- Email: [email protected]
Preventive award deserved
Printing O ffice, W ashington, D .C . 119-Part 6, 1973, pp. 7828. 8. M cD onald, J .C . an d others. T he health o f chrysotile asb esto s mine and mill w orkers of Q uebec. A rch Env H ealth 28:61, 1974. 9. Selikoff. I.J. Epidemiology o f g astroin testinal can cer. Env H ealth Perspect 9:299, 1974. 10. S chneiderm an, M .A . D igestive system c an c e r am ong persons subjected to occupa tional inhalation o f asb esto s particles: A liter a tu re review with em phasis on dose response. E nv H ealth Perspect 9:307, 1975. M. Sincock, A . and Seabright, M. Induction of chrom osom e changes in C hinese ham ster cells by exp o su re to asbestos fibers. N atu re 257:56, 1975. 12. C ohen, E .N . and others. A survey o f a nesth etic health hazards am ong d en tists. JA D A 90:1291, 1975. 13. C ouncil on D ental M aterials and De vices, M ercury vap o r levels in dental offices: A simple sem iquantitative test. J A D A 91:610, 1975.
A A W D a n d inequality m Regarding the letter from Jane W. Selbe com plaining of inequitable m em bership benefits in relation to the A ssociation of A m erican W omen D entists: A s a past president of A A W D and for m any years one o f its extrem ely active m em bers in num erous areas of organized dentistry, I have found my self answ ering m any local and long distance telephone calls from both m en and w om en concerning that letter. M y answ ers to som e of those ques tions have been: T he organization was not formed to encourage w om en in the pursuit of a dental career; how ever, the majority of its m em bers have been deeply de voted to our profession and always have encouraged oth er women to be com e dentists. V erbal reports from charter mem bers led me to believe the organiza tio n was form ed in 1921 as a means of banding together those women around the country w ho sought cour age in num bers in order to com fort ably attend dental meetings and gain benefit from the scientific sessions. C an you imagine the tem erity with w hich a lone fem ale would enter a dental meeting in the early years of this century? T he association’s constitution states only that the objectives of the organization shall be to prom ote good
fellowship and cooperation am ong its mem bers and to aid in the advance m ent of women in dentistry. D uring all my years in A A W D , I never knew a w oman who paid dues to a constituent society, a com ponent society, and to the A D A m erely for the privilege of m em bership in A A W D . T he m ajority of voting mem bers at meeting after meeting has de clared that w omen who w ere not suf ficiently interested in the profession to belong to organized dentistry were not desirable as m em bers o f A A W D (last vote taken at 1974 national meeting). A t the 1975 annual meeting, m ost m em bers in attendance did believe the idea o f a husband-wife or family m em bership in A D A a good one; how ever, no record of a m otion to pe tition the A D A for such a m em ber ship classification is recorded in the m inutes o f the association’s meeting. A t that tim e m ost of u s did not realize the “ opening of P an d o ra’s b ox” it would bring about for the ADA. Father-daughter, motherson—every conceivable family com bination, plus those incorporated groups who consider them selves a “ fam ily” of so rts—w ould have to share the same privileges as husbandwife. A A W D ’s request, justifiably, could not be granted w ithout accurate sta tistics on the num ber of m em berships, cost increases, reduction of expenses, and elimination of m ass mailings in volved. Surely we all know it will be wise to plan ahead for the increased num ber of dentists graduating in the next four years—but not ju st for 1,300 w omen. M A R IL Y N E . S T O N E , D D S
desirable needs: —a m aster card with m atching ex tension sheets; —provides a new bill w ithout show ing any previous services, charges, or paym ents; —provides for the use of the easiest and m ost accurate m ethod of copying, “ photocopying” ; —provides for m onthly bills for com pleted services and supplies for the sam e patient during any one month w ithout carry-over m istakes; and —in this m ethod, an easy to handle 514x814 inch card may be used and photocopied onto any larger form p re ferred by a third p arty , usually 8Vix 11 inch for their ease of handling. In sum m ary this is a m ethod of making records that consists of the steps of: providing a m aster sheet including a top portion having perm anent indicia identifying a doctor and a patient and a bottom section having an area of perm anent indicia establish ing lengthw ise colum ns for use in recording services perform ed by the doctor; photocopying said m aster sheet after perform ed services are recorded thereon, providing an ex tension sheet of the size and shape as said area and having identical indicia on its face for recording services sub sequently perform ed by the doctor for the identified patient; and th en , before the recording of said subsequent ser vices, adhesively securing said exten sion sheet on said bottom portion in a position in which its indicia is an exact replacem ent of the now cov ered area; and thereafter photocopy ing the modified m aster sh eet with the copy appearing as that of a first used m aster sheet. G EO R G E K E M P S T E R , D M D B R O C K T O N , M ASS
