- Email: [email protected]
Taking Responsibility
statement to state health inves tigators. The state investigators have said they are continuing to probe the Acer case but will not comment on specifics. [The nurse] said he met Acer in 1985 and they remained friends until the dentist’s death in September 1990. They did not have sex, said [the nurse], who is a homosexual.” This is a very important omission from the JADA article! We dentists have been sub jected to a lot of questions from patients, to finger-pointing blame from the media, to worry and concern by our staff and ourselves, to intense scrutiny by OSHA and then to all of the highly expensive changes mandated to our dental practices. We have an absolute right to know ALL the facts. In James Berry’s article in the same JADA issue, he stated that “U.S. dentists perform more than 1 billion dental procedures each year in the course of more than 500 million dental visits.” In the Gooch and others article, they state in reference to the five HIVinfected patients of Dr. Acer, “To date, these five infections remain the only documented transmissions of HIV from an infected health care worker to patients.” That means all dental patients, plus the rest of the medical treatment facilities in the world. The JADA article ruled out the probability of cross contamination by instruments but seems to be in a quandary as to what happened in Dr. Acer’s practice. JADA is supposed to be a scientific journal devoted to keeping us subscribers fully informed on current events, studies and trends related to 14
JADA, Vol. 124, April 1993
our profession. Through it, we should not be intimidated into refusing to acknowledge [theories] that might offend the “politically correct” crowd. Our training was dependent on the scientific method of investigation. James D. Rawlins Jr., D.D.S. Longwood, Fla. E d ito r’s note: Manuscripts submitted to JADA undergo very thorough peer review, and only those contributions that withstand scientific scrutiny are published. If we were to receive a manuscript that contained scientific evidence to support Dr. Rawlins’ hypoth esis, and it was accepted through the peer review process, we would be pleased to publish it in The Journal. To date, we have not received such a manuscript. In fact, we note that a recent issue of the journal Nature included an article questioning whether Dr. Acer was even responsible for ’ infecting his patients. This issue must be resolved by appropriate scientific inquiry and discussion. In the mean time, JADA will continue to accept for review scientific manuscripts that address any aspect of this matter. TAKING RESPONSIBILITY
In most discussions about health care, two main concerns are brought forth. The first is rising health care costs, which essentially relate to demo graphy and technology; that is, more people needing/requesting more and more sophisticated care. The other is access to care, with questions of location, affordability and knowledge of availability. In general, the current
discussion sounds less like a conversation about health care than about illness care, sickness care or medical treatment care—all of which sorely need attention right now. However, how to deal with the health status of people has not been mentioned often in the ongoing debate. If we are serious about reforming health care in terms of improving the health of people, should we not also look beyond the immediate concerns of the health care complex at ways to help people improve and maintain health? Shouldn’t we, in addition to looking at ways to diminish the need and use for costly technological treatments, be looking at means to encourage and promote healthy practices in everyday life? What I am proposing is that the need for care can be lessened through changes in attitudes and behavior, through prevention, through promotion and education, through encouraging people to take responsibility for their own health and well-being. As that well-known philos opher/possum Pogo said, “We have seen the enemy, and it is us.” Or as Einstein put it, “The significant problems we have cannot be solved at the same level of thinking which created them.” Would it be possible to direct some of that good American “can do” toward creating attitudes about individual responsibility in health? What would it look like if healthy behavior were in vogue, “the thing to do” in our society? What if wellness and environ mental concerns rivaled the appeal of cosmetics and cars
and McDonald’s in popular culture? After all, America does have the most sophisticated advertising and marketing in the world. We can sell Coke to Mongolian yogurt eaters, so why not health to fast food junkies? What would it mean to the world, given that what America does first, the rest of the world inevitably picks up later? One example of what I have in mind is the vastly improved dental caries incidence in the western world that is the result of cooperation among profes sionals (dentists and scientists), governments (water fluorida tion), industry (toothpaste, toothbrush and mouthwash makers) and our popular culture’s standards of dental beauty and fresh breath (the way to be, which is healthy). Leena Sederlof, D.D.S., M.S. W ashington, D.C.
dentistry, on compliance with the bloodborne pathogens standard. In this video, the application of rubber dam was shown three times in the dental setting. Dental dam is also specifically stated in the OSHA regulations as an optional device, combined with the use of high-volume evacuation, to minimize circulation of bloodborne pathogens. The procedure of the appli cation of dental dam is taught at every dental university in the United States. It is simple for the dentist to use and offers many benefits to their practice. Why doesn’t the ADA support dental dam as a vital part of infection control procedures as it does gloves, masks, gowns, handpiece sterilization, etc.? Thomas E. Chapman President and Chief E xecutive Officer The H ygenic Corp. Akron, Ohio
WHY NO DENTAL. DAM?
