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Rejuvenation now
LETTERS
communities having a fluoridated water supply are inconclusive. Some studies suggest a benefit; others do not. Two retrospective studies6,7 comparing caries in children who received fluoride supplements and whose mothers had received fluo ride supplements during pregnancy, with caries in children who received fluoride supplements only postnatally suggest some additional benefit. Data from Dr. Glenn’s study do not readily permit any evaluation of en hanced beneficial effect from expo sure to prenatal dietary fluoride supplement in an optimally fluori dated area. The Council does not recommend the use of dietary fluoride supple ments in a fluoridated community. Its recommendations are indicated in the Table, page 175. These are es sentially the same recommendations as those recently published by the C om m ittee on N u tritio n of the American Academy of Pediatrics.8 The Council is not aware of any data which would indicate that “superior teeth are produced by a single daily dose of fluoride as compared to fractionatedadministration.” G ORD ON H. SC H R O T E N B O E R , PhD SE C R E T A R Y , CO U N C IL ON D EN TA L T H E R A P E U T IC S
1. G lenn, F .B . Im m u nity conveyed by a sod iu m -flu o rid e su p p lem en t during p reg nancy. Part 2 . 1 Dent Child 4 6 (l):1 7 -2 4 , 1979. 2. Corpron, R.E., and Burt, B.A. Fluorosis from supplem entation w ith fluoride tablets. A case report. J M ich Dent Assoc 60(12):615-618, 1978. 3. Aasenden, R., and Peebles, T.C. Effects of fluoride supplem entation from birth on human deciduous and perm anent teeth. A rch Oral Biol 19(A priI):321-326, 1974. 4. Englander, H.R., and DePaola, P.F. En hanced anticaries action from drinking water containing 5 ppm fluoride. JADA 98 (l):3 5 -3 9 , 1979. 5. Englander, H.R. Is 1 ppm flu orid e in drinking water optimum for dental caries pre vention? JADA 9 8 (2 ):1 8 6 -1 8 7 ,1979. 6. K ailis, D .G., and others. Flu orid e and caries: observations on the effects of prenatal and postnatal flu oride on som e Perth pre school children. M ed J Aust 2(12/7):1037-1040, 1968. 7. Prichard, J.L. T he pre-natal and post-natal effects of fluoride supplem ents on West Aus tralian schoolchildren, aged 6, 7, and 8, Perth, 1967. Aust Dent J 1 4 (5 ):3 3 5 -3 3 8 ,1969. 8. Com m ittee on N utrition. Fluoride sup plementation: revised dosage schedule. Pediat rics 6 3 (1 ):1 5 0 -1 5 2 ,1979.
A ten-year follow-up □ There is a misprint in our article published in the June issue of The Journal (“Immediate permanent re construction of a mandibular con tinuity defect with use of a pros thesis of chromium-cobalt alloy”). On page 944, column 1, under the heading of “Treatment,” the date of the operation is given as March 7, 1978. It should be March 7, 1968. The follow-up, as mentioned in the summary, covers a ten-year period. N. R O B E R T M A R K O W ITZ , DMD O K LA H O M A C IT Y
Dental education in medical schools □ Dr. Lorber’s statement (The Jour nal, Nov 1978) that “physicians re ceived their MD degree without hav ing any more knowledge of the scope of modern dentistry than they had when entering medical school as freshmen” is no doubt influenced by the fact that 56 US medical schools are not connected with schools of dentistry and are “mouthless” 1 in terms of stomatological in struction. In 1968, Dr. Richard T. Smith, chairman of the pathology depart ment, University of Florida College of Medicine, recognized the problem and granted the oral medicine de partment of the dental college eight hours each fall quarter to.expose the sophomore medical students to what is most important regarding health care of the oral cavity. With pathology as the curriculum core, the medical students attend three one-hour lectures and five hours of laboratory time devoted to the oral conditions they are most likely to encounter— soft tissue changes (herpetic stomatitis, aph thous stomatitis, pemphigus, lichen planus); precancerous lesions and epidermoid cancer; odontogenic tumors; salivary gland tumors; and sarcomas of the jaws. Emphasis is also placed on the relative frequency of tumor metastasis to the jaws. Examples of obvious caries and periodontal disease are presented, and the importance of retaining nat
TO
THE
E D IT O R
ural teeth is emphasized. The mod ification of dental treatment for pa tients with systemic disease, those with implants or transplants, and those undergoing chemotherapy or radiation therapy is discussed. We agree with Sognnaes1 that American medical schools which lack dental school affiliation- should explore opportunities for establish ing sources for teaching such fun damental information. H ARO LD R. S T A N L E Y , D D S, M S RO N A LD A. BA U G H M A N , DDS G EO RG E E. G A RR IN G TO N , D D S, M PH G A IN ESV IL LE, F L A
