- Email: [email protected]
NATIONAL ADVERTISING CAMPAIGN
LETTERS
O ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, doublespaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. APPRECIATED COVER
I was very pleased and appreciated the March cover. Hopefully, a diversity of ethnic photographs will continue to appear. W.J. Walker, D.M.D. Augusta, Ga. ALLIANCE
I'm in complete agreement with Dr. Hudson of Spokane, Wash. (Letters, March JADA) in his opinions voiced regarding Dr. Douglas Benn's Alliance for Best Clinical Practices in Dentistry. Dr. Benn's stance is alarming in today's climate of minimally invasive dentistry. I wouldn't want to wait until decay was "close to the nerve" in my mouth. Who determines "close"? With air abrasion there is no reason not to treat incipient lesions (or even stains), bonding them or sealing them. The cycle of refilling these dentists profess is completely outdated. I shudder to think of the harm they could do here. Bruce C. Gronner, D.D.S.
Chicago
39 years who has always been interested in root canal therapy, I would like to share with you what I have learned mostly from my own mistakes. If you fill a root canal short of the apex, you are asking for trouble years from now. Look at your patients' old root canals and those done by other dentists. The radiolucencies are on the canals that are filled short of the apex. The canals that are filled long look great. What works well is to fill every canal 1 millimeter long of the apex, not slightly short as most textbooks recommend. Because of tooth flexure, cracked teeth are much more common when you use a post in a canal. I suggest drilling out the pulp chamber as well as the top 2 to 3 mm of the root canal, then using gutta-percha. Build up the tooth with composite or amalgam. Be sure to use a good bonding agent such as Amalgambond. Years ago I used posts in nearly every tooth. Now I use none. Cracked teeth may not show up for several years, but at my age I have seen this happen many times. I now use the Thernafil system with the plastic obturators. This technique is very userfriendly, makes it easy to fill the canals slightly long of the apex and is biologically inert. If the canal is sterile I have seen no more pain on a long filing than a filling short of the apex. For the past few years that I have been using this technique, I have seen no failures, even in those canals that were grossly overfilled. Gerald K. B'refls, D.D.S. West Columbia, S.C.
CRACKED-TOOTH SYNDROME
NATIONAL ADVERTISING CAMPAIGN
As a general dentist for the past
I believe that the results from
the January Question of the Month are not particularly surprising. Many dentists are concerned about shrinking practice revenues as a result of the encroachment of managed cost/managed care. An additional dues surcharge of approximately $300 per year will likely continue to meet resistance. However, I believe that the same 70 percent or more of the respondents would answer affirmatively if they were asked if they support the concept of a national advertising campaign. Where does that leave us? Why don't dentists exert pressure on dental suppliers and especially preventive and homecare product producers and distributors to contribute to an advertising campaign? I realize that many of them do spend money on institutional-type advertising, but it needs to be directed more toward the benefits of dentistry and not as ancillary to their product information. We provide the basis for their success and they have a vested interest in seeing private practice dentistry not only survive but prosper. It is unusual to find product suppliers that dispense free samples any more due undoubtedly to cost concerns. However, they seem more than happy to send us coupons to distribute to our patients to promote their products. In our office, we receive these patient education fliers and coupons practically every week. If they want our help in promoting their products, then why don't we solicit their assistance in promoting the value of dental care to the public? I want to be clear that I don't fault them in the slightest. After all, what they are doing is sound business practice. It's time dentistry learns from
688 JADA, Vol. 128, June 1997 i A I
_rt,4^;i'sCe@:&*->.50#zvOAb2981FoSut;d,n_s
ELLETTERS
EASE Gum Disease
NO DUES INCREASE FOR NATIONAL ADVERTISING
Video code no. X790 $40.00
%.sldodorsi i_ksW
Plaque code no.
W379
$22.95
.____v__
_
__
ffi * *
____
, _l .:
_n_N
_
-
Wi_,
.<
... _
,,,, ,5 ,,fi,
_,_isSoF
X
_
_
_
Ca
i< j aS_ On
_
_ 1-w s
tu
!
e
4q_r_ a_ur ;_r t4.4_ sw oq
#1 Best seller
saX
Brochure Periodontal Diseases: A Major Cause of Tooth Loss code no. W121 $35.00 per 100
Ask about our
Special Gum Disease Package Help your patients prevent the progress of gum disease with the Periodontal Diseases Video, Brochures and Plaque from the American Dental Association. With these excellent educational materials, you also will be able to put your patients at greater ease. That's because all three are designed to clearly explain and answer questions about prevention, signs of risk and corrective procedures. They're the perfect tools for educating your patients as well as building and maintaining your practice.
