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Stations and dentures
profession of private practitioners charging high fees to maintain ineffi cient practices. The loser would be the public, those who look to the den tal profession to provide an important segment of total health care. Finally, Dr. Schoen’s suggestion that the dental profession is not exer cising self-control in its use of new methods of dental care delivery must be rejected simply on the basis of pres ent activity. The careful deliberations of nearly all state boards of dental examiners, with the active support and participation of state societies, relative to practice act changes that permit broader delegation of duties to auxiliaries, and the work of the Coun cil on Dental Education in establish ing standards and guidelines for aux iliary education are but two examples of effort, concern and self-control on the part of our profession. One recognizes that the “ deliber ate speed” being used is not fast en ough for some and much too fast for others; however, the issue is no longer static. Ill-advised and badly timed ac tivities by some members of our pro fession in the recent past have caused great concern in the profession and may well have slowed down progress in utilizing auxiliaries. Our project was designed with the intent of providing useful information that would be helpful to the profes sion as it assesses changes in delivery of care. We believe that this is being accomplished. DALE F . REDIG
—All individuals were of a fastid ious type who seem compelled to keep their dentures exceptionally clean. —The striation lines on all dentures seem to follow a general pattern. —The tissue side of the dentures (palate or ridge) is very polished and lacking in detail. —All patients had one thing in com mon: they were using a dentifrice for natural teeth to clean the denture; brand did not seem to matter. In all cases, this ridging and des truction of tissue detail stopped when use of a dentifrice for natural teeth was discontinued. This also accounts for the similar ridging of plastic crowns, and my cure for this was to discontinue use of plastic crowns as much as possible. I have questioned many older den tists who were in practice prior to 1940, and they do not remember see ing these striations on the older vul canite dentures; but at that time all brushes were of natural bristle. Now it is next to impossible to find a natural bristle denture brush. I do not feel that we can entirely blame dentifrice without mentioning nylon bristle brushes at the same time. I also suspect that many of these pa tients sometimes use household clean ers or lava soap, but won’t admit it. My conclusion is that the polishing agent in a dentifrice seems to cause no harm to natural teeth but, when com bined with vigorous and frequent scrubbing with a nylon brush, is harm ful to plastic. E. J. CROW DER, DDS PONCA CITY, OKLA
Striations and dentures m I have read and reread the article,
“ Erosionlike denture markings possi bly related to hyperactivity of oral soft tissues,” by Allan G. Brodie and Reidar F. Sognnaes (May j a d a , page 1012).
This seems to me to be a case of not being able to see the forest because of the trees. I have been noticing these peculiar striations on dentures and acrylic crowns for the past 30 years. Careful questioning of these denture wearers revealed the following:
■ A u th o r’s reply: This letter from Dr. Crowder, as well as two pre viously printed letters from Mark C. Randall and Ralph DeFelice (June j a d a , page 1248) appear to carry the conviction that changes of the kind we have observed are very satisfactorily explained by overly zealous cleaning, especially with nylon bristle brushes. Dr. DeFelice believes so strongly in toothbrush abrasion as the proven cause of dental erosion that he feels “ it is time idiopathic erosion disap peared from dental literature.” My own interest in these denture markings does indeed stem from a pri
240 ■ LÉtTERS TO THE EDITOR / JADA, Vol. 89, August 1974
mary concern with research on the etiology of so-called idiopathic ero sions, as reviewed in a monograph.1 In that volume, I presented illustra tions from clinical erosion cases (a sample is reproduced in Fig 1), the unpredictably localized patterns of which I could not logically explain on the basis of toothbrush abrasion. In regard to erosionlike patterns on acrylic dental replacements, I have had cases referred to me with enor mous destruction, yet without any toothbrush abrasion (Fig 2). Though the patient, a 38-year-old nervous woman, had never used a brush for cleaning, the buccal surfaces of the acrylic teeth and denture flanges had worn away up to several micrometers per day during a four-year period; the porcelain incisors remained grossly in tact. With regard to the striated denture markings published by Dr. Brodie and myself, I invite Dr. Crowder to check our original text and references again and take one more look at our illus trations, for example that reproduced here as Fig 3 (part of Fig 1 in the orig inal article). It does not seem possible to create these and other similar types of local ized patterns by any form of toothbrushing, unless the patient is told to “ clean one tooth at a time, each with strokes curved in different dir ections and without the brush touch ing adjacent teeth.” Furthermore, be yond the gross appearance, it should be noted that the ultrastructural substriations appear to be so delicate when viewed under the scanning elec tron microscope that they make tooth brush bristles look like telephone poles by comparison. In an effort to summarize these and similar observations, I have prepared a diagrammatic representation (Fig 4) in which I explore the use of a new term, frictional ablation; the term is borrowed from space age terminology where it means the wear on the en amel-like nose cone during reentry due to friction against our natural environment. I am using the term to single out certain obscure intraoral destructive mechanisms that are not explained by obvious abrasive, chem ical, or microbial actions, and hence