ATLANTA
M a kin g records
■ I wish to bring to your attention U nited States P aten t no. 3,960,634 titled “ M ethod of making reco rd s,” issued June 1, 1976. It pertains to the making and tran s fer of records directly from health providers such as doctors and pharm acies to third parties. T he m ethod provides a num ber of
222 ■ LETTERS TO THE EDITOR I JADA, Vol. 93, August 1976
P reven tive a w a rd d ese rve d m I was very im pressed with D r. A braham E. N izel’s article in the M ay j o u r n a l regarding a means of getting preventive program s set up so that our insurance carriers can live with them and include them as part of their coverage. I feel D r. N izel has done a very com plete and thorough analysis of
our problem . I ca n ’t see why this can’t be im plem ented. It certainly seem s to be to everyone’s advantage to elimin ate the need for extensive operative procedures. I would hope that there has been som e definite com m unication on this m atter betw een the insurance carriers and the dental organization. I have my preventive program s es tablished, but the insurance elem ent is becom ing so heavy that I ’m not able to give these tim ely benefits to as m any as I would like. If this could becom e part of their coverage, I think it would be a real m ilestone in our dental delivery system . M ay I express to D r. N izel my hardy approval for this fine article, his tim ely approach to a difficult problem , and his dedication to his profession. I think there would be no doubt that the A D A P reventive D entistry A w ard for 1975 should have been his. T H O M A S M . B A SSE T T , D D S C L E A R F IE L D , U T A H
C lo se auxiliary loophole
■ T he letter of D r. A. H. Kubikian and com m ents by D r. John C oady in the M ay j a d a discuss program s in w hich dental auxiliaries are provided instructions in perform ing irreversible procedures. P rocedures taught to auxiliaries include cavity and crown preparation as well as adm inistration o f local and general anesthetics. Al legedly the objectives of these pro grams are experim entation and re search in pursuit of “ new findings and technological advances” in the art and science of dentistry. It is difficult for me to visualize what new findings or technological advanc es can result from these studies. S urely we can accept the prem ise th at any properly trained person can adequately perform any or all of the duties of a dentist! We also accept the prem ise that if a procedure is delegated to a person of lesser com petence and pay, it can be produced m ore econom ically. A lso, the more duties delegated by the dentist, the m ore time available for him to in crease his productivity—provided he d o esn ’t spend his newly acquired time
on the golf course or telephone. So w hat are these program s really out to prove? T he circum stances surrounding such program s indicate to me that they are intended to be the basis of the forerunner of an attem pt to implem ent tw o-level dentistry in this country in the mode o f the N ew Zealand “ dental n u rse.” In 1973, the H ouse of Delegates adopted the N inth D istrict Resolution no. 82 which stated “ that the A D A stand in opposition to program s which perm it dental auxiliary personnel to cut hard o r soft tissue in the oral cav ity .” U nfortunately, a loophole exists in the background statem ent which ac com panies this resolution. T he loop hole reads ' ‘th at auxiliaries not be perm itted to perform these functions in the tre a tm e n t of p atien ts.” Since the type of program s dis cussed by D rs. Kubikian and Coady persist and since it is believed by many that the intent of such programs ultim ately is fo r the treatm ent of pa tients, it behooves the H ouse of D el egates to give careful consideration to eliminating the loophole in the background statem ent of resolution 82. T here are easier ways to determ ine the difference betw een a lemon m eringue and a chocolate pie than being hit in the face with them. W IL L IA M T R A V IS, D D S D E A R B O R N , M IC H
