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Likes editorial
LETTERS TO THE EDITOR
THE JOURNAL devotes this section to comment by readers on topics of current interest to den tistry. The editor reserves the right to edit all communications to fit available space and requires that all letters be signed. Printed communications do not necessarily reflect the opinion or of ficial policy of the Association. Your participation in this section is invited.
Use rubber dam m T h e a rtic le in th e M a y issu e o f The Journal (p ag e 895) b y Q u islin g , K ang u r, and J a h rs d o e rfe r o n su b c u ta n e o u s e m p h y se m a a fte r a ro u tin e am alg am p re p a ra tio n should b e o f in te re s t to all d e n tists w ho u se a high sp e e d air-tu rb in e drill. It sh o u ld also be o f in te re s t how easily th is situ a tio n c o u ld h a v e b e e n p re v e n te d ; v iz, a w ell-fitting ru b b e r d am . P re v e n tio n o f iatro g en ica lly in d u c e d su b c u ta n e o u s e m p h y se m a is a n o th e r a d d itio n to th e long list o f ru b b e r d a m a d v a n ta g e s. A s long as th e w id e sp re a d n o n -u s e o f th e ru b b e r d am c o n tin u e s, w e can e x p e c t to see m o re c a se re p o rts sim ilar to th e o n e d e sc rib e d in th e a rtic le . T h e fa ct th a t d e a th fro m e m p h y s e m a a fte r u se o f a h ig h -sp eed h a n d p ie c e n e v e r has bee n re p o rte d d o e s n o t p rec lu d e th a t p o ssib ility . T h e a u th o rs su g g e st carefu l use o f th e h ig h -sp eed drill in a re a s o f d is ru p te d oral tissu e s to p re v e n t su b c u ta n e o u s e m p h y se m a . I su g g est p re v en tin g it b y u sin g a w ell-fitting ru b b e r dam . D A V ID M . CASEY, DDS EAST G R E EN B U S H , N Y
Likes editorial m B rav o fo r th o s e k in d w o rd s in th e ed ito ria l, “ A D A n e e d s p e rso n a liz e d m em b ersh ip s e r v ic e s ,” in th e J a n u a ry issu e o f The Journal. 18 ■ JA D A , V o l. 95, J u ly 1977
W hile I h a v e b e e n in v o lv ed in te a c h ing an d w ritin g o f a n d a b o u t d e n tistry , y o u r Journal d o es g et v e ry tire so m e an d a little v arie ty w ould h elp. It is said “ th a t w o rk w ith o u t p lay m ak es J a c k a dull b o y ,” a n d b ein g on a co n s ta n t d ie t o f d e n tistry d o e s p u t you to sleep. I u se a sim p le p ro c e d u re in re a d ing the Journal. I read th e su m m ary o f all th e a rtic le s a n d , if it is in te re stin g to m e, I ’ll go b ac k a n d go th ro u g h th e a rtic le . H o w e v e r, th an k s fo r my th o u g h ts th a t you so a p tly e x p re sse d . H A R R Y A . S IL B E R M A N , DDS JERSEY C IT Y , NJ
Wheelchair transfer ■ C o n g r a t u l a t i o n s f o r p r e s e n tin g p ra c tic a l m e th o d s to im p ro v e d en tal c a re fo r w h e e lc h a ir-b o u n d p eo p le in th e A p r il is s u e o f T he Journal, “ W h e e lc h a ir tr a n s fe r te c h n iq u e s fo r th e d e n tal o ffic e ” (page 719). I w as in te re ste d in th e artic le b o th as th e w ife o f a d e n tist a n d as a p h y si cal th e ra p is t w h o te a c h e s p a tie n ts and th e ir fam ilies tra n s fe r tech n iq u e s. T h e re a re sev e ra l p o in ts w hich m ight be e m p h a siz e d in a d d itio n to th o s e in th e artic le . Be su re to fully u tilize th e p a tie n t’s a n d /o r fam ily ’s k n o w led g e o f an d e x p e rie n c e w ith tran sferrin g . T o p re p a re fo r a safe tra n sfe r, d e te rm in e if th e p a tie n t has one side w h ich is stro n g e r th a n th e o th e r. P la c ing th e w h e e lc h a ir at a slight angle to
