- Email: [email protected]
TETRACYCLINE
L E T T E R S
LETTERS
J
ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within two months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. You may submit your letter via e-mail to “jadaletters@ ada.org”; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. TETRACYCLINE
Dr. Craig Miller and Mr. Gary McGarity’s January JADA article, “Tetracycline-Induced Renal Failure After Dental Treatment” (JADA 2009;140[1]: 56-60), was very interesting for what it left out. Was the use of any antibiotics necessary in the treatment of this patient? In the case report section, there is nothing concerning the treatment of this patient that indicates antibiotics were necessary. Yet penicillin and tetracycline were prescribed on numerous occasions. It seems to me after reading this article that the complica276
JADA, Vol. 140
http://jada.ada.org
tion of tetracycline-induced renal failure was caused by the injudicious use of antibiotics. The extraction of teeth is not an indication for the use of antibiotics. Richard D. Zallen, DDS, MD Director of Dentistry and Oral Maxillofacial Surgery Denver Health Medical Center
Authors’ response: We agree with Dr. Zallen’s assessment. Review of the dental records in this case did not elucidate a reasonable rationale for the need for antibiotics. As he states so well, antibiotics need to be prescribed judiciously, and extraction of teeth is not an indication for the use of antibiotics. Craig S. Miller, DMD, MS Professor Oral Medicine Section Department of Oral Health Practice College of Dentistry and Department of Microbiology Immunology & Molecular Genetics College of Medicine University of Kentucky Lexington
Gary J. McGarity, PharmD, MPA Clinical Pharmacist Veterans Administration Outpatient Pharmacy Baton Rouge, La.
PATIENTS WITH DIABETES
I wish to compliment JADA, the authors and Colgate for developing the October JADA supplement, “Managing the Care of Patients With Diabetes.” However, due to the rapid knowledge turnover involving diabetes care, there are recent changes to the nomenclature of the glycosylated hemoglobin (HbA1c) that should have been conveyed to dental professionals. My concerns with the supplement are twofold. First, Colgate
provided funding to the American Dental Association and American Diabetes Association, resulting in a June 6, 2008, symposium on periodontal disease and diabetes at the 68th Annual Scientific Session meeting of the American Diabetes Association in San Francisco. While on the surface this seemed to some to be a landmark event, it was, unfortunately, poorly attended. In addition, this scientific session provided the eagerly awaited results of the A1c-Derived Average Glucose (ADAG) study.1 This study was conducted after the recent international standardization of the HbA1c methodology2,3 was completed to define the mathematical relationship between the HbA1c and average glucose levels, and whether the HbA1c could be expressed and reported as average glucose in the same units as those units found in the selfmonitoring glucose meters. The clinical significance of this study to the dental profession is that an HbA1c laborotory value could be converted into units that diabetes patients could understand (milligrams per deciliter) during regular use of their glucose meters. This estimated average glucose reading abbreviated as the “eAG.” Test results using the international HbA1c methodology standard must adhere to new changes in nomenclature.2 These changes are too complex to explain due to space limitations. The conversion chart on page 6S from Dr. Mealey’s editorial4 is incorrect, utilizing the old conversion formula (average blood glucose = HbA1c × 35.6 − 77.3). The new conversion formula (eAGmg/dL = 28.7 × HbA1c − 46.7) is illustrated in the table
March 2009
Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.
LETTERS
J
ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within two months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. You may submit your letter via e-mail to “jadaletters@ ada.org”; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. TETRACYCLINE
Dr. Craig Miller and Mr. Gary McGarity’s January JADA article, “Tetracycline-Induced Renal Failure After Dental Treatment” (JADA 2009;140[1]: 56-60), was very interesting for what it left out. Was the use of any antibiotics necessary in the treatment of this patient? In the case report section, there is nothing concerning the treatment of this patient that indicates antibiotics were necessary. Yet penicillin and tetracycline were prescribed on numerous occasions. It seems to me after reading this article that the complica276
JADA, Vol. 140
http://jada.ada.org
tion of tetracycline-induced renal failure was caused by the injudicious use of antibiotics. The extraction of teeth is not an indication for the use of antibiotics. Richard D. Zallen, DDS, MD Director of Dentistry and Oral Maxillofacial Surgery Denver Health Medical Center
Authors’ response: We agree with Dr. Zallen’s assessment. Review of the dental records in this case did not elucidate a reasonable rationale for the need for antibiotics. As he states so well, antibiotics need to be prescribed judiciously, and extraction of teeth is not an indication for the use of antibiotics. Craig S. Miller, DMD, MS Professor Oral Medicine Section Department of Oral Health Practice College of Dentistry and Department of Microbiology Immunology & Molecular Genetics College of Medicine University of Kentucky Lexington
Gary J. McGarity, PharmD, MPA Clinical Pharmacist Veterans Administration Outpatient Pharmacy Baton Rouge, La.
PATIENTS WITH DIABETES
I wish to compliment JADA, the authors and Colgate for developing the October JADA supplement, “Managing the Care of Patients With Diabetes.” However, due to the rapid knowledge turnover involving diabetes care, there are recent changes to the nomenclature of the glycosylated hemoglobin (HbA1c) that should have been conveyed to dental professionals. My concerns with the supplement are twofold. First, Colgate
provided funding to the American Dental Association and American Diabetes Association, resulting in a June 6, 2008, symposium on periodontal disease and diabetes at the 68th Annual Scientific Session meeting of the American Diabetes Association in San Francisco. While on the surface this seemed to some to be a landmark event, it was, unfortunately, poorly attended. In addition, this scientific session provided the eagerly awaited results of the A1c-Derived Average Glucose (ADAG) study.1 This study was conducted after the recent international standardization of the HbA1c methodology2,3 was completed to define the mathematical relationship between the HbA1c and average glucose levels, and whether the HbA1c could be expressed and reported as average glucose in the same units as those units found in the selfmonitoring glucose meters. The clinical significance of this study to the dental profession is that an HbA1c laborotory value could be converted into units that diabetes patients could understand (milligrams per deciliter) during regular use of their glucose meters. This estimated average glucose reading abbreviated as the “eAG.” Test results using the international HbA1c methodology standard must adhere to new changes in nomenclature.2 These changes are too complex to explain due to space limitations. The conversion chart on page 6S from Dr. Mealey’s editorial4 is incorrect, utilizing the old conversion formula (average blood glucose = HbA1c × 35.6 − 77.3). The new conversion formula (eAGmg/dL = 28.7 × HbA1c − 46.7) is illustrated in the table
March 2009
Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.