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Safety Examples
LETTERS TO THE ED IT O R
Several JADA articles on MPD have demonstrated inappropriate petulance and peevishness. . . . Some are not based on substantial fact but make broad ac cusations and pointless innuendoes. . . . Since 1969, there have been many MPD syndrome articles in JADA. . .. most of which are contradictory. The four cardi nal symptoms are pain and muscular ten derness, which are subjective; and click ing and limitation, which are objective. The MPD syndrome articles dem on strated that treatment of emotional factors resulted in reduction of the painful (sub jective) symptoms in many (but not all) of the patients. These treatments had no ef fect on the m easurable (objective) symptoms, clicking, or limitation. This has always been a serious flaw in the exegesis of the MPD syndrome. If a syn drome consists of a group of symptoms, successful treatment should eliminate all or at least a majority of them, particularly those that can be measured. This has not been the case. The proponents of MPD syndrome have not been able to show that clicking and limitation are in any way re lated to emotional disorders, etiologically or therapeutically. Therefore, their ex planation of the syndrome is and always has been scientifically incomplete. There is beginning to be a consensus about the definitions and descriptions of TMJ problems affecting patients who come seeking treatment. The ADA Coun cil on Dental Care Programs recently pre sented an excellent outline of various TMJ problems and acceptable methods of treatment (JADA, September 1982). This Council report is a major step forward. This type of information needs to be pub lished and emphasized in JADA. Perhaps someone w ill present a credi ble definition of MPD syndrome (if it is possible) so that there w ill be no misunderstanding or confusion about which of the patients have it.
nally, frustration. The article was initially informative and somewhat encouraging. It is indeed encouraging to realize that a syndrome, which for many years was misdiagnosed and sometimes ignored, is finally beginning to be understood. It is even more encouraging to realize that it can be treated conservatively with good short- and long-term results. What is confusing and frustrating is the fact that Drs. Greene and Laskin appear to feel the need to slap the wrist of the dental profession. The dental profession has as sumed primary responsibility for treat ment of MPD syndrome mainly because it is our responsibility, and also because the medical profession has refused to educate itself in this area. Unfortunately, many of the patients with MPD syndrome whom I have seen have a history of multiple visits to medical specialists with little, if any, results whatsoever. The last thing our profession needs is to be chastised for trying to correct a situa tion that has gone so long without correc tion. We have not buried our heads in the sand and ignored the problem, but have made a concentrated effort to find a feasi ble solution. Perhaps the article w ill stim ulate further thought in this direction, but I be lieve that those of us who choose to treat MPD syndrome are far from being iso lated “from the mainstream of modern pain management.” JEFF R. BEAL, DDS SAN ANTONIO, TEX
Cervical erosion
□ Many factors are likely to have a part in the cause of cervical erosive lesions of teeth. We have proposed, however, that the primary factor may be the tensile stress created during mastication and bruxism. In accordance with this model, the tensile stresses created during masti cation and parafunctional movements cause the bending of teeth. Tooth struc ture, particularly enamel, although compressively strong, is relatively weak under tension.1"3 The tensile forces may cause the disruption of chemical bonds and create microcracks in the area of greatest stress, the cervical area at the ful W ILLIAM B. FARRAR, DDS crum. The weakened tooth substance MONTGOMERY, ALA would become susceptible to trauma, 1. Laskin, D.M., conference ed. Derangements of abrasion, and chemical dissolution, re the temporomandibular joint. JADA 79(1):87-177, sulting in the development of the typical 1969. wedge-shaped lesions. Perhaps this concept of tensile stress □ I began reading Drs. Greene and Las- can adequately explain the cervical ero kin’s article, “Long-term evaluation of sive lesions observed by Dr. Stroner, “Cervical erosion involving the lingual tre a tm e n t for m y o fa s c ia l paindysfunction syndrome: a comparative surface of a mandibular canine and adja analysis” (August), with a great eagerness cent premolars” (August). A lthough that turned quickly to confusion and, fi much experimentation remains to be
550 ■ JADA, Vol. 107, October 1983
done to lend validity to the model, it does provide a logical basis on which research and treatment (treatment reducing o rA eliminating lateral forces on affected teeth) can be contemplated and tested. W ILLIAM C. LEE, DDS, MA W. STEPHEN EAKLE, DDS' UNIVERSITY OF CALIFORNIA SAN FRANCISCO 1. Phillips, R.W. Skinner’s science of dental mate- ^ rials, ed 7. Philadelphia, W. B. Saunders Co, 1973, pp 49-51. 2. Craig, R.G.; Peyton, F.A.; and Johnson, D .W .^ Compression properties of enamel, dental cements, and gold. J Dent Res 40:936-940, 1961. * 3. Bowen, R., and Rodriguez, M. Tensile strength and modulus of elasticity of tooth structure and sev eral restorative materials. JADA 64(3):378-387, 1962.
