- Email: [email protected]
MPD syndrome
L E T T E R S TO T H E E D IT O R
tant. M. F. Dolwick, in his research, em phasizes that TMJ surgery cannot achieve relief for these patients without first eliminating the generalized component via conservative means. . . .
which, except for a few bold practitio ners, has refused to take it seriously as though it could be voted down or simply swept under the rug. I am writing to ask for a new hearing.
GREG D. BOBIER, DMD WEST HEMPSTEAD, NY
THEODORE H. INGALLS, MD DIRECTOR, EPIDEMIOLOGY STUDY CENTER FRAMINGHAM, MASS
Peer review has been one of remarkable premium sta bility. I am at a loss to un d e rstand Dr. Schneiderman’s conclusion that the arti cle suggests that the ADA’s insurance car rier (Life Insurance of North America) is a “nonprofit, charitable organization.” I presume that the comment is in response to the article’s mention that the insurance company has relinquished its right to terminate the master policy. If this is in deed the case, Dr. Schneiderman should know that the insurance company didn’t offer this policy concession out of “char ity,” but agreed to it after hard bargaining on the part of the Council on Insurance. DAVID DWYER ASSISTANT SECRETARY COUNCIL ON INSURANCE
MPD syndrome
□ I would like to compliment the peer review article by Dr. J. M. Weaver on my book, iontophoresis in Dental Practice. In regard to the sterilization criteria by Cidex, I must admit the reviewer has made me blush. The 20-minute recom mendation is an error and should read 20 hours. (Dr. Weaver and others recom mend at least ten hours.) I apologize for this error and w ill take action to correct the book through an errata page as well as my operating room manual. LOUIS P. GANGAROSA, SR., DDS, PhD MEDICAL COLLEGE OF GEORGIA AUGUSTA, GA
Session summary □ Your summary of the scientific meet ings at the annual session was done ex tremely well in the December issue, and I wish to commend the editors for this fine inclusion. Reading about some of the ideas discussed helped make me feel a part of modern dentistry.
□ Dr. Farrar’s call for a revised definition of the myofascial pain dysfunction syn ROBERT W. HERR, DDS drome (Letters, October 1983) highlights JACKSONVILLE, ILL the crucial distinction between patients with true TMJ problems and others with more diffuse facial pain affecting the mas ticatory muscles. Although most often Mercury toxicity: a rebuttal these two types are grouped together under the headline of “TMJ patients,” it is □ I am the author of the epidemiologic actually a small minority who have lo study referred to indirectly in your calized joint pain. Such a realization is of November editorial, “Mercury: muddled utmost importance when treatment mo media ahead?” I say indirectly, for my ar dalities are considered. Surgical treat ticle is tossed aside as merely a rumor; in ment has application for a certain per fact, it does not appear even to have been centage of those with true TMJ pain. read. Certainly, it is not reviewed but is However, there is no in d icatio n for quickly dismissed as “health hogwash.” surgery in those with pain of a more gen As the specialty journal (American Jour eralized nature. nal of Forensic Medicine and Pathology, Further, I believe that a significant pro- March 1983), in which it appeared is not p o r t io n of the p o p u la t io n have read by many in the dental profession, asymptomatic clicking of the joints. and as I doubt that dentists w ill have seen When patients have facial pain, a well- anything but a scanty headline or re chronicled history must be done and a ference (“rumor”) in the press, I am en thorough examination performed to dis closing a reprint entitled “Epidemiology, tinguish that subset of patients in whom etiology, and prevention of m ultip le antecedent painfree clicking may be a sclerosis: hypothesis and fact.” This is my co n fo u n d in g factor (rather than an illness I have watched progress person etiologic one) in the appearance of diffuse ally for 32 years. Clinically, its pathogen muscle tenderness. Again, surgery would esis appears to have involved both lead be inappropriate for this group of pa and mercury intoxication. tients. In all events, I assure you that I am pass Consideration of patients who have ing on no rumor, though for 150 years true TMJ pain concurrent with gener now the threat of mercury toxicity has alized muscle tenderness is also impor hovered over the dental profession,