To find out more and to order, call 1.800.947.4746 or visit our web site: http://www.ada.org When ordering, please refer to Code No. 97069. MasterCard and VISA accepted. 7a.m.-6p.m. cst.
Hurry! Prices expire 9/1/97.
AD
the business world. We will be happy to help their businesses succeed when they help dentistry as we know it survive, grow and prosper. Tom Howley, D.D.S. Lansdale, Pa.
OA
American Dental Association 211 E. Chicago Ave. Chicago, IL 60611-2678
I read with interest your article that stated 70 percent of respondents were not in favor of a dues increase to pay for national advertising (Question of the Month report, March JADA). I do not feel we (members of the ADA) can make such judgments. We simply do not have enough information. While you did supply a pie chart that allocates expenses, it would be more informative if we had a total breakdown of income and expenses, such as the breakdown of the 31 percent operations account. Possibly we could reduce some of these operational costs and pay for national advertising. I believe we are entitled to have access to all the expenses and income of the ADA. I also believe we should have national advertising. Marketing is the key to educating the public. Delores L. Hammer, D.D.S. Hickory, N.C. NITROUS OXIDE
In the March JADA article "Nitrous Oxide in the Dental Environment: Assessing the Risk, Reducing the Exposure," by Dr. William R. Howard, NIOSH and ACGIH recommendations of a 25- and 50-parts per-million maximum exposure to waste nitrous oxide were mentioned several times. While the paper never expressly stated that these levels were appropriate limits, it tacitly implied they were. Both of these organizations derived their levels based on studies by Bruce and colleagues' and Bruce and Bach.2 Bruce has had two retractions published for these findings in Anesthesia Analgesia (1983;62:617) and Anesthesiology (1991;74:1160-1), where he stated, "There is no longer any need to refer to our conclusions as 'controversial.' They were wrong, derived from data subject to inadvertent sampling bias and not applicable to the general population. The NIOSH standards should be revised." There has never been an animal or human study that showed any problems below 1,000 ppm. Several authors, including Nunn and Sweeney, have suggested that 450 ppm would be appropriate, safe, conservative, maximum levels for nitrous
O ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, doublespaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. APPRECIATED COVER
I was very pleased and appreciated the March cover. Hopefully, a diversity of ethnic photographs will continue to appear. W.J. Walker, D.M.D. Augusta, Ga. ALLIANCE
I'm in complete agreement with Dr. Hudson of Spokane, Wash. (Letters, March JADA) in his opinions voiced regarding Dr. Douglas Benn's Alliance for Best Clinical Practices in Dentistry. Dr. Benn's stance is alarming in today's climate of minimally invasive dentistry. I wouldn't want to wait until decay was "close to the nerve" in my mouth. Who determines "close"? With air abrasion there is no reason not to treat incipient lesions (or even stains), bonding them or sealing them. The cycle of refilling these dentists profess is completely outdated. I shudder to think of the harm they could do here. Bruce C. Gronner, D.D.S.
Chicago
39 years who has always been interested in root canal therapy, I would like to share with you what I have learned mostly from my own mistakes. If you fill a root canal short of the apex, you are asking for trouble years from now. Look at your patients' old root canals and those done by other dentists. The radiolucencies are on the canals that are filled short of the apex. The canals that are filled long look great. What works well is to fill every canal 1 millimeter long of the apex, not slightly short as most textbooks recommend. Because of tooth flexure, cracked teeth are much more common when you use a post in a canal. I suggest drilling out the pulp chamber as well as the top 2 to 3 mm of the root canal, then using gutta-percha. Build up the tooth with composite or amalgam. Be sure to use a good bonding agent such as Amalgambond. Years ago I used posts in nearly every tooth. Now I use none. Cracked teeth may not show up for several years, but at my age I have seen this happen many times. I now use the Thernafil system with the plastic obturators. This technique is very userfriendly, makes it easy to fill the canals slightly long of the apex and is biologically inert. If the canal is sterile I have seen no more pain on a long filing than a filling short of the apex. For the past few years that I have been using this technique, I have seen no failures, even in those canals that were grossly overfilled. Gerald K. B'refls, D.D.S. West Columbia, S.C.