th e d e n ta l c h a ir, h av e th e fro n t edge c lo s e s t to th e d e n ta l ch a ir to u ch in g th e d e n ta l ch air. T h e p a tie n t’s stro n g e r sid e should be n e x t to th e dental c h a ir. S ee th a t n o t o n ly a re th e brak es se t se c u re ly , b u t th a t th e fo o tp lates a re ra ise d a s w ell as sw u ng o u t to the side. T o p e rfo rm a n y p a tie n t tra n sfe r safely an d c o m fo rta b ly , p ro c e e d slow ly , allow ing th e p a tie n t to d o as m uch fo r h im self as p o ssib le. In a m o b ile p a tie n t tra n sfe r, the p a tie n t w ill b e p iv o tin g o n the foot n e x t to th e d en tal c h air. T h e d en tist c a n p ro v id e m ax im u m a ssista n c e by p lacin g h is fo o t o n th e inside o f the p a tie n t’s p iv o tal fo o t. H is shin should c ro s s th e sh in o f th e p a tie n t an d his k n ee sh o u ld re s t o n th e o u tsid e o f the p a tie n t’s k n e e , fo rm in g an X . T h is will allow th e d e n tist to re a d ily b lock the p a tie n t’s k n e e in e x te n sio n w hile both p iv o t. T h e d e n tist th e n sh o u ld b en d his h ip s an d k n e e s, o b serv in g g o od body m e c h a n ic s an d p e rm ittin g th e thigh a n d hip m u sc les to d o th e w o rk , a v o id ing s tra in o n th e spinal m u sc u latu re. O n c e in th is p o sitio n , h e should g ra sp th e p a tie n t firm ly by th e b a c k o f th e b elt a n d w a istb an d . T h is is p re fe r a b le to a h ig h er g ra s p u n d e r th e arm s b e c a u se th e c e n te r o f g rav ity o f the b o d y is in th e p elv ic a re a ; w hen this is c o n tro lle d , th e re s t o f th e b o d y m ay b e re a d ily c o n tro lle d . I t is also p ref e ra b le b e c a u se th e p a tie n t m ay hav e s h o u ld e r p a in o r w e a k n e ss, as in h em iplegia o r a rth ritis , w h ich c o u ld be ag g ra v a te d b y g rasp in g him firm ly un d e r th e a rm s. In s tru c t th e p a tie n t to b e n d fo r w a rd , g ettin g his h ea d o v e r his k n ees, b ac k fle x e d . O n c e in th is p o sitio n he sh o u ld g ra sp th e arm o f his chair, p u sh in g to sta n d , th e d e n tist assisting him in to th e sta n d in g p o sitio n . T h e p a tie n t an d d e n tist th e n p iv o t, the p a tie n t re a c h in g fo r th e se a t o f the d e n tal c h a ir and sittin g in th e dental ch air. In an im m o b ile p a tie n t tra n sfe r, g o o d b o d y m ech a n ics (bending a t h ip s an d k n e e s) fo r th o se assistin g in th e tr a n s fe r sh o u ld b e stre sse d . In a sliding b o a rd tra n sfe r, th e w h e e lc h a ir sh o u ld b e as clo se a s p o s sible to th e d e n tal c h air. It w ould be help fu l fo r m o st p a tie n ts to h av e the
THE JOURNAL devotes this section to comment by readers on topics of current interest to den tistry. The editor reserves the right to edit all communications to fit available space and requires that all letters be signed. Printed communications do not necessarily reflect the opinion or of ficial policy of the Association. Your participation in this section is invited.
Use rubber dam m T h e a rtic le in th e M a y issu e o f The Journal (p ag e 895) b y Q u islin g , K ang u r, and J a h rs d o e rfe r o n su b c u ta n e o u s e m p h y se m a a fte r a ro u tin e am alg am p re p a ra tio n should b e o f in te re s t to all d e n tists w ho u se a high sp e e d air-tu rb in e drill. It sh o u ld also be o f in te re s t how easily th is situ a tio n c o u ld h a v e b e e n p re v e n te d ; v iz, a w ell-fitting ru b b e r d am . P re v e n tio n o f iatro g en ica lly in d u c e d su b c u ta n e o u s e m p h y se m a is a n o th e r a d d itio n to th e long list o f ru b b e r d a m a d v a n ta g e s. A s long as th e w id e sp re a d n o n -u s e o f th e ru b b e r d am c o n tin u e s, w e can e x p e c t to see m o re c a se re p o rts sim ilar to th e o n e d e sc rib e d in th e a rtic le . T h e fa ct th a t d e a th fro m e m p h y s e m a a fte r u se o f a h ig h -sp eed h a n d p ie c e n e v e r has bee n re p o rte d d o e s n o t p rec lu d e th a t p o ssib ility . T h e a u th o rs su g g e st carefu l use o f th e h ig h -sp eed drill in a re a s o f d is ru p te d oral tissu e s to p re v e n t su b c u ta n e o u s e m p h y se m a . I su g g est p re v en tin g it b y u sin g a w ell-fitting ru b b e r dam . D A V ID M . CASEY, DDS EAST G R E EN B U S H , N Y
Likes editorial m B rav o fo r th o s e k in d w o rd s in th e ed ito ria l, “ A D A n e e d s p e rso n a liz e d m em b ersh ip s e r v ic e s ,” in th e J a n u a ry issu e o f The Journal. 18 ■ JA D A , V o l. 95, J u ly 1977
