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Social Issues
Let me work to my full capacity as a h ealth care professional. Give me your respect and promote me as the educator in your office. I promise I will stay in your office and in th e profession forever. Give me $2,000 per year for an IRA and I promise I’ll never leave! I have always worked two days per week in dental offices. This is w hat it would take to have me practice five days a week. H ere is your answ er to underutilization. H ere’s w hat the hygienists are really saying w hen they say they w ant their own practices. Let us m anage a periodontal center w ithin your own dental practice. M arsha R aff M ayer M illbrae, Calif. E d ito r ’s note: As a m atte r of policy, th e letters section of JADA is reserved for the com m ents of ADA-member dentists. In Ms. M ayer’s case (and for Dr. Kam inetzky), we have m ade an exception. So m uch of our coverage in recent m onths has related to dental hygiene issues, we thought it only fair th a t a hygienist be given the opportunity to speak h er m ind and share her views w ith dentistry. DENTAL HANDPIECES
Prolonging the well-being of the dental handpiece is not totally incom patible w ith heat sterilization, provided other handpiece m aintenance protocol is followed. Prolonging the well being of our p atients m ust be our prim ary goal, however, and we m ust “do no harm .” In th a t regard, Dr. Zinm an in 18
JADA, Vol. 123, November 1992
his lette r (August) is correct. We are not done when we sterilize the workhorse in stru m en t in dentistry. The litera tu re is replete with reference to concerns about contam inated dental unit w ater. Research reports indicate th a t pathogens may be present in unacceptably high num bers. More often th an not, such w ater does not m eet the colony-forming u n it standards for drinking or swim m ing pool w ater, let alone w hat we should dem and for dentistry. Biofilms th a t form in the tubings and w ater lines and m ay be re sista n t to flushing w ith biocides (when th a t is possible) are indeed a p a rt of the problem. Check valves, as Dr. Zinm an notes, are of help in reducing th e effect of active retraction; however, they fail and th eir failure often goes unnoticed. A th ird factor is the passive retraction th a t occurs, despite the presence of a work ing check valve. This backflow (a n aturally occurring phenom enon when liquids or gases flow in and open path system) should no longer be ignored as a potential factor facilitating cross-contam ination. As co-inventor of the system th a t perm its sterilized and individ ualized p a tie n t coolant which I believe Dr. Zinman is referring to, I can tell you th a t there have been significant b arriers to bring our innovation to the m arketplace. Not the least of these has been the popular but false notion th a t the w ater em anating from the handpiece
(even when sterilized) h as the same quality as the ta p w ater in the sink a few feet away. L e slie V. M artens, D.D.S. M in n eap olis SOCIAL ISSUES
For too long, the dental profes sion h as been lagging behind in social aw areness. All too often, we see in our dental journal news item s about our profes sional organizations lobbying to reintroduce tax deduction on student loans, fighting OSHA, helping those who have recently graduated from dental school succeed in private practice and other activities. Little is ever m entioned about w hat the profession is doing to improve th e social ills of our comm unities. Recently, CNN did a poll in which dentists were no longer in the top five as a profession tru sted and well thought of by the public. In previous years, dentists have been in the top five. It is my perception th a t the profession’s lack of proactivism on social issues plus recent m edia coverage of Kimberly Bergalis and dental handpieces have played a big p a rt in this decline of the public tru st. I have had several non-dentally involved family m em bers and friends report to me th a t they have seen the m edia coverage and heard other people say th a t the public perceives the dental profession as “being out to m ake a buck.” Sure, on occasion you hear of dentists going to Third-W orld countries to provide dental care. But it is only for a week or so a t a tim e. Or, when disasters such as fires, hurricanes, or riots
