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National Health Service
LETTERS
TO
THE
E D ITO R
soon enough, supporting tissue can be grafted from the palate. Fur thermore, to take a greater chance of mouth cancer as a substitute for lung cancer doesn’t seem reason able. “I don’t think we need even dis cuss chewing on the basis of it being ugly, disgusting, or unsani tary, especially for our school-age children. It is simply an unhealthy practice... .If I am irate any anyone it is the total medical community, which has not taken a strong pub lic stance in opposition to the frankly very appealing advertising campaign aimed at our children. (The Carlton Fisk and Walt Garri son television commercials are examples.)” CHARLES G. REITINGER, DDS GUNNISON, COLO
Finding a fracture □ The article “Fracture of the an terior nasal spine” (The Journal, Sep tember) has some misleading infor mation. The frequency of fracture of the anterior nasal spine may be low and there may be no reported cases in the literature. However, the conclu sion that such fractures may be missed because clinicians do not in clude lateral radiographs of the face in differential diagnosis is com pletely unjustified. Because the nasal bone is the most frequently fractured of the facial bones,1,2 and other midfacial frac tures are often detectable in the lat eral radiographs of the face, this and the occipito-mental (Water’s) view have been routine for differential diagnosis of midfacial fractures.1,3,4 The posteroanterior and lateral oblique views of the mandible are in dicated for suspected fracture of the mandible, and the submento-vertex and Towne’s views are supplemental for fracture of the condyles and zygomatic arches. There is no justifi able reason for these extra views for diagnosis of fracture of the anterior nasal spine if there are adequate his tory and symptoms and if a good clin ical examination is done. The authors may be correct in as suming that such fractures are fre quently missed, but a quick review of the literature would indicate that the reason is . . . our not putting enough emphasis on the importance of his954 ■ JADA, Vol. 99, December 1979
cal examination were the primary keys to diagnosis. JAY L. SONNENSHEIN, DDS DOUGLAS S. MOST, DDS MORTON MALKIN, DDS BROOKLYN
National Health Service
tory, symptoms, and clinical exami nation. . . . WENDELL S. MORRISON, DDS, MPH CHAPEL HILL, NC 1. Schultz, R.C. Facial injuries. Chicago, Year Book Medical Publishers, 1977. 2. Waite, D.E. Textbook of practical oral surgery. Philadelphia, Lea & Febiger, 1978. 3. Kruger, G.O., ed. Textbook of oral surgery. St. Louis, Mosby, 1979. 4. Converse, J.M. Kazanjian & Converse’s surgical treatment of facial injuries. Baltimore, Williams and Wilkins, 1974.
Authors’ com m ent: Our article was prepared for the purpose of bringing an unusual fracture to the attention of our colleagues. It was a straight forward case. The history was not obscure, and the clinical picture of a laceration at the mucobuccal fold was easily noted. The diagnosis could not be made on the basis of the history and the clinical examination alone. The fracture could be con firmed only with a straight lateral ra diograph (Illustration). It is quite true that the nasal bone is the most frequently fractured of the facial bones. However, the anterior nasal spine is not part of the nasal bone complex and is, in fact, a pro cess of the maxilla, some centimeters distant. Moreover, the routine nasal bone radiographs often exclude the anterior nasal spine because of the cone. Dr. Morrison is correct in stressing the importance of history taking and clinical examination in diagnosis; this is emphasized in the teaching program at our institution. However, there must be cases to cite in which, unlike our case, the history and clini
□ Dr. Waldman’s informative article on dentistry in the the British Na tional Health Service (The Journal, September) made interesting read ing. However, as a general dentist within the system for some 22 years, I feel I must reply and put the practi tioner’s point of view across. It is ob vious to me that Dr. Waldman was primarily in contact with the British academic establishment of the dental schools rather than the grass roots of the health service. They are poles apart for all practical purposes. In 22 years of practice, I had more than a surfeit of socialized dentistry. At its inception, what appeared to be a new and challenging era for the young id e a listic graduate soon turned into a monstrous nightmare fashioned by successive govern ments. The profession was wooed into a scheme with promises that soon were forgotten. The paymaster was the state, and one danced to whatever tune was being played at the time. We suffered cut after cut in our schedule of fees. Very soon, qual ity