More on J. R. Callahan

L E T T E R S T O T H E E D IT O R

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.

That licensure issue m A perplexing and distressing para­ dox has revealed itself to us as a result of a discussion which followed the par­ ticipation of one of us as an examiner on the New Jersey State Board of Dental Examiners. The problem em­ braces ethical, ideological, and phil­ osophical considerations, and we place it before the profession for seri­ ous consideration and thoughtful de­ liberation. Situation: A candidate for licen­ sure in New Jersey, age in his 50s, al­ ready licensed, and with a successful practice in another state, failed the New Jersey board examination (clin­ ical part) on his first try and tried again. On his second testing, he dem­ onstrated the same inability to per­ form clinical procedures that he did the first time. As a matter of fact, his clinical ability was judged to be ter­ rible, his knowledge inadequate, his judgment faulty, and his lack of skill woefully apparent. He failed, without question, a second time. The Board of Examiners, thereby, fulfilled its man­ dated duty to protect the people of New Jersey from incompetent practi­ tioners by thus not granting a license to this inept candidate. But now arise the ethical and phil­ osophical questions. How about the public in the state in which this dentist is already practic­ ing? Is the potential harm this man can cause to people any the less for his professional activity being confined to one state rather than two? Should it not be the moral duty of the New Jer­ sey board (or any board, for that mat­

ter) to report the deficiencies of this practitioner to appropriate authorities in the state in which he currently prac­ tices? Are state loyalties so rigidly geographically restricted that the wel­ fare of the public across the border is of no concern? What we see in this episode is a for­ tuitous acting out of peer review, with revealing results but with no possible satisfactory solution. It suggests that peer review, on a more formalized, or­ ganized, and periodic basis, may in­ deed be indicated for the public wel­ fare. Perhaps, reexamination for re­ licensure may not be as unnecessary as the majority of the dental profes­ sion would like to think, although it is clearly a distasteful concept to most. Several secondary, but equally pro­ vocative, questions also are raised. First, suppose that a report of incom­ petence were in fact made to authori­ ties in the home state, what could now be done? Under the existing system, nothing. If periodic peer review—or réévaluation of level of clinical com­ petence and currency of knowledge— is to be considered as a realistic pos­ sibility in the future, then, perhaps, it would be advisable to build the con­ cept of it as a nonpunitive mechanism —containing no threat of revocation of license. Rather, it should be consid­ ered to be a means of requiring re­ fresher training, renewal of knowl­ edge, and updating of both knowledge and skills through continuing educa­ tion for those whose current compe­ tence is judged inadequate. Second, one can switch polarity there and run through the same in­ tellectual exercise expressed above in a positive vein rather than a negative

one. In other words, if a dentist is judged competent to practice in one state, why not in others, or in all? Pa­ tients have similar health problems and respond similarly in one state as they do in another, and if good clin­ ical therapy works to help people in one state it should do so equally across the state boundaries. So, here we are back on the familiar territory of either complete reciproc­ ity or national licensure. But we do not want to divert the thrust of the com­ munication to this popular debate. We hope that any responses to this letter will address themselves to the serious primary issue—the ethical paradox we have brought up in the first few para­ graphs. ROBERT G O TTSEG EN, DDS R A Y M O N D F . JO H N S O N , D D S C O L U M B IA U N IV E R S IT Y

■ Let’s wake up and join to eliminate the (200) Berlin Walls. If one state board examination is passed, all others should be accepted. L .J . K A R A G E O R G E , D D S P IT T S B U R G H

More on J . R. Callahan ■ I read with considerable interest Alvin L. Morris’s biographic sketch of John Ross Callahan (July j a d a ) . However, it came as a surprise that no mention was made that some of Callahan’s investigations and writings formed the basis for a treatment meth­ od in endodontics still in vogue in sev­ eral sections of this country. In 1931, Harry B. Johnston of At­ lanta ( j a d a , Oct 1931) advocated Cal­ lahan’s sulfuric acid method of cleans­ ing root canals, and to this appended a description of his diffusion filling tech­ nique. This achieved considerable popularity and, despite Callahan’s pri­ ority, became known as the JohnstonCallahan technique. I would have hoped that Dr. Morris could have shed some light on the re­ lationship between these two men. Did they know one another person­ ally and was there direct collaboration between them? Or did Johnson simply adopt Callahan’s technique—having JADA, Vol. 87, O ctober 1973 ■ 779

learned o f it through writings and lec­ tures? Dr. Morris mentions Callahan’s wonderful sense o f humor. I should like to offer a delightful example of his wit which I had quoted previously in my paper on root canal filling ( j a d a , N ov 1956): “ I know of one tooth that was filled just to the end. I know be­ cause I had my thumb over it while filling the canal.” B E N JA M IN S E ID L E R , D D S SC H O O L O F D E N T IS T R Y EM O R Y U N IV E R S IT Y