156 ■ JADA, Vol. 108, February 1984
□ Editor’s Comment: Contrary to Dr. In galls’ allegation, I had indeed read his ar ticle before writing the editorial in ques tion. For those readers without easy ac cess to his article, the article states that his “ . . . one-sided amalgam-filled, infected upper right molars (finally collapsing after multiple abscesses over a period of nearly 5 years and replaced with a partial plate) seem to correlate with loss of hearing on the right, prism-corrected double vision due to oculomotor weakness, and incipient cataract on the right.” He con tin u e s, “ Further clinicalepidemiological appraisals are sorely needed as part of an interdisciplinary ap proach to a postulated role of organic mercury as a neurotoxin, mercury con verted to an organic form when the filling is ultimately exposed to gingival action and oxidation.” Neither this anecdotal report, nor the hypothesis that is yet to be tested, per suades me to alter the editorial position that, . . in the absence of sensitivity to mercury, current evidence indicates there is no reason for an individual to have amalgam restorations removed and that, in fact, the effect of such a procedure could be detrimental to the patient’s oral health.” Furthermore, the editorial provides documentation to demonstrate that those who charge the dental profession with “sweeping under the rug” judicious use of mercury are, at best, uninformed. Such may be the case in this instance, as neither the author nor the editor of the specialty journal finds the term “partial plate” out dated and unprofessional.
Radio waves □ I would appreciate hearing from den tists who have documented cases of pa tients hearing radio stations as a result of recently restored teeth. I am specifically interested in material, patient’s age, teeth (tooth) number of res torations, surfaces restored, radio station (or frequency received), conditions that brought reception of signals to an end (restorations polished, changed), recep tion verified by others listening to same frequency, and patient’s general attitude to dental treatment (apprehensive). MYRON F. LEVENSON, DDS LYNDHURST, OHIO
>
h
*.
tant. M. F. Dolwick, in his research, em phasizes that TMJ surgery cannot achieve relief for these patients without first eliminating the generalized component via conservative means. . . .
which, except for a few bold practitio ners, has refused to take it seriously as though it could be voted down or simply swept under the rug. I am writing to ask for a new hearing.
GREG D. BOBIER, DMD WEST HEMPSTEAD, NY
THEODORE H. INGALLS, MD DIRECTOR, EPIDEMIOLOGY STUDY CENTER FRAMINGHAM, MASS
Peer review has been one of remarkable premium sta bility. I am at a loss to un d e rstand Dr. Schneiderman’s conclusion that the arti cle suggests that the ADA’s insurance car rier (Life Insurance of North America) is a “nonprofit, charitable organization.” I presume that the comment is in response to the article’s mention that the insurance company has relinquished its right to terminate the master policy. If this is in deed the case, Dr. Schneiderman should know that the insurance company didn’t offer this policy concession out of “char ity,” but agreed to it after hard bargaining on the part of the Council on Insurance. DAVID DWYER ASSISTANT SECRETARY COUNCIL ON INSURANCE
MPD syndrome
□ I would like to compliment the peer review article by Dr. J. M. Weaver on my book, iontophoresis in Dental Practice. In regard to the sterilization criteria by Cidex, I must admit the reviewer has made me blush. The 20-minute recom mendation is an error and should read 20 hours. (Dr. Weaver and others recom mend at least ten hours.) I apologize for this error and w ill take action to correct the book through an errata page as well as my operating room manual. LOUIS P. GANGAROSA, SR., DDS, PhD MEDICAL COLLEGE OF GEORGIA AUGUSTA, GA
Session summary □ Your summary of the scientific meet ings at the annual session was done ex tremely well in the December issue, and I wish to commend the editors for this fine inclusion. Reading about some of the ideas discussed helped make me feel a part of modern dentistry.
