Licensure

dentistry won’t h u rt our p atients or us either! Dr. Lewis’s TV presentation was a g reat em barrassm ent to the dental jk profession (and I for one regret m that). However, jr Jf if one or more m lives are Y m saved in each practice by his forcing the I issue, perhaps it will be worth it. Somehow I feel we will survive and come out of this as a more highly respected profession. I certainly hope so, because I w ant to stick around until we life m em bers again get free dues! J a m es F. Ford, D.D.S. C h attan ooga, Tenn. P U B L IC IM A G E

“How dentists see them selves, th eir profession, the public” was flawed (December). The article addressed well the issues concerning how dentists see them selves and their profes­ sion. U nderstandably, as the article pointed out, dentists’ cu rren t feelings about the profession are gloomy and only h a lf would choose dentistry as a career today. B ut why be concerned about w hat dentists perceive to be the public’s image of dentistry, or w hat dentists th ink should be done to improve the public’s image of dentistry, or w hat factors dentists believe affect the public’s image of dentistry? W hat difference does th a t really m ake? Go to the source! Ask the public their views on those topics. You would receive different answers. W ould you ask a. store m anager how custom ers feel about the store’s advertising policy or 16

JADA, Vol. 124, F ebruary 1993

would you ask custom ers? Why would you ask dentists how they feel about dental adver­ tising? You know the answer! Why not ask patients? Who cares if a m ajority of dentists surveyed in this article believe th a t dental advertising is harm ful to the profession’s image? Ask patients! Why not conduct patien t m arketing studies as I did for years? You would find th a t p atients view it totally differently—they love it! We have been brainw ashed into believing th a t patients do not like advertising by professionals, and we accept th a t as gospel. Not so! If dentists were asked if they believed in discounts, they would vote against th a t too— unless it was a non-dental item th a t THEY w anted to purchase—like a car or boat! Then they would buy it only w here they got the biggest discount. Hypocrisy! H. P a u l J a co b i, D.D.S. P alm H arbor, Fla. E Q U IP M E N T P U R C H A S E S

Are we suckers when it comes to evaluating m ajor equipm ent purchases? A laser m anufac­ tu re r will gladly charge us $400 to take their sem inar so we may purchase th eir $50,000 unit. A nother company will happily charge you a sim ilar am ount so you can purchase th eir (expensive) computerized ceramic milling machine. And perhaps you chose not to purchase because the equipm ent is prem ature, not cost effective or very lim ited in clinical use. So you blew the tuition. And the nerve of m anufacturers who ask us to buy sam ples for distribution so we can act as (unpaid)

salespersons for th eir product. B ut m ost of us (not I) do m ake these expenditures. I have noted among my physician friends th a t when new equipm ent is coming on the m arket for medical use, the m anufacturer will wine and dine them (gratis) even though the equipm ent m ay be purchased by th e hospital. Product samples are generously and gladly dispensed for patient sta rte r use—and a t no charge, not even for the shipping. Wake up, colleagues!! If you refuse to be party to these m achinations, the m anufacturers will listen up and tre a t us w ith a respect equal to our medical colleagues. H arold V. C ohen, D.D.S. Old B rid ge, N.J. L IC E N S U R E

After 25 years as a licensed dentist watching the endless debate on licensure, I am so tired of the sanctimonious posturings of state board officials from the most restrictive states pretending th a t they are protecting the public by their low pass rates for non-resident dentists w anting to move into th eir states. It would be refreshing for them to simply adm it th a t they were using the licensure process to preserve m aximal economic opportunity for th eir own sta te ’s residents and to preserve the economic viability of existing practices, and tailor the growth in licensed dentists in th eir state to the growth in the sta te ’s population and to also (possibly) address problems of m aldistribution w ithin the state. D entists are

ORAL RINSE

F B R I D G X (mtiMDr£auc(MEû0i)