W hile I h a v e b e e n in v o lv ed in te a c h ing an d w ritin g o f a n d a b o u t d e n tistry , y o u r Journal d o es g et v e ry tire so m e an d a little v arie ty w ould h elp. It is said “ th a t w o rk w ith o u t p lay m ak es J a c k a dull b o y ,” a n d b ein g on a co n s ta n t d ie t o f d e n tistry d o e s p u t you to sleep. I u se a sim p le p ro c e d u re in re a d ing the Journal. I read th e su m m ary o f all th e a rtic le s a n d , if it is in te re stin g to m e, I ’ll go b ac k a n d go th ro u g h th e a rtic le . H o w e v e r, th an k s fo r my th o u g h ts th a t you so a p tly e x p re sse d . H A R R Y A . S IL B E R M A N , DDS JERSEY C IT Y , NJ
Wheelchair transfer ■ C o n g r a t u l a t i o n s f o r p r e s e n tin g p ra c tic a l m e th o d s to im p ro v e d en tal c a re fo r w h e e lc h a ir-b o u n d p eo p le in th e A p r il is s u e o f T he Journal, “ W h e e lc h a ir tr a n s fe r te c h n iq u e s fo r th e d e n tal o ffic e ” (page 719). I w as in te re ste d in th e artic le b o th as th e w ife o f a d e n tist a n d as a p h y si cal th e ra p is t w h o te a c h e s p a tie n ts and th e ir fam ilies tra n s fe r tech n iq u e s. T h e re a re sev e ra l p o in ts w hich m ight be e m p h a siz e d in a d d itio n to th o s e in th e artic le . Be su re to fully u tilize th e p a tie n t’s a n d /o r fam ily ’s k n o w led g e o f an d e x p e rie n c e w ith tran sferrin g . T o p re p a re fo r a safe tra n sfe r, d e te rm in e if th e p a tie n t has one side w h ich is stro n g e r th a n th e o th e r. P la c ing th e w h e e lc h a ir at a slight angle to
th e d e n ta l c h a ir, h av e th e fro n t edge c lo s e s t to th e d e n ta l ch a ir to u ch in g th e d e n ta l ch air. T h e p a tie n t’s stro n g e r sid e should be n e x t to th e dental c h a ir. S ee th a t n o t o n ly a re th e brak es se t se c u re ly , b u t th a t th e fo o tp lates a re ra ise d a s w ell as sw u ng o u t to the side. T o p e rfo rm a n y p a tie n t tra n sfe r safely an d c o m fo rta b ly , p ro c e e d slow ly , allow ing th e p a tie n t to d o as m uch fo r h im self as p o ssib le. In a m o b ile p a tie n t tra n sfe r, the p a tie n t w ill b e p iv o tin g o n the foot n e x t to th e d en tal c h air. T h e d en tist c a n p ro v id e m ax im u m a ssista n c e by p lacin g h is fo o t o n th e inside o f the p a tie n t’s p iv o tal fo o t. H is shin should c ro s s th e sh in o f th e p a tie n t an d his k n ee sh o u ld re s t o n th e o u tsid e o f the p a tie n t’s k n e e , fo rm in g an X . T h is will allow th e d e n tist to re a d ily b lock the p a tie n t’s k n e e in e x te n sio n w hile both p iv o t. T h e d e n tist th e n sh o u ld b en d his h ip s an d k n e e s, o b serv in g g o od body m e c h a n ic s an d p e rm ittin g th e thigh a n d hip m u sc les to d o th e w o rk , a v o id ing s tra in o n th e spinal m u sc u latu re. O n c e in th is p o sitio n , h e should g ra sp th e p a tie n t firm ly by th e b a c k o f th e b elt a n d w a istb an d . T h is is p re fe r a b le to a h ig h er g ra s p u n d e r th e arm s b e c a u se th e c e n te r o f g rav ity o f the b o d y is in th e p elv ic a re a ; w hen this is c o n tro lle d , th e re s t o f th e b o d y m ay b e re a d ily c o n tro lle d . I t is also p ref e ra b le b e c a u se th e p a tie n t m ay hav e s h o u ld e r p a in o r w e a k n e ss, as in h em iplegia o r a rth ritis , w h ich c o u ld be ag g ra v a te d b y g rasp in g him firm ly un d e r th e a rm s. In s tru c t th e p a tie n t to b e n d fo r w a rd , g ettin g his h ea d o v e r his k n ees, b ac k fle x e d . O n c e in th is p o sitio n he sh o u ld g ra sp th e arm o f his chair, p u sh in g to sta n d , th e d e n tist assisting him in to th e sta n d in g p o sitio n . T h e p a tie n t an d d e n tist th e n p iv o t, the p a tie n t re a c h in g fo r th e se a t o f the d e n tal c h a ir and sittin g in th e dental ch air. In an im m o b ile p a tie n t tra n sfe r, g o o d b o d y m ech a n ics (bending a t h ip s an d k n e e s) fo r th o se assistin g in th e tr a n s fe r sh o u ld b e stre sse d . In a sliding b o a rd tra n sfe r, th e w h e e lc h a ir sh o u ld b e as clo se a s p o s sible to th e d e n tal c h air. It w ould be help fu l fo r m o st p a tie n ts to h av e the