CRACKED-TOOTH SYNDROME
NATIONAL ADVERTISING CAMPAIGN
As a general dentist for the past
I believe that the results from
the January Question of the Month are not particularly surprising. Many dentists are concerned about shrinking practice revenues as a result of the encroachment of managed cost/managed care. An additional dues surcharge of approximately $300 per year will likely continue to meet resistance. However, I believe that the same 70 percent or more of the respondents would answer affirmatively if they were asked if they support the concept of a national advertising campaign. Where does that leave us? Why don't dentists exert pressure on dental suppliers and especially preventive and homecare product producers and distributors to contribute to an advertising campaign? I realize that many of them do spend money on institutional-type advertising, but it needs to be directed more toward the benefits of dentistry and not as ancillary to their product information. We provide the basis for their success and they have a vested interest in seeing private practice dentistry not only survive but prosper. It is unusual to find product suppliers that dispense free samples any more due undoubtedly to cost concerns. However, they seem more than happy to send us coupons to distribute to our patients to promote their products. In our office, we receive these patient education fliers and coupons practically every week. If they want our help in promoting their products, then why don't we solicit their assistance in promoting the value of dental care to the public? I want to be clear that I don't fault them in the slightest. After all, what they are doing is sound business practice. It's time dentistry learns from
688 JADA, Vol. 128, June 1997 i A I
_rt,4^;i'sCe@:&*->.50#zvOAb2981FoSut;d,n_s
ELLETTERS
EASE Gum Disease
NO DUES INCREASE FOR NATIONAL ADVERTISING
Video code no. X790 $40.00
%.sldodorsi i_ksW
Plaque code no.
W379
$22.95
.____v__
_
__
ffi * *
____
, _l .:
_n_N
_
-
Wi_,
.<
... _
,,,, ,5 ,,fi,
_,_isSoF
X
_
_
_
Ca
i< j aS_ On
_
_ 1-w s
tu
!
e
4q_r_ a_ur ;_r t4.4_ sw oq
#1 Best seller
saX
Brochure Periodontal Diseases: A Major Cause of Tooth Loss code no. W121 $35.00 per 100
Ask about our
Special Gum Disease Package Help your patients prevent the progress of gum disease with the Periodontal Diseases Video, Brochures and Plaque from the American Dental Association. With these excellent educational materials, you also will be able to put your patients at greater ease. That's because all three are designed to clearly explain and answer questions about prevention, signs of risk and corrective procedures. They're the perfect tools for educating your patients as well as building and maintaining your practice.
To find out more and to order, call 1.800.947.4746 or visit our web site: http://www.ada.org When ordering, please refer to Code No. 97069. MasterCard and VISA accepted. 7a.m.-6p.m. cst.
Hurry! Prices expire 9/1/97.
AD
the business world. We will be happy to help their businesses succeed when they help dentistry as we know it survive, grow and prosper. Tom Howley, D.D.S. Lansdale, Pa.
OA
American Dental Association 211 E. Chicago Ave. Chicago, IL 60611-2678
I read with interest your article that stated 70 percent of respondents were not in favor of a dues increase to pay for national advertising (Question of the Month report, March JADA). I do not feel we (members of the ADA) can make such judgments. We simply do not have enough information. While you did supply a pie chart that allocates expenses, it would be more informative if we had a total breakdown of income and expenses, such as the breakdown of the 31 percent operations account. Possibly we could reduce some of these operational costs and pay for national advertising. I believe we are entitled to have access to all the expenses and income of the ADA. I also believe we should have national advertising. Marketing is the key to educating the public. Delores L. Hammer, D.D.S. Hickory, N.C. NITROUS OXIDE
In the March JADA article "Nitrous Oxide in the Dental Environment: Assessing the Risk, Reducing the Exposure," by Dr. William R. Howard, NIOSH and ACGIH recommendations of a 25- and 50-parts per-million maximum exposure to waste nitrous oxide were mentioned several times. While the paper never expressly stated that these levels were appropriate limits, it tacitly implied they were. Both of these organizations derived their levels based on studies by Bruce and colleagues' and Bruce and Bach.2 Bruce has had two retractions published for these findings in Anesthesia Analgesia (1983;62:617) and Anesthesiology (1991;74:1160-1), where he stated, "There is no longer any need to refer to our conclusions as 'controversial.' They were wrong, derived from data subject to inadvertent sampling bias and not applicable to the general population. The NIOSH standards should be revised." There has never been an animal or human study that showed any problems below 1,000 ppm. Several authors, including Nunn and Sweeney, have suggested that 450 ppm would be appropriate, safe, conservative, maximum levels for nitrous