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Radiographs & diagnosis
LETTERS TO THE EDITOR THE JOURNAL devotes this section to com m ent by readers on topics of current interest to den tistry. The e d ito r reserves the righ t to edit all com m unications to fit available space and requires that all letters be signed. Printed com m unications do not necessarily reflect the opinion or of ficia l po licy o f the A ssociation. Your pa rticipation in this section is invited.
Prevention prim ary objective • I feel I must take issue with your editorial in t i e D ecem ber Journal (page 1059) in the second paragraph, w here you state, “ D entistry is a rig orous and dem anding profession w hose prim ary objective, very gen erally, is to repair and restore to norm alcy parts o f the oral cavity dam aged by disease or traum a or to create norm alcy as nearly as possible when the parts are m alform ed or m issing.” T ake a good look at yourself in the mirror, D octor! T hat attitude and ap proach has done little to help solve the dental problem s of our patients over the past decade. R ather, 1 would think that our pri m ary objective is the prevention of dental disease, and that the repair and restoration of its effects should be secondary. O ur p atien ts’ dental needs will be met only w hen the attitude of the pro fession is m ore as “ do cto rs” and less as tooth carpenters, m olar m echan ics, and “ d en tu rists.” T here is no sub stitute for sound nutritional guidance. E D G A R M. M I L L E R , D M D LOWV1LLE, NY
E d itor’s note: Preventive dentistry is a very im portant part of dentistry and that thought was the specific rea son for using the term “ very gen erally” in the editorial to suggest that the definition w as not com prehensive.
R adiographs & diagnosis m With all due respect to the efforts
o f the authors o f an article in the N o
vem ber issue of The Journal (page 1010), I m ust submit that their diligent work proves little, for the following reasons: F irst, the m ost frequent reason for error appeared to be “ films not m ounted and identified.” I submit that this is no criterion. T he subm is sion o f radiographs is at the carrier’s request. T he fact that they are un m ounted has nothing to do with their diagnostic value o th er than conven ience. Since they w ere subm itted at the carrier’s request, not the d en tist’s or patient’s, it is the carrier’s problem to identify the radiographs and mount them if they so desire. Second, the criteria are predicated on the assum ption that the radio graphs are the prim ary source of di agnostic inform ation. This may be so for the carrier, but not for the practi tioner. C ertainly, by the au th o r’s def inition of acceptability, some radio graphs in my practice—as the sole source of inform ation—are unac ceptable. But they are not th e sole source of diagnostic inform ation to the doctor rendering treatm ent. T hat is the car rier’s problem in trying to rem otely judge and control the practitioner ren dering treatm ent, not mine. I see no reason to submit the patient to the additional radiation to satisfy this rath er arbitrary requirem ent with little relationship to clinical needs. 1 am not in favor of poor radiographic techniques and hope this is not interpreted in that way. H ow ever, I am equally opposed to som eone, having never seen my patient, using only one available diagnostic criterion to sit in judgm ent o f a subm itted treat ment outline. A pproxim ately 25% o f my practice
is u nder third party paym ent, so I do not live in an ivory tow er. H ow ever, som ew here, som etim e, w e, as a pro fession, have got to stand up and show we are m ore than m echanics using one criterion in deciding treat ment for a patient. If we accept from the carrier the proposed list of rejections, we are only a step o r tw o from som e “ punchc a rd ” diagnostic procedure to be used by all carriers in determ ining patient need, eligibility, quality o f care, and so forth, by clerks w ho d o n ’t know mesial from distal. W hen this day a r rives, we will no longer deserve or enjoy the status of profession. EL I E. W H I T E , J R . , D D S M E R RITT ISLA N D , FLA
M isleading statistics m A recen t, inform ative letter to the editor in the N o v em b er j a d a from Dr. M yron A llukian and others (page 884) pleads for a “ more detailed ex am ination” of the relation betw een the C onsum er Price Index (C P I) and the index of dental fees. While the com m ents in the letter appropriately segment the record of the last decade into controlled and uncontrolled per iods, the additional detail is less perti nent, and its labeling is misleading. Let me briefly illustrate the meaning of their last colum n of figures with an exam ple. In 1965, Jo h n Smith spent $10.00 on an oral exam and $0.80 on a Big Mac. In 1971, he spent $13.77 on an oral exam and $1.03 on a Big Mac. Such are the facts. N ow to clear up these confusing figures. T he price of the oral exam in creased $3.77 and the price of the Big M ac increased $0.23. This is a 37.7% increase in oral exam fees and a 28.4% increase in the price of a Big Mac. T o illustrate the hidden truth, we calcu late the figure for the last colum n in the letter. T he difference in the differ ences in percent changes in prices as a percent of the p ercent change in the price of a Big M ac is a surprising 32.7%! T heir technique of data presenta tion is well know n among statisti cians, but is inappropriate unless o n e’s objective is to misinform the reader through statistical m anipula tion. Its form in this case is choosing JADA, Vol. 94, February 1977 ■ 211
Prevention prim ary objective • I feel I must take issue with your editorial in t i e D ecem ber Journal (page 1059) in the second paragraph, w here you state, “ D entistry is a rig orous and dem anding profession w hose prim ary objective, very gen erally, is to repair and restore to norm alcy parts o f the oral cavity dam aged by disease or traum a or to create norm alcy as nearly as possible when the parts are m alform ed or m issing.” T ake a good look at yourself in the mirror, D octor! T hat attitude and ap proach has done little to help solve the dental problem s of our patients over the past decade. R ather, 1 would think that our pri m ary objective is the prevention of dental disease, and that the repair and restoration of its effects should be secondary. O ur p atien ts’ dental needs will be met only w hen the attitude of the pro fession is m ore as “ do cto rs” and less as tooth carpenters, m olar m echan ics, and “ d en tu rists.” T here is no sub stitute for sound nutritional guidance. E D G A R M. M I L L E R , D M D LOWV1LLE, NY
E d itor’s note: Preventive dentistry is a very im portant part of dentistry and that thought was the specific rea son for using the term “ very gen erally” in the editorial to suggest that the definition w as not com prehensive.
