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The Reader Comments
The R eader Comments
a t least, has been its history for the past 200 years. W hat has caused its renascence at d if ferent periods I cannot say, an y more than I can say w hether its disappearances have been due to loss of interest on the p a rt of its spon sors or to untow ard occurrences in its ad m inistration. T h e choice of reasons is optional. Charles Frederick Harper
R E P L Y TO DR. BE C K E R
In his letter Dr. Becker takes exception to the view s in m y review of Clinical Applications of Suggestion and Hypnosis by W illiam T. Heron. He contends, “T he use of hypnosis by 2,600 dentists in this country, w ith a conserva tive estim ate of 75,000 inductions, stands as irrefutab le evidence that, contrary to Dr. H arp er’s opinion, hypnosis has been adapted to d entistry.” In other words, “ F ifty m illion Frenchm en can ’t be w rong.” But let us take first things first. W e have established th erap eutic m easures in o ral m edi cine, o ral surgery an d o ral prosthesis by experi m en tal, c lin ical and epidem iologic methods. These have been tried and found satisfactory. T his does not m ean, however, th at we cannot try new methods. T he dental profession is constantly experim enting w ith new methods and procedures and alw ays welcom es any pro cedure th at w ill relieve suffering. However, un til a new procedure has proved itself beyond the shadow of a doubt, the profession neces sarily m ust exercise caution in its use. Now, hypnosis lacks th e background of re search th at qualifies it for general d ental prac tice. Some tim e ago a qualified speaker from B ellevue, addressing a New Jersey section of the A cadem y of D en tal M ed icin e, cautioned the members again st its use in th eir practices. He described it as an excellent tool for the psychiatrist but strongly advised against its use by dentists. T his is in lin e w ith the belief of D r. H eron th a t hypnotism should be gov erned by leg al restrictions. T h at, at least, w ould take its furth er p ractice out of the hands of the am ateurs. In his book, Hypnosis In Dentistry, Aaron A. Moss gives credit to Jam es B raid , a Scot p racticin g in E ngland, for establishing the fact th at suggestion is the dynam ic facto r in producing hypnosis. But suggestion alone does not exp lain a ll the phenom ena of hyp nosis, an y more than does neurosis account for them . Suggestion undoubtedly is a factor in hypnotic effects, perhaps the prim e factor, nobody know s; b ut to com pare th e use of suggestion in hypnotism w ith the methods of suggestion used by the old-fashioned fam ily physician is a lib el upon a service th at is w ithout a m odern p arallel. E very once in a w hile hypnotism emerges from obscurity, struts for a b rief period in the lim eligh t and sinks ag ain into obscurity. T h at,
AC R YLIC R E SIN FIL L IN G S AND TH E DENTAL P U L P
In the M arch 1954 issue of th e j o u r n a l , H. D. Coy states th a t “there is sufficient evidence to show that no serious p u lp al reaction can be ascribed directly to the direct resin filling. T h is conclusion is in d irect contradiction to Gross m an ’s sum m ary.” I should like to c a ll attention to the p ap er by Dr. C oy and others (J.A .D ,A ., 44:251 M arch 1952) w hich includes a table showing th at 5 pulp deaths occurred in 105 cases w here ac ry lic resin fillings h ad been in serted. If pulp deaths can be expected in ap proxim ately 5 p er cent of cases, it is a serious problem. Dr. C oy acknow ledges 10 pulp deaths in his current report and ad d s: “there m ay, of course, have been other instances of pulpal involvem ent in the teeth of patients who did not return to the clin ic.” R ath er than give the impression that there were only 10 p ulp deaths associated w ith the 1,200 fillings w hich w ere inserted, it would have been m ore to the point to state the p er centage of pulp deaths that were observed in the patients w ho returned for check-up. In the 1952 report, less than one third of the patients reported for check-up. If this is equally true of the curren t study, then approxim ately 400 patients return ed for check-up, and 10 pulp deaths were observed, or about 2.5 p er cent. This w ould still be considered a serious th reat to pulp in tegrity, in m y opinion. Of course, it is lik e ly th at few er p u lp al involve m ents are being observed today than a few years ago because dentists are using cem ent bases under ac ry lic fillings m ore often than before and because the acrylic resin filling m aterials them selves have been improved. I agree w ith Dr. C oy’s final statem ent: “S ig nificant im provem ents have been m ade in d i rect fillin g resins, but m uch is yet to be ac com plished in p erfecting them .” Louis I. Grossman, Philadelphia 486
