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T h e R ea d er C om m en ts
j o u r n a l d e v o te s this section to c o m m e n t b y rea d ers on top ics o f cu rren t in terest to d en tistry. T h e ed ito r reserves th e right to ed it all c o m m u n ica tion s to fit available sp a ce and req u ires tha t all letters be signed. A t th e req u est o f th e a u th or, sign a tu res w ill be d e le te d b e fo r e p ublication . P rin te d c o m m u n ica tio n s do n ot necessarily r efle ct th e op in ion or official p o lic y o f th e A ssocia tion . Y o u r p a rticip a tion in this s ec tio n is in vited. T h e E d itor
th e
elemental iodine from material supplied by Heliogen Products, Inc. T h e results o f these studies will be reported on at a later date.
S TU D IE S OF D IL U T E IO D IN E S O L U T IO N S T IL L IN P R O G R E SS
A u stin H . K u tsc h e r
T he paper entitled “ Lack of Effectiveness o f a Dilute Iodine Solution in the Treatm ent of Gingivitis, Pericoronitis and Recurrent A ph thous Stomatitis” published in the July issue of T H E J O U R N A L O F T H E A M E R I C A N D E N T A L a s s o c i a t i o n dealt with the use of an elemen tal iodine solution prepared from tablets sup plied for experimental purposes by H eliogen Products, Inc. Each tablet was stated by the manufacturer to contain: potassium iodide 32.7 mg., chloramine T 29.3 mg., nonreactive organic binder and flavor 165 mg., and effer vescent material 421 mg. O ne tablet added to 120 cc. (4 fluid ounces) o f water may be ex pected to produce a solution o f approximately pH 6. T he results described in this paper (dealing with short term, 4-6 days, therapy only) pertained exclusively to this elemental iodine solution which is in essence what should be understood wherever the product’ s trade mark name “ H eliogen” is used. Since the inception o f the published study (com m encing in Novem ber 1952 and sub mitted for publication in M ay 19 5 3), H eliogen Products, Inc., has cooperated actively with us and, according to inform ation received from the com pany, has intensively sponsored studies and investigated the differences be tween iodine solutions o f various types and concentrations as to both effectiveness and toxicity. Subsequently, the com pany has brought to my attention several pertinent studies. In this connection, H eliogen Products, Inc., has inform ed me that it has m odified and may in the future further m odify its products in keeping with accepted advances in this field. As the result o f my preliminary findings, and since the submission for publica tion o f the published manuscript, I have un dertaken additional clinical (long term ther apy) and laboratory studies with solutions of
P R O T E S T S A N E S T H E S IA A R T IC LE
As one who uses general anesthesia in his practice I wish to protest a recent article in th e j o u r n a l entitled “ Trichloroethylene in Dentistry: General Anesthesia.” I refer particularly to the follow ing state ments: “ Thiopental sodium has been used extensively in dental office practice. Such anes thesia is fraught with great hazards, and the practice cannot be accepted on a basis of good or safe anesthetic principles.” It is amazing to me that anyone experienced in general anesthetics can make a flat state ment o f this type and then give no further proof to back the statement. It must be ap parent to everyone that general anesthesia in any form is fraught with hazards and no agent is free from risk. Like many writers critical o f the office use o f general anesthesia the writers w ould give the impression that trichloroethylene is per fectly safe and easy to use. M ay I quote from the most definitive work on this agent today, T r ic h lo r o e th y le n e A n esth esia by Osterle. “ T h e fairest decision seems to be that tri chloroethylene can cause primary cardiac fail ure in the same way as chloroform , but ex tremely rarely.” M y point is this. T h e writers o f your article give the impression that thiopental sodium is very dangerous and trichloroethylene is very safe. W hat the authors mean is that they like and trust one agent and that they d o not like and trust another agent. In my opinion they have given a very biased and misleading pres entation of a very controversial subject. L eo n a r d L . M c E v o y 257
258 • T H E J O U R N A L O F T H E A M E R IC A N D EN T A L A S S O C IA T IO N
E X T E N D E D S O C IA L S E C U R IT Y
I, and the great m ajority o f my colleagues, believe that the expansion o f Social Security is creeping socialism and demands the most vehement condem nation by all Americans who, if Social Security is expanded, w ould be shackled to this forerunner o f communism. Social Security legislation is receiving sup port from the stealthy left wing of both par ties and from certain writers in our dental magazines, w ho attempt to sway the thinking o f the gullible with fallacious and deceptive promises o f socialistic security. Socialism has been experimented with throughout the w orld many times and has had disastrous consequences, for its insidious pur pose is to hide the fiscal dilemma resulting from governmental incompetency. Barron’ s National Business and Financial W eekly states that 25 per cent o f our national debt becom es due in 1954; hence the urgency to expand the tax program. Since President Eisenhower signed the bill terminating excise taxes, the need is even more urgent. Passing the Social Security tax bill is political expe diency but seems the acme o f fiscal stupidity. O nce the additional link in the chain of so cialism becomes effective, w ho can predict what increased tax will be levied in the future ? T h e effort to stem this far-reaching de bauchery o f Am erican freedom m ay be in vain. H owever, I trust organized dentistry will let its voice be heard so that history may record our effort and our respect for the tra dition on w hich this nation was founded. Garth A . Sherman