w
Dental image-building
□ I write in response to Dr. Pranikoff’ letter (June) in which he yearns for an im proved image for dentistry, and for in creased public awareness of the benefits t of good dental health. The responsibility for educating the public, polishing the image of dentists, and elevating people’s consciousness oL dental care rests primarily with the indi vidual dentist. Many of our colleagues have been extraordinarily creative and successful in achieving these goals in 1 their communities. There was a time, not so long ago, when few dentists had any interest in issues^ such as these. Today, the interest is there, but many of us seem to be looking for someone else to show us the way. The American Dental Association cer tainly has a part to play in the compre hensive promotion of dentistry, but let us not delude ourselves as to where the real burden lies: it lies with us. GORDON LEDINGHAM, DDS PHOENIX ^
Safety examples
'M
□ The picture on page 817 of the June issue shows two practitioners with no"* masks, gloves, or safety glasses. We can, v hardly pick up any dental journal today without at least one article on transmissi ble diseases, aerosol infection, eye injury, or contact dermatitis. In addition, many * dental materials are irritating or just plain messy. By the end of the day, the typical ** dentist’s hands are covered with a mix ture of saliva, blood, cements, impression materials, etching liquids, and various medicaments. The question is how can the profession j ever hope to equal these standards of asepsis and operator safety if dental and -> hygiene students are not taught to operate with glasses, masks, and gloves? A KIRK W. BALDAUF, DDS MARSHFIELD, WIS
Several JADA articles on MPD have demonstrated inappropriate petulance and peevishness. . . . Some are not based on substantial fact but make broad ac cusations and pointless innuendoes. . . . Since 1969, there have been many MPD syndrome articles in JADA. . .. most of which are contradictory. The four cardi nal symptoms are pain and muscular ten derness, which are subjective; and click ing and limitation, which are objective. The MPD syndrome articles dem on strated that treatment of emotional factors resulted in reduction of the painful (sub jective) symptoms in many (but not all) of the patients. These treatments had no ef fect on the m easurable (objective) symptoms, clicking, or limitation. This has always been a serious flaw in the exegesis of the MPD syndrome. If a syn drome consists of a group of symptoms, successful treatment should eliminate all or at least a majority of them, particularly those that can be measured. This has not been the case. The proponents of MPD syndrome have not been able to show that clicking and limitation are in any way re lated to emotional disorders, etiologically or therapeutically. Therefore, their ex planation of the syndrome is and always has been scientifically incomplete. There is beginning to be a consensus about the definitions and descriptions of TMJ problems affecting patients who come seeking treatment. The ADA Coun cil on Dental Care Programs recently pre sented an excellent outline of various TMJ problems and acceptable methods of treatment (JADA, September 1982). This Council report is a major step forward. This type of information needs to be pub lished and emphasized in JADA. Perhaps someone w ill present a credi ble definition of MPD syndrome (if it is possible) so that there w ill be no misunderstanding or confusion about which of the patients have it.