I just finished reading the “OSHA Compliance Check List” for the dental office prepared by the ADA and distributed to its members [through the Jan. 18 ADA News], The subject of the OSHA Check List was compliance with the OSHA bloodborne pathogens standard. In general, [the Check List] is informative and useful to the dentist. We wonder why dental dam was not recommended in this publication to reduce the circulation of bloodborne pathogens, as studies prove a 98 percent reduction when used. Coincidentally, this very same week, I had an oppor tunity to review the video produced by OSHA and intended to assist professionals in various fields, including 16
JADA, Vol. 124, April 1993
E d ito r’s note: Mr. Chap- » man, the ADA does support the use of dental dam. ADA informational materials on infection control contain frequent references to the use and advantages of dental dam as a barrier to the spread of microorganisms. The lack of inclusion of dental dam in the ADA/OSHA Compliance Check List was neither an oversight nor a slight to dental dam’s effective ness. The OSHA Check List was designed specifically to address only the federal agency’s requirements. Dental dam is not among those requirements. The effectiveness of dental dam in reducing the spread of bloodborne pathogens has been well documented in this Journal. A product that can
provide a barrier that is 98 percent effective should find greater use by the dental practitioner. By including dental dam in its infection control publications, the ADA has demonstrated its support for this product. DELEGATING DUTIES
Dr. Gordon Christensen’s article, “The Cracked Tooth Syndrome” (February), gives me cause to feel uneasy. As a practicing dentist, I have been confronted with the seemingly impossible task of diagnosing the true cause of periodic and intermittent tooth pain. I have been confronted with the problem for over 30 years, and continue to expect similar diagnostic confronta tions on a daily basis for as long as I continue to practice. I couldn’t agree more with Dr. Christensen’s observation that diagnosing the severity of a cracked tooth is nearly impossible. Likewise, I couldn’t disagree more with his direction that “it is advisable to instruct assistants and dental hygienists in the use of diagnostic tools for the purpose of identifying a tooth with a cracked cusp.” It is purely the dentist’s professional responsibility to perform the full gamut of appropriate diagnostic tests to determine the cause of a perceived problem, and there after to make the logical treatment recommendations for its resolution. Delegating to an auxiliary the performance of a task that plays a role in making a differential diagnosis is an abrogation of the doctor’s professional responsibility. Certain state dental practice acts prohibit the making of a diagnosis by an auxiliary, as
JADA, Vol. 124, April 1993
our profession. Through it, we should not be intimidated into refusing to acknowledge [theories] that might offend the “politically correct” crowd. Our training was dependent on the scientific method of investigation. James D. Rawlins Jr., D.D.S. Longwood, Fla. E d ito r’s note: Manuscripts submitted to JADA undergo very thorough peer review, and only those contributions that withstand scientific scrutiny are published. If we were to receive a manuscript that contained scientific evidence to support Dr. Rawlins’ hypoth esis, and it was accepted through the peer review process, we would be pleased to publish it in The Journal. To date, we have not received such a manuscript. In fact, we note that a recent issue of the journal Nature included an article questioning whether Dr. Acer was even responsible for ’ infecting his patients. This issue must be resolved by appropriate scientific inquiry and discussion. In the mean time, JADA will continue to accept for review scientific manuscripts that address any aspect of this matter. TAKING RESPONSIBILITY
In most discussions about health care, two main concerns are brought forth. The first is rising health care costs, which essentially relate to demo graphy and technology; that is, more people needing/requesting more and more sophisticated care. The other is access to care, with questions of location, affordability and knowledge of availability. In general, the current
discussion sounds less like a conversation about health care than about illness care, sickness care or medical treatment care—all of which sorely need attention right now. However, how to deal with the health status of people has not been mentioned often in the ongoing debate. If we are serious about reforming health care in terms of improving the health of people, should we not also look beyond the immediate concerns of the health care complex at ways to help people improve and maintain health? Shouldn’t we, in addition to looking at ways to diminish the need and use for costly technological treatments, be looking at means to encourage and promote healthy practices in everyday life? What I am proposing is that the need for care can be lessened through changes in attitudes and behavior, through prevention, through promotion and education, through encouraging people to take responsibility for their own health and well-being. As that well-known philos opher/possum Pogo said, “We have seen the enemy, and it is us.” Or as Einstein put it, “The significant problems we have cannot be solved at the same level of thinking which created them.” Would it be possible to direct some of that good American “can do” toward creating attitudes about individual responsibility in health? What would it look like if healthy behavior were in vogue, “the thing to do” in our society? What if wellness and environ mental concerns rivaled the appeal of cosmetics and cars
and McDonald’s in popular culture? After all, America does have the most sophisticated advertising and marketing in the world. We can sell Coke to Mongolian yogurt eaters, so why not health to fast food junkies? What would it mean to the world, given that what America does first, the rest of the world inevitably picks up later? One example of what I have in mind is the vastly improved dental caries incidence in the western world that is the result of cooperation among profes sionals (dentists and scientists), governments (water fluorida tion), industry (toothpaste, toothbrush and mouthwash makers) and our popular culture’s standards of dental beauty and fresh breath (the way to be, which is healthy). Leena Sederlof, D.D.S., M.S. W ashington, D.C.
