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The Research Cornucopia
124/540 • THE J O U R N A L O F THE A M E R IC A N D EN T A L A S S O C IA T IO N
M E R E A D V E R T IS IN G M E N
I d o not believe it is the duty o f “ the great army o f dentists, physicians and public health workers” to sell fluoridated water. A nd to try to make them d o so is an attempt to reduce learned professions into a body o f mere adver tising men. C oncerned people o f education search for truth constantly. There is a never-ending de sire to know more but, all the time knowing, it is impossible to know A L L . T h e lead edi torial in the February issue o f t h e j o u r n a l denies this search. O n the subj’ect o f fluorida tion, you seem to say, it’ s over, everyone who is smart is for it; all that now remains is to pour the fluoridated water down the throats of the ignorant public. I f there be so much as a protesting gurgle, ignore it as the noise o f a “ dem agogic group . . . utilizers (o f) un scientific argument . . . the uninform ed.” So— off with their heads! Science is king! Long live the big drug com panies! But brains are not the sole property o f the ruling elite. (In fact, we are beginning to wonder if, in the process of modern educa tion, brain pow er might be lost.) Daily I am reminded in my dental office that there are intellectual men, often w ithout m uch formal education, but born with real brain matter, and, the necessary additional quality, the abil ity to use that fearlessly. Statistics no longer impress these men, or glib words o f the “ edu cated.” I f we have anything to thank tele vision for, it is the thick dose of advertising no one but a fool could any longer believe. As in the case o f the cigarette companies, be cause they started with a poor product, all the “ scientific” discoveries of the experts prove N O T H IN G . Carlton F. Brehmer, D.D.S. 1024 N. Seventh Street, Sheboygan, Wisconsin
H IS T A M IN IC C E P H A L A L G IA
Concerning Dr. Alvin L. Krasne’ s article, “ Histaminic Cephalalgia,” published in the September 1959 issue o f t h e j o u r n a l : The article gives an exceedingly accurate description o f the H orton headache syndrome. Speaking as a patient w ho has had this most undesirable ailment for 12 years, I feel almost like an authority on it. I have tried all of the standard remedies, including ergotamine, cafergone, breathing 100 per cent pure oxy gen, and others, and have had no luck. I have been desensitized to histamine (through the prescribed series o f injections) three times, and still am subject to the attacks. I agree that this can be a very disheartening illness,
and it is true that the pain is so severe that the idea o f suicide sometimes flits into the mind. H ow ever, there is one thing that was not mentioned that may bring instantaneous re lief. In some o f these headaches (and this has been true in some o f m in e), 90 per cent of the pain originates from the anterior, middle, and posterior superior alveolar nerves. In fact, and this is where the dentist is called onto the scene, oftentimes some or all o f the teeth on the affected upper jaw feel tender and vaguely ache. So the treatment, if the affected areas are the ones referred to, is merely to block o ff the entire three branches of the alveolar nerve with a powerful local anesthetic like lidocaine or propoxycaine. Sel dom do the headaches last longer than a maximum o f two to three hours, so thus you have anesthesia for the duration of the pain. W hen the region involved is the one referred to, the effect of this treatment borders on the dramatic. H ere is a person so racked with pain that he wants to batter his head against a wall, and yet with a routine dental proce dure you can give him relief, sometimes total relief, in a matter o f minutes. This treatment has worked for several times, in fact in des peration I have twice administered anesthesia to myself during an attack and obtained relief. I pass this on as a means o f helping the patient w ho suffers from histaminic cephalalgia, especially the one w ho can get relief in no other way, whom the dentist might see for a supposed toothache. R ob ert H. Chase, D.D.S. 867/2 E. Front Street, Traverse City, M ich.