B o a rd s a n d p ro fe ssio n a l im a g e m M any controversies have been aired recently in A D A publications, and the m ost controversial seems to be the subject of “ reciprocity” —with the “ image of d entists” running a close second. It is unfortunate that some in this profession should find their public image in need of constant reinforce ment. Y et these people have come by this need legitimately. T he basic den tal licensing procedure in m ost states is a m ajor contributor to the poor professional image one may hold of oneself. If we are to maintain an image of
professionalism com parable to the other large branch of the healing arts, namely m edicine, we m ust throw our skeletons out o f our own closets. We dentists are required to dem on strate manual proficiency to those who exam ine us for state licensure. 1 know of no medical state board exam ination in this nation where it is required of an applicant for licensure to dem onstrate his proficiency in veni puncture, blood pressure reading, fracture reduction, or splint applica tion. T hat an accredited medical college has granted a degree is accepted as com petency in the aforem entioned manual skills. The medical state board exam inations are academ ic and re quire no clinical dem onstration of com petency. F o r the m ost part, these exam inations are com puter graded. D ental state board exam inations force a prospective licensee to enter the public m arketplace in order to secure a “ state board p atien t.” In deed, some dental supply com panies advertise for these patients in the public p ress—thus lending the pro s pective licensee a “ helping h and” and, incidentally, securing a tacit in debtedness from him. N ow our neo p h y te’s image is twice degraded— once by the “ favor” the patient m ust do for him , and second by the dental supply com panies’ “ fav o r.” This requirem ent of skill dem on stration hides a m ore sinister appli cation in licensure procedure: de facto discrim ination. C riteria for manual skill dem on stration are delineated by respective state boards of education, yet actual application of these criteria rests in the subjective interpretation of the individual exam iner. This person may be consciously or subconsciously prejudicial tow ard m inority groups, religious groups, w om en, and so forth, and his prejudice can find its way into his grading procedures. It should be enough for a profes sion as self-regulatory as ours to trust its college accreditation com m ittees. T hese com m ittees determ ine the adequacy of any college teaching pro gram and, once accredited, a dental college’s “ technique” programs should be accepted w ithout question by any state exam ination board and
LETTERS TO THE EDITOR / JADA, Vol. 93, A ugust 1976 ■ 225
A A W D a n d inequality m Regarding the letter from Jane W. Selbe com plaining of inequitable m em bership benefits in relation to the A ssociation of A m erican W omen D entists: A s a past president of A A W D and for m any years one o f its extrem ely active m em bers in num erous areas of organized dentistry, I have found my self answ ering m any local and long distance telephone calls from both m en and w om en concerning that letter. M y answ ers to som e of those ques tions have been: T he organization was not formed to encourage w om en in the pursuit of a dental career; how ever, the majority of its m em bers have been deeply de voted to our profession and always have encouraged oth er women to be com e dentists. V erbal reports from charter mem bers led me to believe the organiza tio n was form ed in 1921 as a means of banding together those women around the country w ho sought cour age in num bers in order to com fort ably attend dental meetings and gain benefit from the scientific sessions. C an you imagine the tem erity with w hich a lone fem ale would enter a dental meeting in the early years of this century? T he association’s constitution states only that the objectives of the organization shall be to prom ote good