dentistry, on compliance with the bloodborne pathogens standard. In this video, the application of rubber dam was shown three times in the dental setting. Dental dam is also specifically stated in the OSHA regulations as an optional device, combined with the use of high-volume evacuation, to minimize circulation of bloodborne pathogens. The procedure of the appli cation of dental dam is taught at every dental university in the United States. It is simple for the dentist to use and offers many benefits to their practice. Why doesn’t the ADA support dental dam as a vital part of infection control procedures as it does gloves, masks, gowns, handpiece sterilization, etc.? Thomas E. Chapman President and Chief E xecutive Officer The H ygenic Corp. Akron, Ohio
WHY NO DENTAL. DAM?
I just finished reading the “OSHA Compliance Check List” for the dental office prepared by the ADA and distributed to its members [through the Jan. 18 ADA News], The subject of the OSHA Check List was compliance with the OSHA bloodborne pathogens standard. In general, [the Check List] is informative and useful to the dentist. We wonder why dental dam was not recommended in this publication to reduce the circulation of bloodborne pathogens, as studies prove a 98 percent reduction when used. Coincidentally, this very same week, I had an oppor tunity to review the video produced by OSHA and intended to assist professionals in various fields, including 16
JADA, Vol. 124, April 1993
E d ito r’s note: Mr. Chap- » man, the ADA does support the use of dental dam. ADA informational materials on infection control contain frequent references to the use and advantages of dental dam as a barrier to the spread of microorganisms. The lack of inclusion of dental dam in the ADA/OSHA Compliance Check List was neither an oversight nor a slight to dental dam’s effective ness. The OSHA Check List was designed specifically to address only the federal agency’s requirements. Dental dam is not among those requirements. The effectiveness of dental dam in reducing the spread of bloodborne pathogens has been well documented in this Journal. A product that can
provide a barrier that is 98 percent effective should find greater use by the dental practitioner. By including dental dam in its infection control publications, the ADA has demonstrated its support for this product. DELEGATING DUTIES
Dr. Gordon Christensen’s article, “The Cracked Tooth Syndrome” (February), gives me cause to feel uneasy. As a practicing dentist, I have been confronted with the seemingly impossible task of diagnosing the true cause of periodic and intermittent tooth pain. I have been confronted with the problem for over 30 years, and continue to expect similar diagnostic confronta tions on a daily basis for as long as I continue to practice. I couldn’t agree more with Dr. Christensen’s observation that diagnosing the severity of a cracked tooth is nearly impossible. Likewise, I couldn’t disagree more with his direction that “it is advisable to instruct assistants and dental hygienists in the use of diagnostic tools for the purpose of identifying a tooth with a cracked cusp.” It is purely the dentist’s professional responsibility to perform the full gamut of appropriate diagnostic tests to determine the cause of a perceived problem, and there after to make the logical treatment recommendations for its resolution. Delegating to an auxiliary the performance of a task that plays a role in making a differential diagnosis is an abrogation of the doctor’s professional responsibility. Certain state dental practice acts prohibit the making of a diagnosis by an auxiliary, as