T H E R E S E A R C H C O R N U C O P IA
T he U nited States Congress has raised, fre quently and substantially, appropriations for dental research, and such funds will be given a hearty w elcom e. There should be little cause for m ixed emotions, yet with each increase, other agencies becom e less inclined to support work in this field, and with the recent jum p in funds, dental research is heading toward con trol by a single appointed authority to approve or reject targets o f investigation. This spells the end to independent research, un less it has com m ercial application. It involves the rather serious threat o f a central author ity over activities traditionally immune to such control.. T o make things worse, the newer restric tions im posed by Congress dem and clairvoy ance o f advisory panelists, this in a field whose leaders have tended to be conservative; it cannot be denied that in its history, den-
THE R EA D ER C O M M E N T S
listry as a science has been at times some what doctrinaire. Since research into new territories involves some gam ble, the present system will shy away from challenges, while favoring investigations not conflicting with prevailing views. Regrettably, it will short change the opening o f new and thus custom arily controversial fields o f research. Sometimes, unfortunately, we lean to the idea that the concept o f m ajority rule by a panel implies infinite wisdom and infallibility. Yet, with the presentation o f new concepts, regardless of merit, there is a certain prob ability that they will meet resistance for some time by a m ajority o f workers in the field. T h e answer? U rge Congress to authorize the apportioning o f a part o f the available federal research funds as institutional grants, in order to encourage the developm ent o f dif ferent schools o f thought, o f w hich time will be a better ju dge than the meeting o f a panel. H . H . N eum ann, D .D .S. 630 W est 168th S treet, N ew York.
A N E S T H E T IC T E C H N IC
T h e anesthetic technic described by D r. Boyd F. Sprague (Sim plified management technic for the physically or mentally handicapped dental patient. J.A .D .A . 59:11 6 9 D ec. 1959) requires further comment. Dr. Sprague states that patients with car diac abnormalities with oxygen deficiency can be worked on safely and easily with his technic as well as patients with blood dyscrasias and glandular defects. Anesthesia with thiopental sodium (administered rectally or intravenous ly) is not inherently safer in a poor risk patient than any other anesthetic used. In some poor risk patients thiopental sodium anesthesia is definitely less safe than other agents. One o f the basic premises o f the paper by Dr. Sprague is that thiopental sodium adm in istered rectally is in some w ay controllable. This fact is highly questionable. T h e rate of absorption o f thiopental sodium from the rec
V O L U M E 60, A P R IL I960 . 125/541
tum has never been determined accurately. M ost evidence indicates that almost total ab sorption o f thiopental sodium from the rectum will occu r in 30 minutes. Therefore, even in the patients in w hich green fluid can be ex tracted from the rectum, controllability is un likely. T h e green color is a dye added to the active agent to distinguish the solution for rectal administration from intravenous solu tion. Therefore, the controllability o f rectal thiopental sodium is in no way analogous to the controllability o f the inert gaseous anes thetics w hich are excreted quantitatively from the lungs im mediately upon cessation o f their administration, a fact w hich accounts for the continuing popularity of inhalation agents for surgical anesthesia. D r. Sprague indicates the sitting position is m ore safe than the supine position during general anesthesia. I must take issue with this point o f view. T h e circulatory system is more subject to collapse if the sitting position is assumed by a patient under the influence o f depressant drugs than by a supine position. Thiopental sodium is a drug w hich has been shown to be a circulatory depressant. In addi tion, the maintenance o f a patent airway and support o f respiration is decidedly m ore diffi cult upon a patient in the sitting position. I must agree with D r. Sprague that rectal thiopental sodium instillation is a highly use ful anesthetic technic. It is no panacea as D r. Sprague states. It is a circulatory and respiratory depressant and should be used with all o f the precautions o f any general anesthet ic. A dequate facilities for postoperative care must be available. I f the sitting position is desirable to carry out the operative proce dure, the dangers and limitations o f this posi tion should be recognized. I d o not argue that Dr. Sprague has not described a valuable technic but only that the reasons he promulgates for choosing this tech nic m ay lead one into a false sense o f security. Leonard Bachman, M .D . D irector, Division of A nesthesiology, T h e Children’ s H ospital of Philadelphia
