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PERSONNEL SHORTAGES
L E T T E R S
consumed indiscriminately. Science and publication are both social processes. Citations do not merely mark the author’s thought processes, nor do they only demonstrate that some readily identifiable person has taken responsibility for the information published. As Dr. Glick intimates, the author’s selection of references reveals his or her biases. Citations also can shed light on a variety of institutional influences. “Citations in scientific works—as a number of studies have shown—do far more than identify the originators of ideas and the sources of data,” historian Anthony Grafton wrote. “They reflect the intellectual styles of different national scientific communities, the pedagogical methods of different graduate programs, and the literary preferences of different journal editors. They regularly refer not only to the precise sources of scientists’ data, but also to larger theories and theoretical schools with which the authors wish or hope to be associated.”1 Products of a complex interplay of institutional norms and personal considerations, citations may constitute a network of public conversations among authors. Blaise Cronin wrote, “The publication process combines reward and recognition. The scientist is rewarded for his efforts by having publication status conferred on his work; that is, he or she receives the seal of approval of the scientific establishment, and those whose work he has cited in turn receive recognition for the part they have played in the development and furtherance of the citing author’s theories.”2 Such conversations can, at times, distort the value of cita442
JADA, Vol. 138
tions. Scientists are sometimes judged by the number of times their work is cited by others. Well-known authors may be cited more than others, not because the information they publish is more significant than that of other authors, but simply because they are well-known.3 Citation indexes, in which citations are tracked, intensify publishing’s dimension beyond disseminating information and have resulted in authors’ employing various stratagems to increase visibility. Information technology philosophers John Seely Brown and Paul Duguid maintain that “documents do not merely carry information, they help make it, structure it, validate it.”4 In the same sense, a scientific article is shaped and validated by its packaging. In many ways that JADA readers who are clinicians rather than scientists may not initially recognize, citations form a vital part of that packaging. Just as authors must take care to appropriately annotate their manuscripts, readers should learn to skillfully interpret the meanings in the citations. Eric K. Curtis, DDS Safford, Ariz. 1. Grafton A. The footnote. Cambridge, Mass: Harvard University Press; 1997:12-3. 2. Cronin B. The citation process: The role and significance of citations in scientific communication. London: Taylor Graham; 1984:13. 3. Lange LL, Frensch PA. Gaining scientific recognition by position: does editorship increase citation rates? Scientometrics 1999; 44(3):45986. 4. Brown JS, Duguid P. The social life of information. Boston: Harvard Business School Press; 2000:189.
PERSONNEL SHORTAGES
I am writing regarding Dr. Timothy Brown and colleagues’ January JADA article, “How Do We Measure Shortages of Dental Hygienists and Dental
Assistants?: Evidence From California: 1997-2005” (JADA 2007;138[1]:94-100). I’m no economist, but the divergences in the slopes of inflation-adjusted wages for dental hygienists versus dental assistants between 1997 and 2004 suggest what may be a permanent decrease in per capita demand for hygiene services in California. In contrast, the relatively stable wages for dental assistants over the same interval suggest little or no change in demand for the clinical services typically provided by California dentists. If accurate, a logical question is: What is behind this apparent per capita decrease in demand for dental hygiene services in California? Because almost all dental hygiene services in California are prescribed by a dentist (rather than the dental hygienist offering his or her services directly to the public), dental hygienists are somewhat isolated from consumer demand. In this light, these data suggest to me that dentists themselves are providing more dental hygiene services, referring their patients to dental hygienists less often and/or that the efficiency of delivery of dental hygiene services has jumped. If so, why? Additional studies that relate such changing clinical dynamics to treatment outcomes, overall patient wellness, insurance coverages and patients’ out-of-pocket costs may produce valuable public health information that could lead to more efficient and more effective utilization of dental and dental hygiene services. Mike Rethman, DDS, MS Kaneohe, Hawaii
Authors’ response: Dr. Rethman states that the trends in inflation-adjusted wages for
http://jada.ada.org April 2007 Copyright ©2007 American Dental Association. All rights reserved.