I N S U F F IC IE N T E VID EN C E FO R C O N C L U S IO N S
A paper by Alexander Seelig and others ap peared in the M ay 1954 issue o f t h e j o u r n a l , page 532. This paper recommends the use of a penicillin G potassium and calcium carbonate paste in the treatment o f exposed dental pulps. T h e recom m endation is based upon results of an experiment done on only one monkey. T h e pulps o f 18 teeth were exposed. T h e paste was placed in 11 teeth. In 8 o f these teeth the fillings were either lost or loose so that there were 3 teeth left which could be used for the study. There was 1 control tooth w hich had the same cement that also covered the 3 teeth on which the paste was used, and there were 4 teeth in which a zinc oxide and eugenol paste was placed over the exposure. T h e cem ent and the zinc oxide eugenol were very injurious to the pulp. This fact is
known and has been described before. T h e penicillin G potassium and calcium carbonate paste, when placed in a large part o f the pulp chamber, prevented the ill effects o f the cement. T h ere are pictures showing that den tin splints w hich were actually pushed into the pulp have osteoid tissue around them and form a partial bridge over the pulp. This occu r rence, too, has been described in the litera ture. T h e title and contents o f Seelig’ s paper are misleading because they give the impression that the new paste mixture was responsible for the healing o f the pulp, whereas in actuality, the paste only prevented the ill effects o f the cement. I believe it is below the dignity o f t h e jo u r n a l to print papers that com e to im portant conclusions in regard to treatment based upon 1 animal, 3 teeth, 1 control tooth and no control as regards the tw o com ponents o f the paste. D id penicillin have anything to do with the results, or was penicillin mainly a m echanical barrier preventing the irritation w hich results when cem ent is placed directly in contact with the pu lp tissue . . . a thing no one in his right mind w ould d o anyhow. In m y opinion, the appearance o f papers like this in the J .A .D .A . do harm. Dentists may be led into using such a paste. T he medical and allied professions w ill believe that the standards o f dental investigations are still far below those o f any other field o f science. H elm ut A . Zander Editor’s n ote: This paper was recom m ended for publication because it demonstrates that penicillin G potassium and calcium carbonate can be used advantageously in exposed pulps o f teeth not previously involved with carious lesions. T h e editorial consultants agree that from a tech nical poin t o f view it does not represent a well controlled piece of research as the reader cannot determine from the report how much o f the beneficial effect came from the penicillin G potassium, and how much was the result o f calcium carbonate. Nevertheless, the study does indicate, even though it does not prove, that the local application o f penicillin might be beneficial. Obviously, m uch m ore study must be given to the subject before final con clusions can be drawn. S T A B IL IT Y O F D E N T U R E S
“ T h e Relation o f Occlusal Surfaces to the Stability o f Dentures,” by R obert S. Ledley, appeared in the M ay issue o f t h e j o u r n a l .
THE R EA D ER C O M M E N T S
This well written article analyzed the forces and the engineering equations o f action and reaction. This work adds weight to the al ready impressive evidence on the influence of occlusion in denture retention. A study of Dr. Ledley’ s article, with its excellent illustrations, w ill afford the student a w orking knowledge o f lateral forces w hich could aid him in the placing o f posterior teeth. But lateral forces are only a part o f the disturbing action, and the writer feels that this fact should be men tioned. D r. Ledley is guilty o f studying a three dimensional m otion in two dimensions. This same error occurs in the work o f K u ith and Boswell, whose work is referred to in the article. Mastication takes place in three dimensions, and by far the most powerful thrust of the
V O L U M E 49. A U G U ST 1954 • 259
m andible is the forw ard com ponent. This thrust results from the horizontal opening hinge action. W hen the mandible moves from its open position in a “ lanternlike swing” to centric closure, the forw ard thrust causes a vector o f m otion that tends constantly to push both upper and low er dentures out o f the mouth. T h e action is analogous to the hinge type nutcracker. T h e nut w ould fly out o f the jaws if it were not held in place. Both student and graduate could im prove their understanding o f this disturbing force in denture instability by reading H arvey Stallard’ s classic article “ T h e Anterior Com ponent o f the Force o f M astication,” D ental Cosmos, M ay 1923, pg. 457. T h ey w ould also profit from my article “ Rationale o f Denture Reten tion,” D en tal D igest, June 1946, pg. 315. W illiam R oy Eberle
j o u r n a l d e v o te s this section to c o m m e n t b y rea d ers on top ics o f cu rren t in terest to d en tistry. T h e ed ito r reserves th e right to ed it all c o m m u n ica tion s to fit available sp a ce and req u ires tha t all letters be signed. A t th e req u est o f th e a u th or, sign a tu res w ill be d e le te d b e fo r e p ublication . P rin te d c o m m u n ica tio n s do n ot necessarily r efle ct th e op in ion or official p o lic y o f th e A ssocia tion . Y o u r p a rticip a tion in this s ec tio n is in vited. T h e E d itor
th e
elemental iodine from material supplied by Heliogen Products, Inc. T h e results o f these studies will be reported on at a later date.