occur, the dental community responds. B ut w hat about the homeless and poor in our communities? They are rig h t in our backyards. W hat are we doing to take care of the dental h ealth of these people? A ren’t they ju st as deserving of our care and attention as those in Third-W orld countries? I’m not saying th a t everyone should give up private practice or th a t a m ajor portion of one’s practice should be dedicated to seeing poor and homeless patients. I know th a t m any in the profession have high school loans th a t need to be paid. But there are other ways to help. Being willing to volunteer a day in a community clinic, donating money to these community clinics, speaking out as dental advocates for the poor, m aking sure legislators know the dental profession is con cerned about the poor by contributing to campaign funds and letting dental companies know you will buy their products if they will support dental program s for the poor and homeless. These are ju st a few examples of w hat we can do. Let’s stop constantly dwelling on how to m ake more money or how to keep the governm ent from regulating the profession so vigorously. We need to balance these things th a t are im portant w ith our social responsibilities. Together, as a profession, we can m ake the most difference in the delivery of dental care to the poor and homeless in our own backyard. J o h n R. Liu, D.D.S. S eattle
THE OBSTETRIC PATIENT
The article, “T reating the Pregnant Dental Patient: Four Basic Rules Addressed” by Dr. Michael Shrout and others addresses im portant aspects of dental care in the obstetric patient (May). The authors should be congratulated for presenting this tim ely issue. Our knowledge base has grown considerably regarding the safety of various medica tions and procedures during pregnancy. Accordingly, it has become clear th at, w ith few exceptions, neither indicated nor preventive health m easures should be w ithheld from the obstetric patient. This is certainly the case w ith dental care. The recom mendation to consider consultation w ith the p atien t’s obstetrician in unusual circumstances is wise, as the m ost likely resu lt of a dialogue between care providers is its benefit to the patient. The Committee on Obstetrics: M aternal and Fetal Medicine of the American College of O bstetricians and Gynecologists strongly supports the views upheld in this article. H arold A. K am inetzky, M.D. The A m erican C ollege o f O b stetrician s and G yn ecologists W ashington
Think Defense Without The Dental Record, you may meet yOUP Waterloo. Defending yourself against malpractice claims requires a dental record that doesn’t come up short. The Dental Record provides an excellent risk m anage ment shield Pecause its comprehensive de sign documents all phases of treatment. Its flexible defense system is built of 14 forms and a revolutionary folder. To add The Dental Record to your empire, call for a starter kit ($10 includes shipping), MasterCard and VISA ac cepted.
800
243 - 4 8 7 5 The DentalRecord B y Dentists, For Dentists
Wisconsin Dental Association, 633 W. Wisconsin Ave., M iiw, Wi 53203
Prolonging the well-being of the dental handpiece is not totally incom patible w ith heat sterilization, provided other handpiece m aintenance protocol is followed. Prolonging the well being of our p atients m ust be our prim ary goal, however, and we m ust “do no harm .” In th a t regard, Dr. Zinm an in 18
JADA, Vol. 123, November 1992
his lette r (August) is correct. We are not done when we sterilize the workhorse in stru m en t in dentistry. The litera tu re is replete with reference to concerns about contam inated dental unit w ater. Research reports indicate th a t pathogens may be present in unacceptably high num bers. More often th an not, such w ater does not m eet the colony-forming u n it standards for drinking or swim m ing pool w ater, let alone w hat we should dem and for dentistry. Biofilms th a t form in the tubings and w ater lines and m ay be re sista n t to flushing w ith biocides (when th a t is possible) are indeed a p a rt of the problem. Check valves, as Dr. Zinm an notes, are of help in reducing th e effect of active retraction; however, they fail and th eir failure often goes unnoticed. A th ird factor is the passive retraction th a t occurs, despite the presence of a work ing check valve. This backflow (a n aturally occurring phenom enon when liquids or gases flow in and open path system) should no longer be ignored as a potential factor facilitating cross-contam ination. As co-inventor of the system th a t perm its sterilized and individ ualized p a tie n t coolant which I believe Dr. Zinman is referring to, I can tell you th a t there have been significant b arriers to bring our innovation to the m arketplace. Not the least of these has been the popular but false notion th a t the w ater em anating from the handpiece