1. Sognnaes, R.F. Why “m outhless” medical schools? N Engl J Med 297(15):837-838, 1977.
Rejuvenation now □ . . . Our Association has pre vented us from changing policy . . . has strangled our ability to effect al teration of methodology . . . and has caused loss of confidence on the part of many practitioners and the pub lic. . . . The attitude of the Associa tion has been, “We know what is best and we will not discuss it further.” This has been the policy regarding delivery of dental care to those who have no third-party coverage and who cannot afford care; to alterna tive methods of delivering fluoride during pregnancy and during the development and maturation of the dentition; to ethical advertising; to reciprocity—to name a few issues. But the profession is not dead. It can be made healthy again as the ed itorial “Beyond prevention” (The Journal, April) says. . . . The socio economic climate is in turmoil. Un fortunately, the health care profes sions do not have access to the councils of the theorists and ideal ists who are promulgating changes. The motivations of the sociologists are probably highly idealistic but their proposals usually fail to take into account the fact that delivery is not so readily accomplished. Cooperation and compromise must be arranged. The public must be shown that the professions are amenable to change if the change is practical. If it is not, they should be JADA, Vol. 99, August 1979 ■ 177
LETTERS
TO
THE
ED IT O R
told why it is not. The public should be told that dentistry, for years, has endeavored to have dental care a mandated health service . . Reduced-fee denture service for the indigent older citizen should be in stituted. .. . We must halt the lack of prevention . . . and revitalize the pro fession by overcoming prejudice, in tolerance of contrary views, and re fusal to compromise. REU BEN FELT M A N , DDS P A SSA IC , NJ
Dental nurses □ At a conference on school-based dental delivery systems, Dr. Dale Re dig presented the position of the As sociation on such matters as the use of Saskatchewan-type dental aux iliaries, and . . . made a sincere plea plea for depolarization on the issues. I admitted to being polarized, but said that the polarization was due to the stone wall erected against Sas katchewan auxiliaries by the dental examining boards, with strong sup port from the Association. My plea is for pilot programs in the use of these auxiliaries in areas of high need in the United States. Only by evaluat ing real operating programs in this
country can the controversy be shifted from emotion to fact so that depolarization can be started. There is a tendency for many den tists to blame the New Zealand den tal nurses for the edentulism still found . . . in New Zealand. This ig nores the high caries incidence due to climate and other factors, the cul tural preference of British popula tions for rem ovable prostheses rather than restorations, and the tendency of dentists there to yield to requests for extractions . . . Actually, edentulism is dropping in New Zea land as younger adults come from the cohorts of children . . . who re ceived dental care from the nurses. . A rising demand is now coming both from public health workers and the public, for school-based dental clinics with Saskatchewan-type aux iliaries. Only by prompt establish ment and evaluation of actual pilot programs can well-founded deci sions be made on this controversial issue. With the leadership of the As sociation, one or more states might be willing to alter their statutes or regulations to permit such pro grams. JA M E S M . DUNNING, D D S, MPH BO STO N
Down on Update □ After reading an advertisement in The Journal, I recently ordered Up date in Clinical Dentistry. Now that I have received my copy, I feel that other readers should know certain facts before deciding to purchase this book: —The title suggests that the book is oriented toward the clinical prac titioner and the ad implies that there is an organized discussion of tech niques currently used in various phases of dentistry. In fact, the book is a random collection of abstracts, and the editors advise writing to the authors for further information or details. —Of the 457 abstracted articles, only three were written as recently as 1975. By comparison, the Febru ary 1979 issue of Dental Abstracts had 83 articles, of which 80 were written in 1978. Thus, a year’s sub scription to this journal would pro vide the reader with nearly 1,000 more current abstracts. The Association sponsors or pub lishes many worthwhile journals, but Update in Clinical Dentistry is not one of them. W . L. H O LTO N , DDS LONDON
THE PRESIDENTS Each m onth, T h e Jo u rn a l prints the picture of a past president of the A m erican Dental A ssociation with a brief biography and a few h istorical highlights of his presidential year. The series began in February 1979 w ith the first president and is continuing in chronological order.