□ Dr. Farrar’s call for a revised definition of the myofascial pain dysfunction syn ROBERT W. HERR, DDS drome (Letters, October 1983) highlights JACKSONVILLE, ILL the crucial distinction between patients with true TMJ problems and others with more diffuse facial pain affecting the mas ticatory muscles. Although most often Mercury toxicity: a rebuttal these two types are grouped together under the headline of “TMJ patients,” it is □ I am the author of the epidemiologic actually a small minority who have lo study referred to indirectly in your calized joint pain. Such a realization is of November editorial, “Mercury: muddled utmost importance when treatment mo media ahead?” I say indirectly, for my ar dalities are considered. Surgical treat ticle is tossed aside as merely a rumor; in ment has application for a certain per fact, it does not appear even to have been centage of those with true TMJ pain. read. Certainly, it is not reviewed but is However, there is no in d icatio n for quickly dismissed as “health hogwash.” surgery in those with pain of a more gen As the specialty journal (American Jour eralized nature. nal of Forensic Medicine and Pathology, Further, I believe that a significant pro- March 1983), in which it appeared is not p o r t io n of the p o p u la t io n have read by many in the dental profession, asymptomatic clicking of the joints. and as I doubt that dentists w ill have seen When patients have facial pain, a well- anything but a scanty headline or re chronicled history must be done and a ference (“rumor”) in the press, I am en thorough examination performed to dis closing a reprint entitled “Epidemiology, tinguish that subset of patients in whom etiology, and prevention of m ultip le antecedent painfree clicking may be a sclerosis: hypothesis and fact.” This is my co n fo u n d in g factor (rather than an illness I have watched progress person etiologic one) in the appearance of diffuse ally for 32 years. Clinically, its pathogen muscle tenderness. Again, surgery would esis appears to have involved both lead be inappropriate for this group of pa and mercury intoxication. tients. In all events, I assure you that I am pass Consideration of patients who have ing on no rumor, though for 150 years true TMJ pain concurrent with gener now the threat of mercury toxicity has alized muscle tenderness is also impor hovered over the dental profession,
156 ■ JADA, Vol. 108, February 1984
□ Editor’s Comment: Contrary to Dr. In galls’ allegation, I had indeed read his ar ticle before writing the editorial in ques tion. For those readers without easy ac cess to his article, the article states that his “ . . . one-sided amalgam-filled, infected upper right molars (finally collapsing after multiple abscesses over a period of nearly 5 years and replaced with a partial plate) seem to correlate with loss of hearing on the right, prism-corrected double vision due to oculomotor weakness, and incipient cataract on the right.” He con tin u e s, “ Further clinicalepidemiological appraisals are sorely needed as part of an interdisciplinary ap proach to a postulated role of organic mercury as a neurotoxin, mercury con verted to an organic form when the filling is ultimately exposed to gingival action and oxidation.” Neither this anecdotal report, nor the hypothesis that is yet to be tested, per suades me to alter the editorial position that, . . in the absence of sensitivity to mercury, current evidence indicates there is no reason for an individual to have amalgam restorations removed and that, in fact, the effect of such a procedure could be detrimental to the patient’s oral health.” Furthermore, the editorial provides documentation to demonstrate that those who charge the dental profession with “sweeping under the rug” judicious use of mercury are, at best, uninformed. Such may be the case in this instance, as neither the author nor the editor of the specialty journal finds the term “partial plate” out dated and unprofessional.
Radio waves □ I would appreciate hearing from den tists who have documented cases of pa tients hearing radio stations as a result of recently restored teeth. I am specifically interested in material, patient’s age, teeth (tooth) number of res torations, surfaces restored, radio station (or frequency received), conditions that brought reception of signals to an end (restorations polished, changed), recep tion verified by others listening to same frequency, and patient’s general attitude to dental treatment (apprehensive). MYRON F. LEVENSON, DDS LYNDHURST, OHIO
>
h
*.