dentistry was sacrificed for the conveyor belt product. We became masters at improvization. Amalgam crowns were the order of the day. Fixed prosthodontics was something of the distant past. Extractions and flipper type dentures constituted a large part of one’s daily routine. We were expected to produce a satisfac tory complete upper and lower den ture for the derisory sum of $28 which, by the way, included the technician’s fee. The rest of our fee schedule would boggle any Ameri can dentist’s mind. Indeed, I would be embarrassed to present one here. We carried on year after year with hope and optimism, although our complaints were utterly disregarded. Eventually the sustained discontent lowered morale to the point of silent revolt. The public had been brain washed into thinking that compre hensive dental care was available. They soon realized that anything more than utility had to be paid for
LETTERS
TO
TH E
E D ITO R
privately. At age 51 I decided that enough was enough. I resigned from the Health Service and am now prac ticing the kind of dentistry I was trained to perform. I enjoy my work and do the many things I was unable to do for 20 years. It is too late for me to be affected by what is on the horizon for dentistry on this side of the Atlantic, but I urge my colleagues to take the time and trouble to study the menu very care fully. Socialized dentistry has very little to offer you, much less the pub lic it pretends to serve. Political expediency will prompt those with vested interests to woo an unsuspect ing profession with rosy offers. Let us not lay ourselves open to use and abuse in the years ahead. Let us not participate as pallbearers for decent dentistry. In the end we will have to face the discontent, wrath, and ulti mate contempt of a public we were seeking to serve. GARNIC CARR AVETOOM, DDS WESTMINSTER, CALIF
More holistic care □ I hope your ed ito rial, “ W ill holism influence dental health?” will be read by dental education ad ministrators who have sectioned their curricula, faculty, and facilities, so that the ultimate result is the di viding of their students’ ability to conceptualize their patients’ dis eases and therapies. Even dentists who graduated 20 or more years ago commonly refer to their patients as “jacket patients,” “endo patients,” or “ amalgam patients.” How many years does it take to undo this chan nelized brainwashing? Who says holism isn’t totally “sci entific”? How do we know kinesiol ogy, meditation, or biorhythm does not affect human dental caries, periodontal disease, aphthous ul cers, or the fit of dentures? Who de termines that the clinician should not utilize these modalities ? To those interested in delivering a more
humanistic service, the detractors all too often seem to be the bacteriologist looking into a culture medium or a pathologist looking down the sights of a microscope rather than a clini cian looking into the eyes of a patient seeking answers for his current prob lem rather than waiting for “proof of efficacy.” Thank you for pointing out den tistry’s long concern about the influ ence of cultural heritage and lifestyle upon the patient’s dental health. Perhaps we will grow enough to fully appreciate the efforts of men like Les ter Burket, Weston Price, Melvin Page, Emanuel Cheraskin, Sumter Arnim, and Robert Barkley. After that, their pioneering work may stir us to move on to more holistic, or comprehensive, care for our patients. RONALD W. FABRICK, DDS GLENVIEW, ILL
THE PRESIDENTS Each m onth, The Journal prints the picture of a past president of the A m erican Dental A ssociation w ith a brief biography and a few historical highlights of h is presidential year. The series began in February 1979 w ith the first president and is continuing in chronological order.
George Hoppin Cushing 1 8 7 1 -1 8 7 2 Doctor Cushing of Chicago was elected 11th president of the Association at the 1871 meeting at White Sulphur Springs, West Virginia. As chairman of the Committee on Dental Literature, he delivered an extensive report, citing the recent “marked improvement” in dental journals. Doctor Cushing was one of the founders of the Illinois State Dental Society and served twice as its president. He also served as president of the Chicago Dental Society and the Chicago Odontological Society. He was recording secretary of the American Dental Association from 1878 to 1883 and from 1885 until his death in 1900. Doctor Cushing was born in Providence, Rhode Island, in 1829. A great fire that burned from October 8 to 11, 1871, destroyed most of Chicago, including the printed Transactions of the American Dental A sso ciation as it was about to be delivered from the publishing house. The United States was awarded $15,500,000 from Great Britain for wartime dam age to the Alabama and other Confederate cruisers.