—All individuals were of a fastid ious type who seem compelled to keep their dentures exceptionally clean. —The striation lines on all dentures seem to follow a general pattern. —The tissue side of the dentures (palate or ridge) is very polished and lacking in detail. —All patients had one thing in com mon: they were using a dentifrice for natural teeth to clean the denture; brand did not seem to matter. In all cases, this ridging and des truction of tissue detail stopped when use of a dentifrice for natural teeth was discontinued. This also accounts for the similar ridging of plastic crowns, and my cure for this was to discontinue use of plastic crowns as much as possible. I have questioned many older den tists who were in practice prior to 1940, and they do not remember see ing these striations on the older vul canite dentures; but at that time all brushes were of natural bristle. Now it is next to impossible to find a natural bristle denture brush. I do not feel that we can entirely blame dentifrice without mentioning nylon bristle brushes at the same time. I also suspect that many of these pa tients sometimes use household clean ers or lava soap, but won’t admit it. My conclusion is that the polishing agent in a dentifrice seems to cause no harm to natural teeth but, when com bined with vigorous and frequent scrubbing with a nylon brush, is harm ful to plastic. E. J. CROW DER, DDS PONCA CITY, OKLA
Striations and dentures m I have read and reread the article,
“ Erosionlike denture markings possi bly related to hyperactivity of oral soft tissues,” by Allan G. Brodie and Reidar F. Sognnaes (May j a d a , page 1012).
This seems to me to be a case of not being able to see the forest because of the trees. I have been noticing these peculiar striations on dentures and acrylic crowns for the past 30 years. Careful questioning of these denture wearers revealed the following:
■ A u th o r’s reply: This letter from Dr. Crowder, as well as two pre viously printed letters from Mark C. Randall and Ralph DeFelice (June j a d a , page 1248) appear to carry the conviction that changes of the kind we have observed are very satisfactorily explained by overly zealous cleaning, especially with nylon bristle brushes. Dr. DeFelice believes so strongly in toothbrush abrasion as the proven cause of dental erosion that he feels “ it is time idiopathic erosion disap peared from dental literature.” My own interest in these denture markings does indeed stem from a pri
240 ■ LÉtTERS TO THE EDITOR / JADA, Vol. 89, August 1974
mary concern with research on the etiology of so-called idiopathic ero sions, as reviewed in a monograph.1 In that volume, I presented illustra tions from clinical erosion cases (a sample is reproduced in Fig 1), the unpredictably localized patterns of which I could not logically explain on the basis of toothbrush abrasion. In regard to erosionlike patterns on acrylic dental replacements, I have had cases referred to me with enor mous destruction, yet without any toothbrush abrasion (Fig 2). Though the patient, a 38-year-old nervous woman, had never used a brush for cleaning, the buccal surfaces of the acrylic teeth and denture flanges had worn away up to several micrometers per day during a four-year period; the porcelain incisors remained grossly in tact. With regard to the striated denture markings published by Dr. Brodie and myself, I invite Dr. Crowder to check our original text and references again and take one more look at our illus trations, for example that reproduced here as Fig 3 (part of Fig 1 in the orig inal article). It does not seem possible to create these and other similar types of local ized patterns by any form of toothbrushing, unless the patient is told to “ clean one tooth at a time, each with strokes curved in different dir ections and without the brush touch ing adjacent teeth.” Furthermore, be yond the gross appearance, it should be noted that the ultrastructural substriations appear to be so delicate when viewed under the scanning elec tron microscope that they make tooth brush bristles look like telephone poles by comparison. In an effort to summarize these and similar observations, I have prepared a diagrammatic representation (Fig 4) in which I explore the use of a new term, frictional ablation; the term is borrowed from space age terminology where it means the wear on the en amel-like nose cone during reentry due to friction against our natural environment. I am using the term to single out certain obscure intraoral destructive mechanisms that are not explained by obvious abrasive, chem ical, or microbial actions, and hence