consumed indiscriminately. Science and publication are both social processes. Citations do not merely mark the author’s thought processes, nor do they only demonstrate that some readily identifiable person has taken responsibility for the information published. As Dr. Glick intimates, the author’s selection of references reveals his or her biases. Citations also can shed light on a variety of institutional influences. “Citations in scientific works—as a number of studies have shown—do far more than identify the originators of ideas and the sources of data,” historian Anthony Grafton wrote. “They reflect the intellectual styles of different national scientific communities, the pedagogical methods of different graduate programs, and the literary preferences of different journal editors. They regularly refer not only to the precise sources of scientists’ data, but also to larger theories and theoretical schools with which the authors wish or hope to be associated.”1 Products of a complex interplay of institutional norms and personal considerations, citations may constitute a network of public conversations among authors. Blaise Cronin wrote, “The publication process combines reward and recognition. The scientist is rewarded for his efforts by having publication status conferred on his work; that is, he or she receives the seal of approval of the scientific establishment, and those whose work he has cited in turn receive recognition for the part they have played in the development and furtherance of the citing author’s theories.”2 Such conversations can, at times, distort the value of cita442
JADA, Vol. 138
tions. Scientists are sometimes judged by the number of times their work is cited by others. Well-known authors may be cited more than others, not because the information they publish is more significant than that of other authors, but simply because they are well-known.3 Citation indexes, in which citations are tracked, intensify publishing’s dimension beyond disseminating information and have resulted in authors’ employing various stratagems to increase visibility. Information technology philosophers John Seely Brown and Paul Duguid maintain that “documents do not merely carry information, they help make it, structure it, validate it.”4 In the same sense, a scientific article is shaped and validated by its packaging. In many ways that JADA readers who are clinicians rather than scientists may not initially recognize, citations form a vital part of that packaging. Just as authors must take care to appropriately annotate their manuscripts, readers should learn to skillfully interpret the meanings in the citations. Eric K. Curtis, DDS Safford, Ariz. 1. Grafton A. The footnote. Cambridge, Mass: Harvard University Press; 1997:12-3. 2. Cronin B. The citation process: The role and significance of citations in scientific communication. London: Taylor Graham; 1984:13. 3. Lange LL, Frensch PA. Gaining scientific recognition by position: does editorship increase citation rates? Scientometrics 1999; 44(3):45986. 4. Brown JS, Duguid P. The social life of information. Boston: Harvard Business School Press; 2000:189.
PERSONNEL SHORTAGES
I am writing regarding Dr. Timothy Brown and colleagues’ January JADA article, “How Do We Measure Shortages of Dental Hygienists and Dental
Assistants?: Evidence From California: 1997-2005” (JADA 2007;138[1]:94-100). I’m no economist, but the divergences in the slopes of inflation-adjusted wages for dental hygienists versus dental assistants between 1997 and 2004 suggest what may be a permanent decrease in per capita demand for hygiene services in California. In contrast, the relatively stable wages for dental assistants over the same interval suggest little or no change in demand for the clinical services typically provided by California dentists. If accurate, a logical question is: What is behind this apparent per capita decrease in demand for dental hygiene services in California? Because almost all dental hygiene services in California are prescribed by a dentist (rather than the dental hygienist offering his or her services directly to the public), dental hygienists are somewhat isolated from consumer demand. In this light, these data suggest to me that dentists themselves are providing more dental hygiene services, referring their patients to dental hygienists less often and/or that the efficiency of delivery of dental hygiene services has jumped. If so, why? Additional studies that relate such changing clinical dynamics to treatment outcomes, overall patient wellness, insurance coverages and patients’ out-of-pocket costs may produce valuable public health information that could lead to more efficient and more effective utilization of dental and dental hygiene services. Mike Rethman, DDS, MS Kaneohe, Hawaii
Authors’ response: Dr. Rethman states that the trends in inflation-adjusted wages for
http://jada.ada.org April 2007 Copyright ©2007 American Dental Association. All rights reserved.