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Much Ado about Plaque
need a new approach that is “ lateral ly o rien ted.” I think we need to break aw ay from our “ safe” research and do some thing daring that does not follow the accepted and approved research. O therw ise, w e are ju s t refining pres ent knowledge.
A s a general practitioner dealing with private paying patients, I realize that we have to contend with the legal com plications of technical assault. H ow ever, as a taxpayer I do not w ant any of my m oney spent to treat pa tients w ho are not defending them selves to the best of their ability.
HENRY C. H EIM ANSOHN, DDS
ROBERT A. MCGEE, DDS
DANVILLE, IND
LAKE W O R TH , FLA
Intraoral radiography N ote: A n im portant line was om itted in the letter fro m F red M . M edwed e jf o f Nashville, Tenn, published in the January issue. The paragraph should have read as follow s: m H ow ever, the Precision technique differs in that it alw ays utilizes a col lim ator designed to fit the given film and uses a system of alignment that allows m ore precise angulation. T herefore, the incident beam is re duced in the order o f 67% instead of 58% with standard no. 2 film as claim ed by U pdegrave and 85% for no. 0 film used with children. T he Preci sion m ethod therefore solves the prob lem of variable film size, w hereas the cone used by D r. U pdegrave uses a fixed aperture. In addition, the P re cision technique includes intraoral shielding w hich greatly reduces the volum e of tissue irradiated by the exit radiation.
C om m ents on resolution ■ This is in regard to the resolution headed “ Plaque control as prerequi site” on page 177 of the January j a d a .
U se o f halothane m Regarding advisability of the use of halothane for dental anesthesia, H enry J. F ioritto (January j a d a , page 36) apparently misses the significance of my letter published in the N ovem ber 1972 JADA. W hen I suggested caution concern ing the use of halothane for outpa tient dental anesthesia, this in no w ay suggested that dental anesthesia is of lesser significance than in-hospital anesthesia (although one might well argue the priority order here). A s a dentist, I can—along with other dentists— control or recom m end controls regarding the use of outpa tient dental anesthetics. A s a dentist, but not as an anesthesiologist, I and other dentists have no control over the policies regarding the adm inistra tion of general anesthesia in hospitals. T he latter is a m atter for the medical anesthesiologist, the form er is a m at ter for the dentist. So when I questioned the w isdom of the continued use of halothane in the dental office in view of the serious questions regarding its safety w hich have been published recently, I could discuss it only regarding its applica tion in dentistry. A s for the advisability of using halo thane for minor office procedures,
m ust we w ait for absolute evidence of serious untow ard sequelae before rec ommending caution? T here is no ab solute proof th a t cholesterol levels af fect the integrity of the vascular sys tem , but enough evidence does exist to call for consideration o f this factor —and m ost of us would be wise to do so. R are indeed is the dental condition o f such a nature that it absolutely de m ands the use o f an outpatient gen eral anesthestic; and if there are such, certainly they do not require the use o f halothane. I do not condem n this agent, but I repeat that it would be wise to tem per with caution one’s be lief that this agent is o f such great im portance in dental office anesthesia that we can ignore its potential dan gers. BENJAM IN S. RECANT, DDS LONG ISLAND CITY, NY
M uch ado 'about plaque ■ T h ere is much ado about plaque to day. T here also was much ado about plaque in 1910. A t that tim e, it was claim ed that potassium sulfocyanate was effective in retarding plaque for mation. William J. G ies and Emily C. Seam an studied the influence o f po tassium sulfocyanate in w eak concen tration (0.006%-0.06%) on form ation of plaque. T he effect of this chem ical agent in inhibiting plaque form ation, as reported in the D en ta l C osm os (52:1141, 1910) Was not confirmed. I t is h o p e d t h a t s o m e o f t h e new er c h e m i c a l a g e n t s b e in g t r i e d , s u c h as C h lo r h e x id in e , w ill b e m o r e e f f e c t iv e . LOUIS I. GROSSMAN, DDS PHILA D ELPH IA
LETTERS TO THE EDITOR / JADA, Vol. 86, May 1973 ■ 935
A s a general practitioner dealing with private paying patients, I realize that we have to contend with the legal com plications of technical assault. H ow ever, as a taxpayer I do not w ant any of my m oney spent to treat pa tients w ho are not defending them selves to the best of their ability.
