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NEED VS. DEMAND
L E T T E R S
millimeter retrofill could be predictably expected to fail in the future. If the authors are really concerned that this tooth was placing their implant in jeopardy, we suggest that the new implant may also be at risk (although it should be noted that the second implant appears to be placed in a more appropriate location). Case 2 is an excellent example of radiographic misinterpretation. The authors claim that the gutta-percha is tracing a sinus tract to the apex of the endodontically treated second premolar when in reality the guttapercha is nowhere near the apex of this tooth, and, as near as we can determine from the radiograph, the endodontically treated tooth appears to have a normal periodontal ligament and intact lamina dura. The object described in Case 3 as a “gutta-percha cone” (Figure 6) has a radiographic appearance unlike any guttapercha cone in our experience. It is much more likely to be a metal Hedstrom-type file—an object stiff enough to create its own path rather than follow a sinus tract. Even so, the object points more directly to the apical extent of the implant created defect, not the root apex of the endodontically treated tooth. The initial implant placement in this case also suffers from the same root proximity issue raised in Case 1. Case 4 is perhaps the most remarkable example of inappropriate attribution. The authors would have us believe that in two weeks time they permanently cured a failing endodontically treated tooth with a single course of antibiotics and an exploratory surgical procedure. 722
We draw readers’ attention to the different angulation of the radiographs and suggest that the “cure” is probably more artifact than reality. There are many other issues raised by this series of case reports, but in the interest of brevity we feel we should close here. We also wish to emphasize that we feel implants can provide an excellent tooth replacement service and, with proper diagnosis and surgical technique, will continue to grow in popularity and use. The role of endodontically treated teeth in the success or failure of implants is an unanswered question and one that we hope will receive more serious consideration in the future. Bradford R. Johnson, D.D.S. Stephen M. Weeks, D.D.S. Department of Endodontics University of Illinois at Chicago NEED VS. DEMAND
How right Dr. Meskin was then and is now (“Back to the Future,” April JADA). The error made in the 1960s, when more dental schools were opened and existing schools enlarged their classes, was that need was confused with demand. There’s a difference. Another oversupply of dentists will not bring costs of dental care down. Many of the expenses of delivering dental care are fixed and unaffected by the supply of dentists. As Dr. Meskin said, the solution is training more auxiliary personnel. That can bring the cost of treatment down and improve access. As to the paucity of dentists in “underserved” areas, you can’t expect dentists to locate in
areas where the population is either unwilling to get treatment or unable to afford the cost of dental care. Randy C. Daniel, D.D.S., M.B.A. Stockbridge, Ga. ALLIED HEALTH PROFESSIONALS
I just read Dr. Meskin’s “Back to the Future” editorial (April JADA). I agree with his view 100 percent. I have continued to make these statements often over the years. We definitely should not increase the class size of dental schools, but we should make every effort to make dentists more efficient by the use of well-trained allied health professionals. It is a winwin situation for the profession and the public. When the profession was booming in the 1970s and early 1980s, I was very involved in the creation of the five categories of allied health professionals included in the California Dental Practice Act. We had developed an entire series of procedures that would allow upward mobility of dental assistants and dental hygienists with appropriate duties and responsibilities. This would allow them to participate as team members in the provision of comprehensive care under the supervision of a dentist. Most of that went by the wayside, especially the expanded-duty portion for the dental assistant and dental hygienist, when the profession (busyness issue) went into a tailspin in the late 1980s. I still believe as Dr. Meskin does (and have believed for at least the last two and one-half decades) that well-trained and
JADA, Vol. 132, June 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.
millimeter retrofill could be predictably expected to fail in the future. If the authors are really concerned that this tooth was placing their implant in jeopardy, we suggest that the new implant may also be at risk (although it should be noted that the second implant appears to be placed in a more appropriate location). Case 2 is an excellent example of radiographic misinterpretation. The authors claim that the gutta-percha is tracing a sinus tract to the apex of the endodontically treated second premolar when in reality the guttapercha is nowhere near the apex of this tooth, and, as near as we can determine from the radiograph, the endodontically treated tooth appears to have a normal periodontal ligament and intact lamina dura. The object described in Case 3 as a “gutta-percha cone” (Figure 6) has a radiographic appearance unlike any guttapercha cone in our experience. It is much more likely to be a metal Hedstrom-type file—an object stiff enough to create its own path rather than follow a sinus tract. Even so, the object points more directly to the apical extent of the implant created defect, not the root apex of the endodontically treated tooth. The initial implant placement in this case also suffers from the same root proximity issue raised in Case 1. Case 4 is perhaps the most remarkable example of inappropriate attribution. The authors would have us believe that in two weeks time they permanently cured a failing endodontically treated tooth with a single course of antibiotics and an exploratory surgical procedure. 722
We draw readers’ attention to the different angulation of the radiographs and suggest that the “cure” is probably more artifact than reality. There are many other issues raised by this series of case reports, but in the interest of brevity we feel we should close here. We also wish to emphasize that we feel implants can provide an excellent tooth replacement service and, with proper diagnosis and surgical technique, will continue to grow in popularity and use. The role of endodontically treated teeth in the success or failure of implants is an unanswered question and one that we hope will receive more serious consideration in the future. Bradford R. Johnson, D.D.S. Stephen M. Weeks, D.D.S. Department of Endodontics University of Illinois at Chicago NEED VS. DEMAND
How right Dr. Meskin was then and is now (“Back to the Future,” April JADA). The error made in the 1960s, when more dental schools were opened and existing schools enlarged their classes, was that need was confused with demand. There’s a difference. Another oversupply of dentists will not bring costs of dental care down. Many of the expenses of delivering dental care are fixed and unaffected by the supply of dentists. As Dr. Meskin said, the solution is training more auxiliary personnel. That can bring the cost of treatment down and improve access. As to the paucity of dentists in “underserved” areas, you can’t expect dentists to locate in
areas where the population is either unwilling to get treatment or unable to afford the cost of dental care. Randy C. Daniel, D.D.S., M.B.A. Stockbridge, Ga. ALLIED HEALTH PROFESSIONALS
I just read Dr. Meskin’s “Back to the Future” editorial (April JADA). I agree with his view 100 percent. I have continued to make these statements often over the years. We definitely should not increase the class size of dental schools, but we should make every effort to make dentists more efficient by the use of well-trained allied health professionals. It is a winwin situation for the profession and the public. When the profession was booming in the 1970s and early 1980s, I was very involved in the creation of the five categories of allied health professionals included in the California Dental Practice Act. We had developed an entire series of procedures that would allow upward mobility of dental assistants and dental hygienists with appropriate duties and responsibilities. This would allow them to participate as team members in the provision of comprehensive care under the supervision of a dentist. Most of that went by the wayside, especially the expanded-duty portion for the dental assistant and dental hygienist, when the profession (busyness issue) went into a tailspin in the late 1980s. I still believe as Dr. Meskin does (and have believed for at least the last two and one-half decades) that well-trained and
JADA, Vol. 132, June 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.