S TU D IE S OF D IL U T E IO D IN E S O L U T IO N S T IL L IN P R O G R E SS
A u stin H . K u tsc h e r
T he paper entitled “ Lack of Effectiveness o f a Dilute Iodine Solution in the Treatm ent of Gingivitis, Pericoronitis and Recurrent A ph thous Stomatitis” published in the July issue of T H E J O U R N A L O F T H E A M E R I C A N D E N T A L a s s o c i a t i o n dealt with the use of an elemen tal iodine solution prepared from tablets sup plied for experimental purposes by H eliogen Products, Inc. Each tablet was stated by the manufacturer to contain: potassium iodide 32.7 mg., chloramine T 29.3 mg., nonreactive organic binder and flavor 165 mg., and effer vescent material 421 mg. O ne tablet added to 120 cc. (4 fluid ounces) o f water may be ex pected to produce a solution o f approximately pH 6. T he results described in this paper (dealing with short term, 4-6 days, therapy only) pertained exclusively to this elemental iodine solution which is in essence what should be understood wherever the product’ s trade mark name “ H eliogen” is used. Since the inception o f the published study (com m encing in Novem ber 1952 and sub mitted for publication in M ay 19 5 3), H eliogen Products, Inc., has cooperated actively with us and, according to inform ation received from the com pany, has intensively sponsored studies and investigated the differences be tween iodine solutions o f various types and concentrations as to both effectiveness and toxicity. Subsequently, the com pany has brought to my attention several pertinent studies. In this connection, H eliogen Products, Inc., has inform ed me that it has m odified and may in the future further m odify its products in keeping with accepted advances in this field. As the result o f my preliminary findings, and since the submission for publica tion o f the published manuscript, I have un dertaken additional clinical (long term ther apy) and laboratory studies with solutions of
P R O T E S T S A N E S T H E S IA A R T IC LE
As one who uses general anesthesia in his practice I wish to protest a recent article in th e j o u r n a l entitled “ Trichloroethylene in Dentistry: General Anesthesia.” I refer particularly to the follow ing state ments: “ Thiopental sodium has been used extensively in dental office practice. Such anes thesia is fraught with great hazards, and the practice cannot be accepted on a basis of good or safe anesthetic principles.” It is amazing to me that anyone experienced in general anesthetics can make a flat state ment o f this type and then give no further proof to back the statement. It must be ap parent to everyone that general anesthesia in any form is fraught with hazards and no agent is free from risk. Like many writers critical o f the office use o f general anesthesia the writers w ould give the impression that trichloroethylene is per fectly safe and easy to use. M ay I quote from the most definitive work on this agent today, T r ic h lo r o e th y le n e A n esth esia by Osterle. “ T h e fairest decision seems to be that tri chloroethylene can cause primary cardiac fail ure in the same way as chloroform , but ex tremely rarely.” M y point is this. T h e writers o f your article give the impression that thiopental sodium is very dangerous and trichloroethylene is very safe. W hat the authors mean is that they like and trust one agent and that they d o not like and trust another agent. In my opinion they have given a very biased and misleading pres entation of a very controversial subject. L eo n a r d L . M c E v o y 257
258 • T H E J O U R N A L O F T H E A M E R IC A N D EN T A L A S S O C IA T IO N
E X T E N D E D S O C IA L S E C U R IT Y
I, and the great m ajority o f my colleagues, believe that the expansion o f Social Security is creeping socialism and demands the most vehement condem nation by all Americans who, if Social Security is expanded, w ould be shackled to this forerunner o f communism. Social Security legislation is receiving sup port from the stealthy left wing of both par ties and from certain writers in our dental magazines, w ho attempt to sway the thinking o f the gullible with fallacious and deceptive promises o f socialistic security. Socialism has been experimented with throughout the w orld many times and has had disastrous consequences, for its insidious pur pose is to hide the fiscal dilemma resulting from governmental incompetency. Barron’ s National Business and Financial W eekly states that 25 per cent o f our national debt becom es due in 1954; hence the urgency to expand the tax program. Since President Eisenhower signed the bill terminating excise taxes, the need is even more urgent. Passing the Social Security tax bill is political expe diency but seems the acme o f fiscal stupidity. O nce the additional link in the chain of so cialism becomes effective, w ho can predict what increased tax will be levied in the future ? T h e effort to stem this far-reaching de bauchery o f Am erican freedom m ay be in vain. H owever, I trust organized dentistry will let its voice be heard so that history may record our effort and our respect for the tra dition on w hich this nation was founded. Garth A . Sherman