Error in article

m There

is a critical error in the ar­ ticle, “ Evaluating the clinical quality of restorations,” authored by G . Ryge andM . Snyder in the August j a d a . On page 371, reference is made to the method of evaluation of technical excellence used by the Philadelphia Department of Public Health Dental Program. The article states, “ Soricelli reported that 50% of the work was rated ‘improvement needed’ and that 43% was rated in various stages of ‘satisfactory.’ ” Reference is made to my presentation at the 21st National Dental Health Conference held in Chicago in April 1970. Reference to this paper (page 572 o f the proceedings o f this conference published by the A D A ) correctly shows the figures that I, in fact, used: “ . . . after about five months of clin­ ical activity, an average evaluation of a technotherapist shows approximate­ ly 50% of the work superior or better and 7% needing improvement, with the remainder in the various ranges of satisfactory.” It is not clear, o f course, whether the authors or the editor erred in this instance; however, the statement is wrong and the grossly incorrect fig­ ures totally destroy the image and real value and evaluation of the techno­ therapist delivery system here in Phil­ adelphia. It does appear also that the authors might well have thoroughly researched the status of our program either by direct communication with me or by a return to the literature. Other publications, for example, “ Practical experience in peer review

— controlling quality in the delivery of dental care” (an edited publication of the paper cited), published in the

American Journal o f Public Health (Oct 1971, pages 2046-2056) certainly are clear, as the following paragraph (page 2055) indicates: “ After about five months o f clinical activity, an average evaluation of a technotherapist showed approximate­ ly fifty (50%) percent o f the work su­ perior or better and seven (7%) per­ cent needing improvement, with the remainder (43%) in the various ranges of satisfactory. Currently, the propor­ tion of superior or better approaches seventy-five (75%) percent and less than one percent showed a need for improvement.” I would suspect that another article entitled “ Implementation of the de­ livery of dental services by auxiliaries — the Philadelphia experience”

(American Journal o f Public Health, Aug 1972) also was available to them prior to the time of publication o f their article. This article deals in more de­ tail with the entire activity and re­ states the facts contained in the quote above. It is unfortunate that the er­ roneous statement (and I assume it was an error) was published and I hope you would feel obliged to pub­ lish a correction. I also deplore the fact that the com­ plete statement as contained in my ar­ ticle referenced, and as reproduced herein above, was not fully included in their reporting. Whether or not an oversight, their reference to and in­ complete report on the Philadelphia program is damaging to us and the de­ livery system. D A V ID A . S O R IC E L L I, D D S P H IL A D E L P H IA

Authors’ reply: The authors wish to correct the error in our article in the August j a d a in the reporting o f the dental school faculty evaluation o f the work of the technotherapists in the Philadelphia Department of Health Dental Care Programs. A s pointed out by Dr. Soricelli in his letter, the sen­ tence should have read, “ Soricelli re­ ported that 50% of the restorations were ‘superior’ or ‘outstanding,’ 7% were rated ‘improvement needed’ and the balance (43%) were in various

780 ■ LETTERS TO THE EDITOR / JADA, Vol. 87, O ctober 1973

stages o f ‘satisfactory.’ ” Since our purpose in citing the reference was to briefly describe the quality evaluation system used in that program, it is most unfortunate that the error detracts from the obvious success and worth of Dr. Soricelli’s pioneering effort in utilizing expanded function auxilia­ ries. We regret very much that a typographical mistake escaped our at­ tention in preparing the final draft of the article. GU N N AR RYGE, DDS M IL D R E D A . S N Y D E R SAN FR A N C ISC O

‘Comments . . . out o f line’ ■ A s the a d a j o u r n a l currently serves as the recognized public po­ litical forum of the dental profession, it is not unlikely that others—insurers, attorneys, governmental agencies, and social organizations— have an in­ terest in material published therein. In this regard, I feel that areas of potential disruptive controversy should be presented with editorial or responsive comment. It is to this end that I address myself to Richard F. Atkinson’s letter (August j a d a , page 243) entitled “ Radiation exposure.” Dr. Atkinson is upset with the fact that certain dental plan administrators require postoperative radiographs for “ impactions, fillings, crowns and fixed bridgework, gingival curettage, and root canal treatment.” H e goes on to state that he usually ignores their requests and that the “ only possible reason for requiring postoperative ra­ diographs is to prove to the insurer that the treatment has been performed and not for any diagnostic or profes­ sional reason.” These comments are completely out of line with contemporary dental education, responsible clinical prac­ tice, and the basic tenets of profes­ sional ethics. The postoperative ra­ diograph is part and parcel of many therapeutic endeavors in that it con­ firms the efficacy of treatment; it is also diagnostic in that it may reveal a potential iatrogenic lesion. To hide behind an all too obvious “ smokescreen” of potential radiation overexposure is to misrepresent the