nally, frustration. The article was initially informative and somewhat encouraging. It is indeed encouraging to realize that a syndrome, which for many years was misdiagnosed and sometimes ignored, is finally beginning to be understood. It is even more encouraging to realize that it can be treated conservatively with good short- and long-term results. What is confusing and frustrating is the fact that Drs. Greene and Laskin appear to feel the need to slap the wrist of the dental profession. The dental profession has as sumed primary responsibility for treat ment of MPD syndrome mainly because it is our responsibility, and also because the medical profession has refused to educate itself in this area. Unfortunately, many of the patients with MPD syndrome whom I have seen have a history of multiple visits to medical specialists with little, if any, results whatsoever. The last thing our profession needs is to be chastised for trying to correct a situa tion that has gone so long without correc tion. We have not buried our heads in the sand and ignored the problem, but have made a concentrated effort to find a feasi ble solution. Perhaps the article w ill stim ulate further thought in this direction, but I be lieve that those of us who choose to treat MPD syndrome are far from being iso lated “from the mainstream of modern pain management.” JEFF R. BEAL, DDS SAN ANTONIO, TEX
Cervical erosion
□ Many factors are likely to have a part in the cause of cervical erosive lesions of teeth. We have proposed, however, that the primary factor may be the tensile stress created during mastication and bruxism. In accordance with this model, the tensile stresses created during masti cation and parafunctional movements cause the bending of teeth. Tooth struc ture, particularly enamel, although compressively strong, is relatively weak under tension.1"3 The tensile forces may cause the disruption of chemical bonds and create microcracks in the area of greatest stress, the cervical area at the ful W ILLIAM B. FARRAR, DDS crum. The weakened tooth substance MONTGOMERY, ALA would become susceptible to trauma, 1. Laskin, D.M., conference ed. Derangements of abrasion, and chemical dissolution, re the temporomandibular joint. JADA 79(1):87-177, sulting in the development of the typical 1969. wedge-shaped lesions. Perhaps this concept of tensile stress □ I began reading Drs. Greene and Las- can adequately explain the cervical ero kin’s article, “Long-term evaluation of sive lesions observed by Dr. Stroner, “Cervical erosion involving the lingual tre a tm e n t for m y o fa s c ia l paindysfunction syndrome: a comparative surface of a mandibular canine and adja analysis” (August), with a great eagerness cent premolars” (August). A lthough that turned quickly to confusion and, fi much experimentation remains to be
550 ■ JADA, Vol. 107, October 1983
done to lend validity to the model, it does provide a logical basis on which research and treatment (treatment reducing o rA eliminating lateral forces on affected teeth) can be contemplated and tested. W ILLIAM C. LEE, DDS, MA W. STEPHEN EAKLE, DDS' UNIVERSITY OF CALIFORNIA SAN FRANCISCO 1. Phillips, R.W. Skinner’s science of dental mate- ^ rials, ed 7. Philadelphia, W. B. Saunders Co, 1973, pp 49-51. 2. Craig, R.G.; Peyton, F.A.; and Johnson, D .W .^ Compression properties of enamel, dental cements, and gold. J Dent Res 40:936-940, 1961. * 3. Bowen, R., and Rodriguez, M. Tensile strength and modulus of elasticity of tooth structure and sev eral restorative materials. JADA 64(3):378-387, 1962.
w
Dental image-building
□ I write in response to Dr. Pranikoff’ letter (June) in which he yearns for an im proved image for dentistry, and for in creased public awareness of the benefits t of good dental health. The responsibility for educating the public, polishing the image of dentists, and elevating people’s consciousness oL dental care rests primarily with the indi vidual dentist. Many of our colleagues have been extraordinarily creative and successful in achieving these goals in 1 their communities. There was a time, not so long ago, when few dentists had any interest in issues^ such as these. Today, the interest is there, but many of us seem to be looking for someone else to show us the way. The American Dental Association cer tainly has a part to play in the compre hensive promotion of dentistry, but let us not delude ourselves as to where the real burden lies: it lies with us. GORDON LEDINGHAM, DDS PHOENIX ^
Safety examples
'M
□ The picture on page 817 of the June issue shows two practitioners with no"* masks, gloves, or safety glasses. We can, v hardly pick up any dental journal today without at least one article on transmissi ble diseases, aerosol infection, eye injury, or contact dermatitis. In addition, many * dental materials are irritating or just plain messy. By the end of the day, the typical ** dentist’s hands are covered with a mix ture of saliva, blood, cements, impression materials, etching liquids, and various medicaments. The question is how can the profession j ever hope to equal these standards of asepsis and operator safety if dental and -> hygiene students are not taught to operate with glasses, masks, and gloves? A KIRK W. BALDAUF, DDS MARSHFIELD, WIS