microorganisms, the saliva test described here deals with salivary chemistry, oligosaccharides, and their influence on pellicle/plaque formation versus agglutination of oral bacteria.
Denny PC, Denny PA, Takashima J, et al: A novel saliva test for caries risk assessment. Calif Dent Assoc J 34:287-294, 2006 Reprints available from PC Denny, Den 4114A, Mail Code 0641, Div 2DSC, Univ of Southern California, School of Dentistry, 925 W 34th St, Los Angeles, CA 90089
Dental Ethics Keep it civil Background.—Dentists may criticize and demean fellow dentists, publicly commenting on mistakes or minor incidents that they may have, in fact, experienced in their own practice. Some dentists criticize others out of jealousy for having become successful. Often, the purpose is to win a patient to the practice, but the issue can be blown out of proportion, with 1 case of microleakage under temporary restorations going all the way to court when a fellow dentist sounded off to the patient involved. Such critical behavior creates a distrust of dentists in general in the minds of the public. Bashing Others.—The dental internet forums permit dentists to say things that they would never have said to a person’s face. Hiding behind the anonymity of a computer and delivering venomous attacks is both unprofessional and unacceptable. Furthermore, editorials and professional publications have promulgated as facts things that were merely heard or thought. Often authors’ attempts to discredit others are based on insufficient, inaccurate, and mis-
taken “knowledge.” Like the McCarthyism of a previous age, it is wrong behavior and paints every dentist with a broad stroke of unprofessional actions. Personal Opinion and Practice.—Dentists generally try to do what they believe is best for their patients. Questioning the ethics of a dentist who holds personal beliefs different from your own is especially troubling. The moral police of dentistry do not exist. Dentists differ in their beliefs of what is right, and challenging their ethics because their beliefs differ from yours is inappropriate. What Goes Around Backfires.—Speakers who use their platform to discredit others generally end up discrediting themselves in the eyes of the majority of their listeners. Dentists lose respect for speakers who use this tactic of criticizing other dentists or other groups rather than merely presenting their personal beliefs and philosophies.
Volume 52 • Issue 1 • 2007 11
A Better Course.—You may personally believe that some dentists are doing what is wrong compared to the way that you would do the same thing. Personally attacking these individuals by labeling them as unethical or morally wrong is the wrong approach. It is fairer to see them as misguided or as not knowing what they don’t know. To use your position as a speaker or author or simply as a dentist to whom a patient has appealed after a difficult situation to discredit others is not appropriate. Beyond avoiding this behavior personally, it is each dentist’s responsibility to approach people who are discrediting others and tell them to please stop. Such behavior gives dentistry in general a black eye and hurts all practitioners, most of whom are genuinely trying to do what is right.
Clinical Significance.—Children shouldn’t hear parents criticize each other. Silly analogy, perhaps; but many years ago, I listened to a prominent lecturer/author vehemently attack another lecturer/author, much to his own discredit. Ethics may require us to be critical; we must also be fair.
Dickerson WG: Are we destroying the profession from within? LVI Visions July/Aug/Sept pp 6-8, 2006 Reprints not available
Devices Dental loupes Background.—Dental magnification can change the way a dentist practices. With proper adjustments, magnification significantly increases the quality of care delivered and makes the practice environment safer and healthier. Adjustments.—Changes introduced by dental magnification involve the depth of field and the size of the viewable field. The depth of field decreases, which limits body movement. Low-magnification loupes provide the greatest field depth and can ease the adjustment to the use of magnification. In making adaptations, some practitioners feel slightly dizzy at first. Rather than giving up or looking around the lens, it is best to limit yourself to simple procedures for a week or so until you become more comfortable. In addition, securing the headband tightly prevents movements of the loupes, which can be disconcerting. Gains.—All objects in the viewable field become larger and clearer. Thus, you no longer have to work so closely to the patient. This means that the common position of having the tip of your nose touch the patient’s tongue is not needed. You will no longer experience the spray of saliva and blood from the patient. Viewing from a longer distance permits you to practice in a more ergonomic position. Within a year or so, you can move to higher magnification loupes. A prismatic system that is more complex than the Galilean system of low magnification is commonly required for magnifications higher than 3. The best loupes in the range of 3.5 to 5 combine excellent optics and good ergonomic design. These have the advantage of reducing eyestrain and
12 Dental Abstracts
general fatigue. Higher magnification does limit the depth of field and size of the viewable field; again, you must stick with it and become used to the new way to see the world. Discussion.—Investing in dental magnification loupes can pay significant dividends in the long run. You can work by using a more ergonomic posture and avoid the negative effects of being so close to the patient. Making the adjustment requires time and patience. It is best to work first with low-magnification devices, then move to the higher magnification loupes. The next step will be the microscope, which is quickly being adapted for use in general dental practice.
Clinical Significance.—If you can’t see it, you can’t do it. If you think you still have the visual acuity you enjoyed when you were 25, forget it. Multi-lens systems, either Galilean or prismatic, will both improve the quality of your work as well as reduce stress. If you haven’t already, the time to start is now. Get magnification and get used to it. Surgical microscopes will be the next step toward better visualization.