M E R E A D V E R T IS IN G M E N
I d o not believe it is the duty o f “ the great army o f dentists, physicians and public health workers” to sell fluoridated water. A nd to try to make them d o so is an attempt to reduce learned professions into a body o f mere adver tising men. C oncerned people o f education search for truth constantly. There is a never-ending de sire to know more but, all the time knowing, it is impossible to know A L L . T h e lead edi torial in the February issue o f t h e j o u r n a l denies this search. O n the subj’ect o f fluorida tion, you seem to say, it’ s over, everyone who is smart is for it; all that now remains is to pour the fluoridated water down the throats of the ignorant public. I f there be so much as a protesting gurgle, ignore it as the noise o f a “ dem agogic group . . . utilizers (o f) un scientific argument . . . the uninform ed.” So— off with their heads! Science is king! Long live the big drug com panies! But brains are not the sole property o f the ruling elite. (In fact, we are beginning to wonder if, in the process of modern educa tion, brain pow er might be lost.) Daily I am reminded in my dental office that there are intellectual men, often w ithout m uch formal education, but born with real brain matter, and, the necessary additional quality, the abil ity to use that fearlessly. Statistics no longer impress these men, or glib words o f the “ edu cated.” I f we have anything to thank tele vision for, it is the thick dose of advertising no one but a fool could any longer believe. As in the case o f the cigarette companies, be cause they started with a poor product, all the “ scientific” discoveries of the experts prove N O T H IN G . Carlton F. Brehmer, D.D.S. 1024 N. Seventh Street, Sheboygan, Wisconsin
H IS T A M IN IC C E P H A L A L G IA
Concerning Dr. Alvin L. Krasne’ s article, “ Histaminic Cephalalgia,” published in the September 1959 issue o f t h e j o u r n a l : The article gives an exceedingly accurate description o f the H orton headache syndrome. Speaking as a patient w ho has had this most undesirable ailment for 12 years, I feel almost like an authority on it. I have tried all of the standard remedies, including ergotamine, cafergone, breathing 100 per cent pure oxy gen, and others, and have had no luck. I have been desensitized to histamine (through the prescribed series o f injections) three times, and still am subject to the attacks. I agree that this can be a very disheartening illness,
and it is true that the pain is so severe that the idea o f suicide sometimes flits into the mind. H ow ever, there is one thing that was not mentioned that may bring instantaneous re lief. In some o f these headaches (and this has been true in some o f m in e), 90 per cent of the pain originates from the anterior, middle, and posterior superior alveolar nerves. In fact, and this is where the dentist is called onto the scene, oftentimes some or all o f the teeth on the affected upper jaw feel tender and vaguely ache. So the treatment, if the affected areas are the ones referred to, is merely to block o ff the entire three branches of the alveolar nerve with a powerful local anesthetic like lidocaine or propoxycaine. Sel dom do the headaches last longer than a maximum o f two to three hours, so thus you have anesthesia for the duration of the pain. W hen the region involved is the one referred to, the effect of this treatment borders on the dramatic. H ere is a person so racked with pain that he wants to batter his head against a wall, and yet with a routine dental proce dure you can give him relief, sometimes total relief, in a matter o f minutes. This treatment has worked for several times, in fact in des peration I have twice administered anesthesia to myself during an attack and obtained relief. I pass this on as a means o f helping the patient w ho suffers from histaminic cephalalgia, especially the one w ho can get relief in no other way, whom the dentist might see for a supposed toothache. R ob ert H. Chase, D.D.S. 867/2 E. Front Street, Traverse City, M ich.