I N S U F F IC IE N T E VID EN C E FO R C O N C L U S IO N S
A paper by Alexander Seelig and others ap peared in the M ay 1954 issue o f t h e j o u r n a l , page 532. This paper recommends the use of a penicillin G potassium and calcium carbonate paste in the treatment o f exposed dental pulps. T h e recom m endation is based upon results of an experiment done on only one monkey. T h e pulps o f 18 teeth were exposed. T h e paste was placed in 11 teeth. In 8 o f these teeth the fillings were either lost or loose so that there were 3 teeth left which could be used for the study. There was 1 control tooth w hich had the same cement that also covered the 3 teeth on which the paste was used, and there were 4 teeth in which a zinc oxide and eugenol paste was placed over the exposure. T h e cem ent and the zinc oxide eugenol were very injurious to the pulp. This fact is
known and has been described before. T h e penicillin G potassium and calcium carbonate paste, when placed in a large part o f the pulp chamber, prevented the ill effects o f the cement. T h ere are pictures showing that den tin splints w hich were actually pushed into the pulp have osteoid tissue around them and form a partial bridge over the pulp. This occu r rence, too, has been described in the litera ture. T h e title and contents o f Seelig’ s paper are misleading because they give the impression that the new paste mixture was responsible for the healing o f the pulp, whereas in actuality, the paste only prevented the ill effects o f the cement. I believe it is below the dignity o f t h e jo u r n a l to print papers that com e to im portant conclusions in regard to treatment based upon 1 animal, 3 teeth, 1 control tooth and no control as regards the tw o com ponents o f the paste. D id penicillin have anything to do with the results, or was penicillin mainly a m echanical barrier preventing the irritation w hich results when cem ent is placed directly in contact with the pu lp tissue . . . a thing no one in his right mind w ould d o anyhow. In m y opinion, the appearance o f papers like this in the J .A .D .A . do harm. Dentists may be led into using such a paste. T he medical and allied professions w ill believe that the standards o f dental investigations are still far below those o f any other field o f science. H elm ut A . Zander Editor’s n ote: This paper was recom m ended for publication because it demonstrates that penicillin G potassium and calcium carbonate can be used advantageously in exposed pulps o f teeth not previously involved with carious lesions. T h e editorial consultants agree that from a tech nical poin t o f view it does not represent a well controlled piece of research as the reader cannot determine from the report how much o f the beneficial effect came from the penicillin G potassium, and how much was the result o f calcium carbonate. Nevertheless, the study does indicate, even though it does not prove, that the local application o f penicillin might be beneficial. Obviously, m uch m ore study must be given to the subject before final con clusions can be drawn. S T A B IL IT Y O F D E N T U R E S
“ T h e Relation o f Occlusal Surfaces to the Stability o f Dentures,” by R obert S. Ledley, appeared in the M ay issue o f t h e j o u r n a l .
THE R EA D ER C O M M E N T S
This well written article analyzed the forces and the engineering equations o f action and reaction. This work adds weight to the al ready impressive evidence on the influence of occlusion in denture retention. A study of Dr. Ledley’ s article, with its excellent illustrations, w ill afford the student a w orking knowledge o f lateral forces w hich could aid him in the placing o f posterior teeth. But lateral forces are only a part o f the disturbing action, and the writer feels that this fact should be men tioned. D r. Ledley is guilty o f studying a three dimensional m otion in two dimensions. This same error occurs in the work o f K u ith and Boswell, whose work is referred to in the article. Mastication takes place in three dimensions, and by far the most powerful thrust of the
V O L U M E 49. A U G U ST 1954 • 259
m andible is the forw ard com ponent. This thrust results from the horizontal opening hinge action. W hen the mandible moves from its open position in a “ lanternlike swing” to centric closure, the forw ard thrust causes a vector o f m otion that tends constantly to push both upper and low er dentures out o f the mouth. T h e action is analogous to the hinge type nutcracker. T h e nut w ould fly out o f the jaws if it were not held in place. Both student and graduate could im prove their understanding o f this disturbing force in denture instability by reading H arvey Stallard’ s classic article “ T h e Anterior Com ponent o f the Force o f M astication,” D ental Cosmos, M ay 1923, pg. 457. T h ey w ould also profit from my article “ Rationale o f Denture Reten tion,” D en tal D igest, June 1946, pg. 315. W illiam R oy Eberle