Am brose Law rence 1 8 6 7 -1 8 6 8 Doctor Lawrence of Lowell, Mass, was elected seventh president of the Association at the 1867 meeting in Cincinnati. The westernmost state dental society represented at that meeting was the Missouri State Dental As sociation. Doctor Lawrence was a member of a committee that recommended that dental students be accepted as members of the American Dental Association and suggested qualifications for their membership. He presented a paper at the 1867 meeting in which he asserted that too little attention was given by the profession to the importance of chemistry. He was a professor of prosthe tic dentistry. Doctor Lawrence was born in New Hampshire in 1816 and died in 1893. President Johnson, who had attempted to remove Edwin M. Stanton, secre tary of war, was impeached by the House of Representatives in 1868 but ac quitted by the Senate. The Fourteenth Amendment was ratified. Alaska was formally transferred to the United States October 18, 1867.
communities having a fluoridated water supply are inconclusive. Some studies suggest a benefit; others do not. Two retrospective studies6,7 comparing caries in children who received fluoride supplements and whose mothers had received fluo ride supplements during pregnancy, with caries in children who received fluoride supplements only postnatally suggest some additional benefit. Data from Dr. Glenn’s study do not readily permit any evaluation of en hanced beneficial effect from expo sure to prenatal dietary fluoride supplement in an optimally fluori dated area. The Council does not recommend the use of dietary fluoride supple ments in a fluoridated community. Its recommendations are indicated in the Table, page 175. These are es sentially the same recommendations as those recently published by the C om m ittee on N u tritio n of the American Academy of Pediatrics.8 The Council is not aware of any data which would indicate that “superior teeth are produced by a single daily dose of fluoride as compared to fractionatedadministration.” G ORD ON H. SC H R O T E N B O E R , PhD SE C R E T A R Y , CO U N C IL ON D EN TA L T H E R A P E U T IC S
1. G lenn, F .B . Im m u nity conveyed by a sod iu m -flu o rid e su p p lem en t during p reg nancy. Part 2 . 1 Dent Child 4 6 (l):1 7 -2 4 , 1979. 2. Corpron, R.E., and Burt, B.A. Fluorosis from supplem entation w ith fluoride tablets. A case report. J M ich Dent Assoc 60(12):615-618, 1978. 3. Aasenden, R., and Peebles, T.C. Effects of fluoride supplem entation from birth on human deciduous and perm anent teeth. A rch Oral Biol 19(A priI):321-326, 1974. 4. Englander, H.R., and DePaola, P.F. En hanced anticaries action from drinking water containing 5 ppm fluoride. JADA 98 (l):3 5 -3 9 , 1979. 5. Englander, H.R. Is 1 ppm flu orid e in drinking water optimum for dental caries pre vention? JADA 9 8 (2 ):1 8 6 -1 8 7 ,1979. 6. K ailis, D .G., and others. Flu orid e and caries: observations on the effects of prenatal and postnatal flu oride on som e Perth pre school children. M ed J Aust 2(12/7):1037-1040, 1968. 7. Prichard, J.L. T he pre-natal and post-natal effects of fluoride supplem ents on West Aus tralian schoolchildren, aged 6, 7, and 8, Perth, 1967. Aust Dent J 1 4 (5 ):3 3 5 -3 3 8 ,1969. 8. Com m ittee on N utrition. Fluoride sup plementation: revised dosage schedule. Pediat rics 6 3 (1 ):1 5 0 -1 5 2 ,1979.