NDC #37000-007-01

DESCRIPTION: Peridex is an oral rinse containing 0.12% chlorhexidine gluconate (I, I 'hexamethylene bis [5-(p-chlorophenyl) b iguanidej di-D-gluconateJ in a base containing water. 11.6% alcohol, glycerin, PEG-40 sorbitan diisostearate, flavor, sodium saccharin, and FD&C Blue No. I. Peridex is a near-neutral solution (pH range 5-7). Chlorhexidine gluconate is a salt o f chlorhexidine and gluco n ic acid. Its chem ical structure is: NH NH

NH NH

H OH H H •2

IH OOC —<|— i —C—i — OV3M J OH H OH OH

INDICATION: Peridex is indicated for use between dental visits as part o f a professional program for the treatm ent o f gingivitis as characterized by redness and sw elling o f the gingivae, including gingival bleeding u po n probing. Peridex has n ot been tested am ong patients w ith acute necrotizing ulcerative gingivitis (ANUG). For patients having coexisting gingivitis and periodontitis, see PRECAUTIONS.

CONTRAINDICATIONS: Peridex should n ot be used by persons w h o are kn o w n to be hypersensitive to chlorhexidine gluconate.

WARNINGS: The effect o f Peridex on periodontitis has not been determ ined. An increase in supragingival calculus w as noted in clinical testing in Peridex users compared w ith control users. It is n ot kn o w n if Peridex use results in an increase in subgingival calculus. Calculus deposits should be removed b y a dental prophylaxis a t intervals n o t greater than six months. Rare hypersensitivity a nd generalized allergic reactions have also been reported. Peridex should n o t be used by persons w h o have a sensitivity to it o r its components.

PRECAUTIONS: GENERAL: 1. For patients having coexisting gingivitis and periodontitis, the presence or absence o f gingival inflam m ation fo llo w in g treatm ent w ith Peridex should n o t be used as a m ajor indicator o f underlying periodontitis. 2. Peridex can cause staining o f oral surfaces, such as tooth surfaces, restorations, and the dorsum o f the tongue. N o t all patients w ill experience a visually significant increase in toothstaining. In clinical testing, 56% o f Peridex users exhibited a measurable increase in facial anterior stain, com pared to 35% o f control users after six months; 15% o f Peridex users developed w h a t was ju d g e d to be heavy stain, com pared to 1% o f control users after six months. Stain w ill be m ore pronounced in patients w h o have heavier accum ulations o f unrem oved plaque. Stain resulting from use o f Peridex does n ot adversely affect health o f the gingivae or other oral tissues. Stain can be removed fro m most tooth surfaces by conventional professional prophylactic techniques. A dd itio na l tim e may be required to com plete the prophylaxis. Discretion should be used w h e n prescribing to patients w ith anterior facial restorations w ith rough surfaces o r margins. If natural stain cannot be removed from these surfaces by a dental prophylaxis, patients should be excluded from Peridex treatm ent if permanent d iscoloration is unacceptable. Stain in these areas may be d ifficult to remove by dental prophylaxis and o n rare occasions m ay necessitate replacement o f these restorations. 3. Some patients m ay experience an alteration in taste perception w h ile undergoing treatment w ith Peridex. M o st patients accom m odate to this effect w ith continued use o f Peridex. N o instances o f perm anent taste a lteration due to Peridex have been reported.