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QQ
T io r o n ih o r 1 Q7Q
TO
THE
E D ITO R
soon enough, supporting tissue can be grafted from the palate. Fur thermore, to take a greater chance of mouth cancer as a substitute for lung cancer doesn’t seem reason able. “I don’t think we need even dis cuss chewing on the basis of it being ugly, disgusting, or unsani tary, especially for our school-age children. It is simply an unhealthy practice... .If I am irate any anyone it is the total medical community, which has not taken a strong pub lic stance in opposition to the frankly very appealing advertising campaign aimed at our children. (The Carlton Fisk and Walt Garri son television commercials are examples.)” CHARLES G. REITINGER, DDS GUNNISON, COLO
Finding a fracture □ The article “Fracture of the an terior nasal spine” (The Journal, Sep tember) has some misleading infor mation. The frequency of fracture of the anterior nasal spine may be low and there may be no reported cases in the literature. However, the conclu sion that such fractures may be missed because clinicians do not in clude lateral radiographs of the face in differential diagnosis is com pletely unjustified. Because the nasal bone is the most frequently fractured of the facial bones,1,2 and other midfacial frac tures are often detectable in the lat eral radiographs of the face, this and the occipito-mental (Water’s) view have been routine for differential diagnosis of midfacial fractures.1,3,4 The posteroanterior and lateral oblique views of the mandible are in dicated for suspected fracture of the mandible, and the submento-vertex and Towne’s views are supplemental for fracture of the condyles and zygomatic arches. There is no justifi able reason for these extra views for diagnosis of fracture of the anterior nasal spine if there are adequate his tory and symptoms and if a good clin ical examination is done. The authors may be correct in as suming that such fractures are fre quently missed, but a quick review of the literature would indicate that the reason is . . . our not putting enough emphasis on the importance of his954 ■ JADA, Vol. 99, December 1979
cal examination were the primary keys to diagnosis. JAY L. SONNENSHEIN, DDS DOUGLAS S. MOST, DDS MORTON MALKIN, DDS BROOKLYN
National Health Service
tory, symptoms, and clinical exami nation. . . . WENDELL S. MORRISON, DDS, MPH CHAPEL HILL, NC 1. Schultz, R.C. Facial injuries. Chicago, Year Book Medical Publishers, 1977. 2. Waite, D.E. Textbook of practical oral surgery. Philadelphia, Lea & Febiger, 1978. 3. Kruger, G.O., ed. Textbook of oral surgery. St. Louis, Mosby, 1979. 4. Converse, J.M. Kazanjian & Converse’s surgical treatment of facial injuries. Baltimore, Williams and Wilkins, 1974.
Authors’ com m ent: Our article was prepared for the purpose of bringing an unusual fracture to the attention of our colleagues. It was a straight forward case. The history was not obscure, and the clinical picture of a laceration at the mucobuccal fold was easily noted. The diagnosis could not be made on the basis of the history and the clinical examination alone. The fracture could be con firmed only with a straight lateral ra diograph (Illustration). It is quite true that the nasal bone is the most frequently fractured of the facial bones. However, the anterior nasal spine is not part of the nasal bone complex and is, in fact, a pro cess of the maxilla, some centimeters distant. Moreover, the routine nasal bone radiographs often exclude the anterior nasal spine because of the cone. Dr. Morrison is correct in stressing the importance of history taking and clinical examination in diagnosis; this is emphasized in the teaching program at our institution. However, there must be cases to cite in which, unlike our case, the history and clini
□ Dr. Waldman’s informative article on dentistry in the the British Na tional Health Service (The Journal, September) made interesting read ing. However, as a general dentist within the system for some 22 years, I feel I must reply and put the practi tioner’s point of view across. It is ob vious to me that Dr. Waldman was primarily in contact with the British academic establishment of the dental schools rather than the grass roots of the health service. They are poles apart for all practical purposes. In 22 years of practice, I had more than a surfeit of socialized dentistry. At its inception, what appeared to be a new and challenging era for the young id e a listic graduate soon turned into a monstrous nightmare fashioned by successive govern ments. The profession was wooed into a scheme with promises that soon were forgotten. The paymaster was the state, and one danced to whatever tune was being played at the time. We suffered cut after cut in our schedule of fees. Very soon, qual ity dentistry was sacrificed for