A ten-year follow-up □ There is a misprint in our article published in the June issue of The Journal (“Immediate permanent re construction of a mandibular con tinuity defect with use of a pros thesis of chromium-cobalt alloy”). On page 944, column 1, under the heading of “Treatment,” the date of the operation is given as March 7, 1978. It should be March 7, 1968. The follow-up, as mentioned in the summary, covers a ten-year period. N. R O B E R T M A R K O W ITZ , DMD O K LA H O M A C IT Y
Dental education in medical schools □ Dr. Lorber’s statement (The Jour nal, Nov 1978) that “physicians re ceived their MD degree without hav ing any more knowledge of the scope of modern dentistry than they had when entering medical school as freshmen” is no doubt influenced by the fact that 56 US medical schools are not connected with schools of dentistry and are “mouthless” 1 in terms of stomatological in struction. In 1968, Dr. Richard T. Smith, chairman of the pathology depart ment, University of Florida College of Medicine, recognized the problem and granted the oral medicine de partment of the dental college eight hours each fall quarter to.expose the sophomore medical students to what is most important regarding health care of the oral cavity. With pathology as the curriculum core, the medical students attend three one-hour lectures and five hours of laboratory time devoted to the oral conditions they are most likely to encounter— soft tissue changes (herpetic stomatitis, aph thous stomatitis, pemphigus, lichen planus); precancerous lesions and epidermoid cancer; odontogenic tumors; salivary gland tumors; and sarcomas of the jaws. Emphasis is also placed on the relative frequency of tumor metastasis to the jaws. Examples of obvious caries and periodontal disease are presented, and the importance of retaining nat
TO
THE
E D IT O R
ural teeth is emphasized. The mod ification of dental treatment for pa tients with systemic disease, those with implants or transplants, and those undergoing chemotherapy or radiation therapy is discussed. We agree with Sognnaes1 that American medical schools which lack dental school affiliation- should explore opportunities for establish ing sources for teaching such fun damental information. H ARO LD R. S T A N L E Y , D D S, M S RO N A LD A. BA U G H M A N , DDS G EO RG E E. G A RR IN G TO N , D D S, M PH G A IN ESV IL LE, F L A