fellowship and cooperation am ong its mem bers and to aid in the advance m ent of women in dentistry. D uring all my years in A A W D , I never knew a w oman who paid dues to a constituent society, a com ponent society, and to the A D A m erely for the privilege of m em bership in A A W D . T he m ajority of voting mem bers at meeting after meeting has de clared that w omen who w ere not suf ficiently interested in the profession to belong to organized dentistry were not desirable as m em bers o f A A W D (last vote taken at 1974 national meeting). A t the 1975 annual meeting, m ost m em bers in attendance did believe the idea o f a husband-wife or family m em bership in A D A a good one; how ever, no record of a m otion to pe tition the A D A for such a m em ber ship classification is recorded in the m inutes o f the association’s meeting. A t that tim e m ost of u s did not realize the “ opening of P an d o ra’s b ox” it would bring about for the ADA. Father-daughter, motherson—every conceivable family com bination, plus those incorporated groups who consider them selves a “ fam ily” of so rts—w ould have to share the same privileges as husbandwife. A A W D ’s request, justifiably, could not be granted w ithout accurate sta tistics on the num ber of m em berships, cost increases, reduction of expenses, and elimination of m ass mailings in volved. Surely we all know it will be wise to plan ahead for the increased num ber of dentists graduating in the next four years—but not ju st for 1,300 w omen. M A R IL Y N E . S T O N E , D D S
desirable needs: —a m aster card with m atching ex tension sheets; —provides a new bill w ithout show ing any previous services, charges, or paym ents; —provides for the use of the easiest and m ost accurate m ethod of copying, “ photocopying” ; —provides for m onthly bills for com pleted services and supplies for the sam e patient during any one month w ithout carry-over m istakes; and —in this m ethod, an easy to handle 514x814 inch card may be used and photocopied onto any larger form p re ferred by a third p arty , usually 8Vix 11 inch for their ease of handling. In sum m ary this is a m ethod of making records that consists of the steps of: providing a m aster sheet including a top portion having perm anent indicia identifying a doctor and a patient and a bottom section having an area of perm anent indicia establish ing lengthw ise colum ns for use in recording services perform ed by the doctor; photocopying said m aster sheet after perform ed services are recorded thereon, providing an ex tension sheet of the size and shape as said area and having identical indicia on its face for recording services sub sequently perform ed by the doctor for the identified patient; and th en , before the recording of said subsequent ser vices, adhesively securing said exten sion sheet on said bottom portion in a position in which its indicia is an exact replacem ent of the now cov ered area; and thereafter photocopy ing the modified m aster sh eet with the copy appearing as that of a first used m aster sheet. G EO R G E K E M P S T E R , D M D B R O C K T O N , M ASS
ATLANTA
M a kin g records
■ I wish to bring to your attention U nited States P aten t no. 3,960,634 titled “ M ethod of making reco rd s,” issued June 1, 1976. It pertains to the making and tran s fer of records directly from health providers such as doctors and pharm acies to third parties. T he m ethod provides a num ber of
222 ■ LETTERS TO THE EDITOR I JADA, Vol. 93, August 1976
P reven tive a w a rd d ese rve d m I was very im pressed with D r. A braham E. N izel’s article in the M ay j o u r n a l regarding a means of getting preventive program s set up so that our insurance carriers can live with them and include them as part of their coverage. I feel D r. N izel has done a very com plete and thorough analysis of
our problem . I ca n ’t see why this can’t be im plem ented. It certainly seem s to be to everyone’s advantage to elimin ate the need for extensive operative procedures. I would hope that there has been som e definite com m unication on this m atter betw een the insurance carriers and the dental organization. I have my preventive program s es tablished, but the insurance elem ent is becom ing so heavy that I ’m not able to give these tim ely benefits to as m any as I would like. If this could becom e part of their coverage, I think it would be a real m ilestone in our dental delivery system . M ay I express to D r. N izel my hardy approval for this fine article, his tim ely approach to a difficult problem , and his dedication to his profession. I think there would be no doubt that the A D A P reventive D entistry A w ard for 1975 should have been his. T H O M A S M . B A SSE T T , D D S C L E A R F IE L D , U T A H
C lo se auxiliary loophole