HENRY C. H EIM ANSOHN, DDS
ROBERT A. MCGEE, DDS
DANVILLE, IND
LAKE W O R TH , FLA
Intraoral radiography N ote: A n im portant line was om itted in the letter fro m F red M . M edwed e jf o f Nashville, Tenn, published in the January issue. The paragraph should have read as follow s: m H ow ever, the Precision technique differs in that it alw ays utilizes a col lim ator designed to fit the given film and uses a system of alignment that allows m ore precise angulation. T herefore, the incident beam is re duced in the order o f 67% instead of 58% with standard no. 2 film as claim ed by U pdegrave and 85% for no. 0 film used with children. T he Preci sion m ethod therefore solves the prob lem of variable film size, w hereas the cone used by D r. U pdegrave uses a fixed aperture. In addition, the P re cision technique includes intraoral shielding w hich greatly reduces the volum e of tissue irradiated by the exit radiation.
C om m ents on resolution ■ This is in regard to the resolution headed “ Plaque control as prerequi site” on page 177 of the January j a d a .
U se o f halothane m Regarding advisability of the use of halothane for dental anesthesia, H enry J. F ioritto (January j a d a , page 36) apparently misses the significance of my letter published in the N ovem ber 1972 JADA. W hen I suggested caution concern ing the use of halothane for outpa tient dental anesthesia, this in no w ay suggested that dental anesthesia is of lesser significance than in-hospital anesthesia (although one might well argue the priority order here). A s a dentist, I can—along with other dentists— control or recom m end controls regarding the use of outpa tient dental anesthetics. A s a dentist, but not as an anesthesiologist, I and other dentists have no control over the policies regarding the adm inistra tion of general anesthesia in hospitals. T he latter is a m atter for the medical anesthesiologist, the form er is a m at ter for the dentist. So when I questioned the w isdom of the continued use of halothane in the dental office in view of the serious questions regarding its safety w hich have been published recently, I could discuss it only regarding its applica tion in dentistry. A s for the advisability of using halo thane for minor office procedures,
m ust we w ait for absolute evidence of serious untow ard sequelae before rec ommending caution? T here is no ab solute proof th a t cholesterol levels af fect the integrity of the vascular sys tem , but enough evidence does exist to call for consideration o f this factor —and m ost of us would be wise to do so. R are indeed is the dental condition o f such a nature that it absolutely de m ands the use o f an outpatient gen eral anesthestic; and if there are such, certainly they do not require the use o f halothane. I do not condem n this agent, but I repeat that it would be wise to tem per with caution one’s be lief that this agent is o f such great im portance in dental office anesthesia that we can ignore its potential dan gers. BENJAM IN S. RECANT, DDS LONG ISLAND CITY, NY
M uch ado 'about plaque ■ T h ere is much ado about plaque to day. T here also was much ado about plaque in 1910. A t that tim e, it was claim ed that potassium sulfocyanate was effective in retarding plaque for mation. William J. G ies and Emily C. Seam an studied the influence o f po tassium sulfocyanate in w eak concen tration (0.006%-0.06%) on form ation of plaque. T he effect of this chem ical agent in inhibiting plaque form ation, as reported in the D en ta l C osm os (52:1141, 1910) Was not confirmed. I t is h o p e d t h a t s o m e o f t h e new er c h e m i c a l a g e n t s b e in g t r i e d , s u c h as C h lo r h e x id in e , w ill b e m o r e e f f e c t iv e . LOUIS I. GROSSMAN, DDS PHILA D ELPH IA
LETTERS TO THE EDITOR / JADA, Vol. 86, May 1973 ■ 935