1. Sognnaes, R.F. Why “m outhless” medical schools? N Engl J Med 297(15):837-838, 1977.
Rejuvenation now □ . . . Our Association has pre vented us from changing policy . . . has strangled our ability to effect al teration of methodology . . . and has caused loss of confidence on the part of many practitioners and the pub lic. . . . The attitude of the Associa tion has been, “We know what is best and we will not discuss it further.” This has been the policy regarding delivery of dental care to those who have no third-party coverage and who cannot afford care; to alterna tive methods of delivering fluoride during pregnancy and during the development and maturation of the dentition; to ethical advertising; to reciprocity—to name a few issues. But the profession is not dead. It can be made healthy again as the ed itorial “Beyond prevention” (The Journal, April) says. . . . The socio economic climate is in turmoil. Un fortunately, the health care profes sions do not have access to the councils of the theorists and ideal ists who are promulgating changes. The motivations of the sociologists are probably highly idealistic but their proposals usually fail to take into account the fact that delivery is not so readily accomplished. Cooperation and compromise must be arranged. The public must be shown that the professions are amenable to change if the change is practical. If it is not, they should be JADA, Vol. 99, August 1979 ■ 177
LETTERS
TO
THE
ED IT O R
told why it is not. The public should be told that dentistry, for years, has endeavored to have dental care a mandated health service . . Reduced-fee denture service for the indigent older citizen should be in stituted. .. . We must halt the lack of prevention . . . and revitalize the pro fession by overcoming prejudice, in tolerance of contrary views, and re fusal to compromise. REU BEN FELT M A N , DDS P A SSA IC , NJ
Dental nurses □ At a conference on school-based dental delivery systems, Dr. Dale Re dig presented the position of the As sociation on such matters as the use of Saskatchewan-type dental aux iliaries, and . . . made a sincere plea plea for depolarization on the issues. I admitted to being polarized, but said that the polarization was due to the stone wall erected against Sas katchewan auxiliaries by the dental examining boards, with strong sup port from the Association. My plea is for pilot programs in the use of these auxiliaries in areas of high need in the United States. Only by evaluat ing real operating programs in this
country can the controversy be shifted from emotion to fact so that depolarization can be started. There is a tendency for many den tists to blame the New Zealand den tal nurses for the edentulism still found . . . in New Zealand. This ig nores the high caries incidence due to climate and other factors, the cul tural preference of British popula tions for rem ovable prostheses rather than restorations, and the tendency of dentists there to yield to requests for extractions . . . Actually, edentulism is dropping in New Zea land as younger adults come from the cohorts of children . . . who re ceived dental care from the nurses. . A rising demand is now coming both from public health workers and the public, for school-based dental clinics with Saskatchewan-type aux iliaries. Only by prompt establish ment and evaluation of actual pilot programs can well-founded deci sions be made on this controversial issue. With the leadership of the As sociation, one or more states might be willing to alter their statutes or regulations to permit such pro grams. JA M E S M . DUNNING, D D S, MPH BO STO N
Down on Update □ After reading an advertisement in The Journal, I recently ordered Up date in Clinical Dentistry. Now that I have received my copy, I feel that other readers should know certain facts before deciding to purchase this book: —The title suggests that the book is oriented toward the clinical prac titioner and the ad implies that there is an organized discussion of tech niques currently used in various phases of dentistry. In fact, the book is a random collection of abstracts, and the editors advise writing to the authors for further information or details. —Of the 457 abstracted articles, only three were written as recently as 1975. By comparison, the Febru ary 1979 issue of Dental Abstracts had 83 articles, of which 80 were written in 1978. Thus, a year’s sub scription to this journal would pro vide the reader with nearly 1,000 more current abstracts. The Association sponsors or pub lishes many worthwhile journals, but Update in Clinical Dentistry is not one of them. W . L. H O LTO N , DDS LONDON
THE PRESIDENTS Each m onth, T h e Jo u rn a l prints the picture of a past president of the A m erican Dental A ssociation with a brief biography and a few h istorical highlights of his presidential year. The series began in February 1979 w ith the first president and is continuing in chronological order.
Am brose Law rence 1 8 6 7 -1 8 6 8 Doctor Lawrence of Lowell, Mass, was elected seventh president of the Association at the 1867 meeting in Cincinnati. The westernmost state dental society represented at that meeting was the Missouri State Dental As sociation. Doctor Lawrence was a member of a committee that recommended that dental students be accepted as members of the American Dental Association and suggested qualifications for their membership. He presented a paper at the 1867 meeting in which he asserted that too little attention was given by the profession to the importance of chemistry. He was a professor of prosthe tic dentistry. Doctor Lawrence was born in New Hampshire in 1816 and died in 1893. President Johnson, who had attempted to remove Edwin M. Stanton, secre tary of war, was impeached by the House of Representatives in 1868 but ac quitted by the Senate. The Fourteenth Amendment was ratified. Alaska was formally transferred to the United States October 18, 1867.