USAGE IN PREGNANCY: Pregnancy Category B. Reproduction and fertility studies w ith chlorhexidine gluconate have been conducted. N o evidence o f im paired fertility was observed in rats a t doses up to 100 m g/kg/day, a nd no evidence o f harm to the fetus was observed in rats and rabbits a t doses u p to 300 m g /kg /d a y a nd 40 m g /k g /d a y respectively. These doses are approxim ately 100, 300, and 40 times tha t w h ich w o u ld result from a person's ingesting 30 ml (2 capfuls) o f Peridex per day. Since controlled studies in pregnant w o m e n have n ot been conducted, the benefits o f the drug in pregnant w o m e n should be w e ig he d against possible risk to the fetus. NURSING MOTHERS: It is n o t k n o w n w h e th e r this drug is excreted in hum an milk. Because m any drugs are excreted in hum an milk, caution should be exercised w h e n Peridex is adm inistered to a nursing w o m a n. In p arturition a nd lactation studies w ith rats, no evidence o f im paired parturition or o f toxic effects to suckling pups was observed w h e n chlorhexidine gluconate was adm inistered to dam s a t doses tha t were over 100 tim es greater than that w h ich w o u ld result from a person's ingesting 30 m l (2 capfuls) o f Peridex per day. PEDIATRIC USE: Clinical effectiveness and safety o f Peridex have n o t been established in children u nder the age o f 18. CARCINOGENESIS, MUTAGENESIS: In a drinking w ater study in rats, carcinogenesis was not observed. The highest dose o f chlorhexidine gluconate used in this study, 38 m g/kg/day, is at least 500 tim es the a m o u n t that w o u ld be ingested from the recom m ended daily dose o f Peridex. In tw o m am m alian in vivo m utagenic studies w ith chlorhexidine gluconate, mutagenesis was n o t observed. The highest dose o f chlorhexidine gluconate used in a mouse d om inant lethal assay was 1000 m g /k g /d a y and in a hamster cytogenetics test was 250 m g/kg/day, i.e., > 3 2 00 tim es the a m o u n t that w o u ld be ingested from the recom m ended daily dose o f Peridex.

ADVERSE REACTIONS: The most com m on side effects associated w ith chlorhexidine gluconate oral rinses are (I) an increase in staining o f teeth and other oral surfaces, (2) an increase in calculus form ation, and (3) an alteration in taste perception; see WARNINGS and PRECAU­ TIONS. N o serious systemic adverse reactions associated w ith use o f Peridex were observed in clinical testing. M in o r irritation and superficial desquam ation o f the oral mucosa have been noted in patients using Peridex, particularly am ong children. A ltho u gh there have been no reports o f parotitis (inflammation or swelling o f salivary glands) am ong Peridex users in controlled clinical studies, transient parotitis has been reported in research studies w ith chlorhexidine-containing mouthrinses.

OVERDOSAGE: Ingestion o f 1 o r 2 ounces o f Peridex by a small child (—10 kg body w eight) m igh t result in gastric distress, in clu din g nausea, o r signs o f a lcohol intoxication. Medical attention should be sought if more tha n 4 ounces o f Peridex is ingested by a small child or if signs o f a lcohol intoxication develop.

DOSAGE AND ADMINISTRATION: Peridex therapy should be initiated directly fo llo w in g a dental prophylaxis. Patients using Peridex should be reevaluated and given a thorough prophylaxis at intervals no lo nger than six months. Recommended use is tw ice daily oral rinsing for 30 seconds, m orning and evening after toothbrushing. Usual dosage is 1/2 fl. oz. (marked in cap) o f u ndiluted Peridex. Peridex is n ot intended for ingestion and should be expectorated after rinsing. Date o f Issuance January 1988 M ade by Procter & Gamble Cincinnati, O hio 45202

© 1989 by Procter & G am ble Printed in U.S.A.

18

JADA, Vol. 124, February 1993

May 1989

p a rt of th e public and entitled to protection as well as the lay public. A case could be made th a t th e public is protected by m anagem ent of the dental profession in th a t way, as well as benefiting the public by only adm itting the finest of the outof-state applicants. While this wouldn’t m ake me too happy, I could respect this and deal with it better th an hearing them say th a t dentists who are graduates of accredited schools, honorably licensed in other states, not on the m alpractice registry, who have been providing quality dental care for years a re n ’t good enough to perform dentistry in th eir state. If these states won’t license by credentials they should be honest and forthright and not insult our professional abilities and intelligence. Irl A. G lad felter Jr., D.D.S K ansas City, Mo A FO ND FA REW ELL

O ur wonderful head of library services, A letha Kowitz, is retiring after two-plus decades of superior service to our organization. On behalf of all the ADA m em bers who did research, ordered articles and books or otherwise used or benefited from the ADA library, we wish her good luck and m any, m any thanks. E llis J . N eib u rger, D.D.S W aukegan, 111