■ T he letter of D r. A. H. Kubikian and com m ents by D r. John C oady in the M ay j a d a discuss program s in w hich dental auxiliaries are provided instructions in perform ing irreversible procedures. P rocedures taught to auxiliaries include cavity and crown preparation as well as adm inistration o f local and general anesthetics. Al legedly the objectives of these pro grams are experim entation and re search in pursuit of “ new findings and technological advances” in the art and science of dentistry. It is difficult for me to visualize what new findings or technological advanc es can result from these studies. S urely we can accept the prem ise th at any properly trained person can adequately perform any or all of the duties of a dentist! We also accept the prem ise that if a procedure is delegated to a person of lesser com petence and pay, it can be produced m ore econom ically. A lso, the more duties delegated by the dentist, the m ore time available for him to in crease his productivity—provided he d o esn ’t spend his newly acquired time
on the golf course or telephone. So w hat are these program s really out to prove? T he circum stances surrounding such program s indicate to me that they are intended to be the basis of the forerunner of an attem pt to implem ent tw o-level dentistry in this country in the mode o f the N ew Zealand “ dental n u rse.” In 1973, the H ouse of Delegates adopted the N inth D istrict Resolution no. 82 which stated “ that the A D A stand in opposition to program s which perm it dental auxiliary personnel to cut hard o r soft tissue in the oral cav ity .” U nfortunately, a loophole exists in the background statem ent which ac com panies this resolution. T he loop hole reads ' ‘th at auxiliaries not be perm itted to perform these functions in the tre a tm e n t of p atien ts.” Since the type of program s dis cussed by D rs. Kubikian and Coady persist and since it is believed by many that the intent of such programs ultim ately is fo r the treatm ent of pa tients, it behooves the H ouse of D el egates to give careful consideration to eliminating the loophole in the background statem ent of resolution 82. T here are easier ways to determ ine the difference betw een a lemon m eringue and a chocolate pie than being hit in the face with them. W IL L IA M T R A V IS, D D S D E A R B O R N , M IC H
B o a rd s a n d p ro fe ssio n a l im a g e m M any controversies have been aired recently in A D A publications, and the m ost controversial seems to be the subject of “ reciprocity” —with the “ image of d entists” running a close second. It is unfortunate that some in this profession should find their public image in need of constant reinforce ment. Y et these people have come by this need legitimately. T he basic den tal licensing procedure in m ost states is a m ajor contributor to the poor professional image one may hold of oneself. If we are to maintain an image of
professionalism com parable to the other large branch of the healing arts, namely m edicine, we m ust throw our skeletons out o f our own closets. We dentists are required to dem on strate manual proficiency to those who exam ine us for state licensure. 1 know of no medical state board exam ination in this nation where it is required of an applicant for licensure to dem onstrate his proficiency in veni puncture, blood pressure reading, fracture reduction, or splint applica tion. T hat an accredited medical college has granted a degree is accepted as com petency in the aforem entioned manual skills. The medical state board exam inations are academ ic and re quire no clinical dem onstration of com petency. F o r the m ost part, these exam inations are com puter graded. D ental state board exam inations force a prospective licensee to enter the public m arketplace in order to secure a “ state board p atien t.” In deed, some dental supply com panies advertise for these patients in the public p ress—thus lending the pro s pective licensee a “ helping h and” and, incidentally, securing a tacit in debtedness from him. N ow our neo p h y te’s image is twice degraded— once by the “ favor” the patient m ust do for him , and second by the dental supply com panies’ “ fav o r.” This requirem ent of skill dem on stration hides a m ore sinister appli cation in licensure procedure: de facto discrim ination. C riteria for manual skill dem on stration are delineated by respective state boards of education, yet actual application of these criteria rests in the subjective interpretation of the individual exam iner. This person may be consciously or subconsciously prejudicial tow ard m inority groups, religious groups, w om en, and so forth, and his prejudice can find its way into his grading procedures. It should be enough for a profes sion as self-regulatory as ours to trust its college accreditation com m ittees. T hese com m ittees determ ine the adequacy of any college teaching pro gram and, once accredited, a dental college’s “ technique” programs should be accepted w ithout question by any state exam ination board and
LETTERS TO THE EDITOR / JADA, Vol. 93, A ugust 1976 ■ 225