(even when sterilized) h as the same quality as the ta p w ater in the sink a few feet away. L e slie V. M artens, D.D.S. M in n eap olis SOCIAL ISSUES
For too long, the dental profes sion h as been lagging behind in social aw areness. All too often, we see in our dental journal news item s about our profes sional organizations lobbying to reintroduce tax deduction on student loans, fighting OSHA, helping those who have recently graduated from dental school succeed in private practice and other activities. Little is ever m entioned about w hat the profession is doing to improve th e social ills of our comm unities. Recently, CNN did a poll in which dentists were no longer in the top five as a profession tru sted and well thought of by the public. In previous years, dentists have been in the top five. It is my perception th a t the profession’s lack of proactivism on social issues plus recent m edia coverage of Kimberly Bergalis and dental handpieces have played a big p a rt in this decline of the public tru st. I have had several non-dentally involved family m em bers and friends report to me th a t they have seen the m edia coverage and heard other people say th a t the public perceives the dental profession as “being out to m ake a buck.” Sure, on occasion you hear of dentists going to Third-W orld countries to provide dental care. But it is only for a week or so a t a tim e. Or, when disasters such as fires, hurricanes, or riots
occur, the dental community responds. B ut w hat about the homeless and poor in our communities? They are rig h t in our backyards. W hat are we doing to take care of the dental h ealth of these people? A ren’t they ju st as deserving of our care and attention as those in Third-W orld countries? I’m not saying th a t everyone should give up private practice or th a t a m ajor portion of one’s practice should be dedicated to seeing poor and homeless patients. I know th a t m any in the profession have high school loans th a t need to be paid. But there are other ways to help. Being willing to volunteer a day in a community clinic, donating money to these community clinics, speaking out as dental advocates for the poor, m aking sure legislators know the dental profession is con cerned about the poor by contributing to campaign funds and letting dental companies know you will buy their products if they will support dental program s for the poor and homeless. These are ju st a few examples of w hat we can do. Let’s stop constantly dwelling on how to m ake more money or how to keep the governm ent from regulating the profession so vigorously. We need to balance these things th a t are im portant w ith our social responsibilities. Together, as a profession, we can m ake the most difference in the delivery of dental care to the poor and homeless in our own backyard. J o h n R. Liu, D.D.S. S eattle
THE OBSTETRIC PATIENT
The article, “T reating the Pregnant Dental Patient: Four Basic Rules Addressed” by Dr. Michael Shrout and others addresses im portant aspects of dental care in the obstetric patient (May). The authors should be congratulated for presenting this tim ely issue. Our knowledge base has grown considerably regarding the safety of various medica tions and procedures during pregnancy. Accordingly, it has become clear th at, w ith few exceptions, neither indicated nor preventive health m easures should be w ithheld from the obstetric patient. This is certainly the case w ith dental care. The recom mendation to consider consultation w ith the p atien t’s obstetrician in unusual circumstances is wise, as the m ost likely resu lt of a dialogue between care providers is its benefit to the patient. The Committee on Obstetrics: M aternal and Fetal Medicine of the American College of O bstetricians and Gynecologists strongly supports the views upheld in this article. H arold A. K am inetzky, M.D. The A m erican C ollege o f O b stetrician s and G yn ecologists W ashington
Think Defense Without The Dental Record, you may meet yOUP Waterloo. Defending yourself against malpractice claims requires a dental record that doesn’t come up short. The Dental Record provides an excellent risk m anage ment shield Pecause its comprehensive de sign documents all phases of treatment. Its flexible defense system is built of 14 forms and a revolutionary folder. To add The Dental Record to your empire, call for a starter kit ($10 includes shipping), MasterCard and VISA ac cepted.
800
243 - 4 8 7 5 The DentalRecord B y Dentists, For Dentists
Wisconsin Dental Association, 633 W. Wisconsin Ave., M iiw, Wi 53203