the conveyor belt product. We became masters at improvization. Amalgam crowns were the order of the day. Fixed prosthodontics was something of the distant past. Extractions and flipper type dentures constituted a large part of one’s daily routine. We were expected to produce a satisfac tory complete upper and lower den ture for the derisory sum of $28 which, by the way, included the technician’s fee. The rest of our fee schedule would boggle any Ameri can dentist’s mind. Indeed, I would be embarrassed to present one here. We carried on year after year with hope and optimism, although our complaints were utterly disregarded. Eventually the sustained discontent lowered morale to the point of silent revolt. The public had been brain washed into thinking that compre hensive dental care was available. They soon realized that anything more than utility had to be paid for
LETTERS
TO
TH E
E D ITO R
privately. At age 51 I decided that enough was enough. I resigned from the Health Service and am now prac ticing the kind of dentistry I was trained to perform. I enjoy my work and do the many things I was unable to do for 20 years. It is too late for me to be affected by what is on the horizon for dentistry on this side of the Atlantic, but I urge my colleagues to take the time and trouble to study the menu very care fully. Socialized dentistry has very little to offer you, much less the pub lic it pretends to serve. Political expediency will prompt those with vested interests to woo an unsuspect ing profession with rosy offers. Let us not lay ourselves open to use and abuse in the years ahead. Let us not participate as pallbearers for decent dentistry. In the end we will have to face the discontent, wrath, and ulti mate contempt of a public we were seeking to serve. GARNIC CARR AVETOOM, DDS WESTMINSTER, CALIF
More holistic care □ I hope your ed ito rial, “ W ill holism influence dental health?” will be read by dental education ad ministrators who have sectioned their curricula, faculty, and facilities, so that the ultimate result is the di viding of their students’ ability to conceptualize their patients’ dis eases and therapies. Even dentists who graduated 20 or more years ago commonly refer to their patients as “jacket patients,” “endo patients,” or “ amalgam patients.” How many years does it take to undo this chan nelized brainwashing? Who says holism isn’t totally “sci entific”? How do we know kinesiol ogy, meditation, or biorhythm does not affect human dental caries, periodontal disease, aphthous ul cers, or the fit of dentures? Who de termines that the clinician should not utilize these modalities ? To those interested in delivering a more
humanistic service, the detractors all too often seem to be the bacteriologist looking into a culture medium or a pathologist looking down the sights of a microscope rather than a clini cian looking into the eyes of a patient seeking answers for his current prob lem rather than waiting for “proof of efficacy.” Thank you for pointing out den tistry’s long concern about the influ ence of cultural heritage and lifestyle upon the patient’s dental health. Perhaps we will grow enough to fully appreciate the efforts of men like Les ter Burket, Weston Price, Melvin Page, Emanuel Cheraskin, Sumter Arnim, and Robert Barkley. After that, their pioneering work may stir us to move on to more holistic, or comprehensive, care for our patients. RONALD W. FABRICK, DDS GLENVIEW, ILL
THE PRESIDENTS Each m onth, The Journal prints the picture of a past president of the A m erican Dental A ssociation w ith a brief biography and a few historical highlights of h is presidential year. The series began in February 1979 w ith the first president and is continuing in chronological order.
George Hoppin Cushing 1 8 7 1 -1 8 7 2 Doctor Cushing of Chicago was elected 11th president of the Association at the 1871 meeting at White Sulphur Springs, West Virginia. As chairman of the Committee on Dental Literature, he delivered an extensive report, citing the recent “marked improvement” in dental journals. Doctor Cushing was one of the founders of the Illinois State Dental Society and served twice as its president. He also served as president of the Chicago Dental Society and the Chicago Odontological Society. He was recording secretary of the American Dental Association from 1878 to 1883 and from 1885 until his death in 1900. Doctor Cushing was born in Providence, Rhode Island, in 1829. A great fire that burned from October 8 to 11, 1871, destroyed most of Chicago, including the printed Transactions of the American Dental A sso ciation as it was about to be delivered from the publishing house. The United States was awarded $15,500,000 from Great Britain for wartime dam age to the Alabama and other Confederate cruisers.
Q fifì
m I A FÌA
V ili
T io r o n ih o r 1 Q7Q