R adiographs & diagnosis m With all due respect to the efforts
o f the authors o f an article in the N o
vem ber issue of The Journal (page 1010), I m ust submit that their diligent work proves little, for the following reasons: F irst, the m ost frequent reason for error appeared to be “ films not m ounted and identified.” I submit that this is no criterion. T he subm is sion o f radiographs is at the carrier’s request. T he fact that they are un m ounted has nothing to do with their diagnostic value o th er than conven ience. Since they w ere subm itted at the carrier’s request, not the d en tist’s or patient’s, it is the carrier’s problem to identify the radiographs and mount them if they so desire. Second, the criteria are predicated on the assum ption that the radio graphs are the prim ary source of di agnostic inform ation. This may be so for the carrier, but not for the practi tioner. C ertainly, by the au th o r’s def inition of acceptability, some radio graphs in my practice—as the sole source of inform ation—are unac ceptable. But they are not th e sole source of diagnostic inform ation to the doctor rendering treatm ent. T hat is the car rier’s problem in trying to rem otely judge and control the practitioner ren dering treatm ent, not mine. I see no reason to submit the patient to the additional radiation to satisfy this rath er arbitrary requirem ent with little relationship to clinical needs. 1 am not in favor of poor radiographic techniques and hope this is not interpreted in that way. H ow ever, I am equally opposed to som eone, having never seen my patient, using only one available diagnostic criterion to sit in judgm ent o f a subm itted treat ment outline. A pproxim ately 25% o f my practice
is u nder third party paym ent, so I do not live in an ivory tow er. H ow ever, som ew here, som etim e, w e, as a pro fession, have got to stand up and show we are m ore than m echanics using one criterion in deciding treat ment for a patient. If we accept from the carrier the proposed list of rejections, we are only a step o r tw o from som e “ punchc a rd ” diagnostic procedure to be used by all carriers in determ ining patient need, eligibility, quality o f care, and so forth, by clerks w ho d o n ’t know mesial from distal. W hen this day a r rives, we will no longer deserve or enjoy the status of profession. EL I E. W H I T E , J R . , D D S M E R RITT ISLA N D , FLA
M isleading statistics m A recen t, inform ative letter to the editor in the N o v em b er j a d a from Dr. M yron A llukian and others (page 884) pleads for a “ more detailed ex am ination” of the relation betw een the C onsum er Price Index (C P I) and the index of dental fees. While the com m ents in the letter appropriately segment the record of the last decade into controlled and uncontrolled per iods, the additional detail is less perti nent, and its labeling is misleading. Let me briefly illustrate the meaning of their last colum n of figures with an exam ple. In 1965, Jo h n Smith spent $10.00 on an oral exam and $0.80 on a Big Mac. In 1971, he spent $13.77 on an oral exam and $1.03 on a Big Mac. Such are the facts. N ow to clear up these confusing figures. T he price of the oral exam in creased $3.77 and the price of the Big M ac increased $0.23. This is a 37.7% increase in oral exam fees and a 28.4% increase in the price of a Big Mac. T o illustrate the hidden truth, we calcu late the figure for the last colum n in the letter. T he difference in the differ ences in percent changes in prices as a percent of the p ercent change in the price of a Big M ac is a surprising 32.7%! T heir technique of data presenta tion is well know n among statisti cians, but is inappropriate unless o n e’s objective is to misinform the reader through statistical m anipula tion. Its form in this case is choosing JADA, Vol. 94, February 1977 ■ 211