T H E R E S E A R C H C O R N U C O P IA
T he U nited States Congress has raised, fre quently and substantially, appropriations for dental research, and such funds will be given a hearty w elcom e. There should be little cause for m ixed emotions, yet with each increase, other agencies becom e less inclined to support work in this field, and with the recent jum p in funds, dental research is heading toward con trol by a single appointed authority to approve or reject targets o f investigation. This spells the end to independent research, un less it has com m ercial application. It involves the rather serious threat o f a central author ity over activities traditionally immune to such control.. T o make things worse, the newer restric tions im posed by Congress dem and clairvoy ance o f advisory panelists, this in a field whose leaders have tended to be conservative; it cannot be denied that in its history, den-
THE R EA D ER C O M M E N T S
listry as a science has been at times some what doctrinaire. Since research into new territories involves some gam ble, the present system will shy away from challenges, while favoring investigations not conflicting with prevailing views. Regrettably, it will short change the opening o f new and thus custom arily controversial fields o f research. Sometimes, unfortunately, we lean to the idea that the concept o f m ajority rule by a panel implies infinite wisdom and infallibility. Yet, with the presentation o f new concepts, regardless of merit, there is a certain prob ability that they will meet resistance for some time by a m ajority o f workers in the field. T h e answer? U rge Congress to authorize the apportioning o f a part o f the available federal research funds as institutional grants, in order to encourage the developm ent o f dif ferent schools o f thought, o f w hich time will be a better ju dge than the meeting o f a panel. H . H . N eum ann, D .D .S. 630 W est 168th S treet, N ew York.
A N E S T H E T IC T E C H N IC
T h e anesthetic technic described by D r. Boyd F. Sprague (Sim plified management technic for the physically or mentally handicapped dental patient. J.A .D .A . 59:11 6 9 D ec. 1959) requires further comment. Dr. Sprague states that patients with car diac abnormalities with oxygen deficiency can be worked on safely and easily with his technic as well as patients with blood dyscrasias and glandular defects. Anesthesia with thiopental sodium (administered rectally or intravenous ly) is not inherently safer in a poor risk patient than any other anesthetic used. In some poor risk patients thiopental sodium anesthesia is definitely less safe than other agents. One o f the basic premises o f the paper by Dr. Sprague is that thiopental sodium adm in istered rectally is in some w ay controllable. This fact is highly questionable. T h e rate of absorption o f thiopental sodium from the rec
V O L U M E 60, A P R IL I960 . 125/541
tum has never been determined accurately. M ost evidence indicates that almost total ab sorption o f thiopental sodium from the rectum will occu r in 30 minutes. Therefore, even in the patients in w hich green fluid can be ex tracted from the rectum, controllability is un likely. T h e green color is a dye added to the active agent to distinguish the solution for rectal administration from intravenous solu tion. Therefore, the controllability o f rectal thiopental sodium is in no way analogous to the controllability o f the inert gaseous anes thetics w hich are excreted quantitatively from the lungs im mediately upon cessation o f their administration, a fact w hich accounts for the continuing popularity of inhalation agents for surgical anesthesia. D r. Sprague indicates the sitting position is m ore safe than the supine position during general anesthesia. I must take issue with this point o f view. T h e circulatory system is more subject to collapse if the sitting position is assumed by a patient under the influence o f depressant drugs than by a supine position. Thiopental sodium is a drug w hich has been shown to be a circulatory depressant. In addi tion, the maintenance o f a patent airway and support o f respiration is decidedly m ore diffi cult upon a patient in the sitting position. I must agree with D r. Sprague that rectal thiopental sodium instillation is a highly use ful anesthetic technic. It is no panacea as D r. Sprague states. It is a circulatory and respiratory depressant and should be used with all o f the precautions o f any general anesthet ic. A dequate facilities for postoperative care must be available. I f the sitting position is desirable to carry out the operative proce dure, the dangers and limitations o f this posi tion should be recognized. I d o not argue that Dr. Sprague has not described a valuable technic but only that the reasons he promulgates for choosing this tech nic m ay lead one into a false sense o f security. Leonard Bachman, M .D . D irector, Division of A nesthesiology, T h e Children’ s H ospital of Philadelphia