Sadan A: Technologies that alter the way we practice. Quintessence Int 37:89, 2006 Reprints not available
Clinical Significance.—Understanding the susceptibility of individuals to caries permits focusing preventive measures. Rather than studying specific microorganisms, the saliva test described here deals with salivary chemistry, oligosaccharides, and their influence on pellicle/plaque formation versus agglutination of oral bacteria.
Denny PC, Denny PA, Takashima J, et al: A novel saliva test for caries risk assessment. Calif Dent Assoc J 34:287-294, 2006 Reprints available from PC Denny, Den 4114A, Mail Code 0641, Div 2DSC, Univ of Southern California, School of Dentistry, 925 W 34th St, Los Angeles, CA 90089
Dental Ethics Keep it civil Background.—Dentists may criticize and demean fellow dentists, publicly commenting on mistakes or minor incidents that they may have, in fact, experienced in their own practice. Some dentists criticize others out of jealousy for having become successful. Often, the purpose is to win a patient to the practice, but the issue can be blown out of proportion, with 1 case of microleakage under temporary restorations going all the way to court when a fellow dentist sounded off to the patient involved. Such critical behavior creates a distrust of dentists in general in the minds of the public. Bashing Others.—The dental internet forums permit dentists to say things that they would never have said to a person’s face. Hiding behind the anonymity of a computer and delivering venomous attacks is both unprofessional and unacceptable. Furthermore, editorials and professional publications have promulgated as facts things that were merely heard or thought. Often authors’ attempts to discredit others are based on insufficient, inaccurate, and mis-
taken “knowledge.” Like the McCarthyism of a previous age, it is wrong behavior and paints every dentist with a broad stroke of unprofessional actions. Personal Opinion and Practice.—Dentists generally try to do what they believe is best for their patients. Questioning the ethics of a dentist who holds personal beliefs different from your own is especially troubling. The moral police of dentistry do not exist. Dentists differ in their beliefs of what is right, and challenging their ethics because their beliefs differ from yours is inappropriate. What Goes Around Backfires.—Speakers who use their platform to discredit others generally end up discrediting themselves in the eyes of the majority of their listeners. Dentists lose respect for speakers who use this tactic of criticizing other dentists or other groups rather than merely presenting their personal beliefs and philosophies.
Volume 52 • Issue 1 • 2007 11
A Better Course.—You may personally believe that some dentists are doing what is wrong compared to the way that you would do the same thing. Personally attacking these individuals by labeling them as unethical or morally wrong is the wrong approach. It is fairer to see them as misguided or as not knowing what they don’t know. To use your position as a speaker or author or simply as a dentist to whom a patient has appealed after a difficult situation to discredit others is not appropriate. Beyond avoiding this behavior personally, it is each dentist’s responsibility to approach people who are discrediting others and tell them to please stop. Such behavior gives dentistry in general a black eye and hurts all practitioners, most of whom are genuinely trying to do what is right.
Clinical Significance.—Children shouldn’t hear parents criticize each other. Silly analogy, perhaps; but many years ago, I listened to a prominent lecturer/author vehemently attack another lecturer/author, much to his own discredit. Ethics may require us to be critical; we must also be fair.
Dickerson WG: Are we destroying the profession from within? LVI Visions July/Aug/Sept pp 6-8, 2006 Reprints not available
Devices Dental loupes Background.—Dental magnification can change the way a dentist practices. With proper adjustments, magnification significantly increases the quality of care delivered and makes the practice environment safer and healthier. Adjustments.—Changes introduced by dental magnification involve the depth of field and the size of the viewable field. The depth of field decreases, which limits body movement. Low-magnification loupes provide the greatest field depth and can ease the adjustment to the use of magnification. In making adaptations, some practitioners feel slightly dizzy at first. Rather than giving up or looking around the lens, it is best to limit yourself to simple procedures for a week or so until you become more comfortable. In addition, securing the headband tightly prevents movements of the loupes, which can be disconcerting. Gains.—All objects in the viewable field become larger and clearer. Thus, you no longer have to work so closely to the patient. This means that the common position of having the tip of your nose touch the patient’s tongue is not needed. You will no longer experience the spray of saliva and blood from the patient. Viewing from a longer distance permits you to practice in a more ergonomic position. Within a year or so, you can move to higher magnification loupes. A prismatic system that is more complex than the Galilean system of low magnification is commonly required for magnifications higher than 3. The best loupes in the range of 3.5 to 5 combine excellent optics and good ergonomic design. These have the advantage of reducing eyestrain and
12 Dental Abstracts
general fatigue. Higher magnification does limit the depth of field and size of the viewable field; again, you must stick with it and become used to the new way to see the world. Discussion.—Investing in dental magnification loupes can pay significant dividends in the long run. You can work by using a more ergonomic posture and avoid the negative effects of being so close to the patient. Making the adjustment requires time and patience. It is best to work first with low-magnification devices, then move to the higher magnification loupes. The next step will be the microscope, which is quickly being adapted for use in general dental practice.
Clinical Significance.—If you can’t see it, you can’t do it. If you think you still have the visual acuity you enjoyed when you were 25, forget it. Multi-lens systems, either Galilean or prismatic, will both improve the quality of your work as well as reduce stress. If you haven’t already, the time to start is now. Get magnification and get used to it. Surgical microscopes will be the next step toward better visualization.
Sadan A: Technologies that alter the way we practice. Quintessence Int 37:89, 2006 Reprints not available