a t least, has been its history for the past 200 years. W hat has caused its renascence at d if ferent periods I cannot say, an y more than I can say w hether its disappearances have been due to loss of interest on the p a rt of its spon sors or to untow ard occurrences in its ad m inistration. T h e choice of reasons is optional. Charles Frederick Harper
R E P L Y TO DR. BE C K E R
In his letter Dr. Becker takes exception to the view s in m y review of Clinical Applications of Suggestion and Hypnosis by W illiam T. Heron. He contends, “T he use of hypnosis by 2,600 dentists in this country, w ith a conserva tive estim ate of 75,000 inductions, stands as irrefutab le evidence that, contrary to Dr. H arp er’s opinion, hypnosis has been adapted to d entistry.” In other words, “ F ifty m illion Frenchm en can ’t be w rong.” But let us take first things first. W e have established th erap eutic m easures in o ral m edi cine, o ral surgery an d o ral prosthesis by experi m en tal, c lin ical and epidem iologic methods. These have been tried and found satisfactory. T his does not m ean, however, th at we cannot try new methods. T he dental profession is constantly experim enting w ith new methods and procedures and alw ays welcom es any pro cedure th at w ill relieve suffering. However, un til a new procedure has proved itself beyond the shadow of a doubt, the profession neces sarily m ust exercise caution in its use. Now, hypnosis lacks th e background of re search th at qualifies it for general d ental prac tice. Some tim e ago a qualified speaker from B ellevue, addressing a New Jersey section of the A cadem y of D en tal M ed icin e, cautioned the members again st its use in th eir practices. He described it as an excellent tool for the psychiatrist but strongly advised against its use by dentists. T his is in lin e w ith the belief of D r. H eron th a t hypnotism should be gov erned by leg al restrictions. T h at, at least, w ould take its furth er p ractice out of the hands of the am ateurs. In his book, Hypnosis In Dentistry, Aaron A. Moss gives credit to Jam es B raid , a Scot p racticin g in E ngland, for establishing the fact th at suggestion is the dynam ic facto r in producing hypnosis. But suggestion alone does not exp lain a ll the phenom ena of hyp nosis, an y more than does neurosis account for them . Suggestion undoubtedly is a factor in hypnotic effects, perhaps the prim e factor, nobody know s; b ut to com pare th e use of suggestion in hypnotism w ith the methods of suggestion used by the old-fashioned fam ily physician is a lib el upon a service th at is w ithout a m odern p arallel. E very once in a w hile hypnotism emerges from obscurity, struts for a b rief period in the lim eligh t and sinks ag ain into obscurity. T h at,
AC R YLIC R E SIN FIL L IN G S AND TH E DENTAL P U L P
In the M arch 1954 issue of th e j o u r n a l , H. D. Coy states th a t “there is sufficient evidence to show that no serious p u lp al reaction can be ascribed directly to the direct resin filling. T h is conclusion is in d irect contradiction to Gross m an ’s sum m ary.” I should like to c a ll attention to the p ap er by Dr. C oy and others (J.A .D ,A ., 44:251 M arch 1952) w hich includes a table showing th at 5 pulp deaths occurred in 105 cases w here ac ry lic resin fillings h ad been in serted. If pulp deaths can be expected in ap proxim ately 5 p er cent of cases, it is a serious problem. Dr. C oy acknow ledges 10 pulp deaths in his current report and ad d s: “there m ay, of course, have been other instances of pulpal involvem ent in the teeth of patients who did not return to the clin ic.” R ath er than give the impression that there were only 10 p ulp deaths associated w ith the 1,200 fillings w hich w ere inserted, it would have been m ore to the point to state the p er centage of pulp deaths that were observed in the patients w ho returned for check-up. In the 1952 report, less than one third of the patients reported for check-up. If this is equally true of the curren t study, then approxim ately 400 patients return ed for check-up, and 10 pulp deaths were observed, or about 2.5 p er cent. This w ould still be considered a serious th reat to pulp in tegrity, in m y opinion. Of course, it is lik e ly th at few er p u lp al involve m ents are being observed today than a few years ago because dentists are using cem ent bases under ac ry lic fillings m ore often than before and because the acrylic resin filling m aterials them selves have been improved. I agree w ith Dr. C oy’s final statem ent: “S ig nificant im provem ents have been m ade in d i rect fillin g resins, but m uch is yet to be ac com plished in p erfecting them .” Louis I. Grossman, Philadelphia 486