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Those lying lips
L E T T E R S T O T H E E D IT O R T H E JO U R N A L d e v o te s th is se ctio n to co m m e n t b y rea d e rs on to p ic s o f cu rren t in te rest to d e n tistry. T h e ed ito r r e s e rv e s the rig h t to ed it a ll c o m m u n ic a tio n s to fit a v a ila b le sp a c e a n d re q u ire s that a ll letters b e s ig n e d . P rin ted c o m m u n ic a tio n s d o n o t n e c e s sa rily refle ct th e o p in io n o r o ffic ia l p o lic y o f th e A ss o c ia tio n . Y o u r p a rtic ip a tio n in th is s e c tio n is in vite d .
T h o s e ly in g lip s
□ In the article on quality assurance (The Journal, February), Hine and Bishop use the follow in g phrase in the summary, referring to the crea tion o f a dental quality assurance system: “ . . . with the ever present and helpful assistance o f the gov ernment.” A syndicated newspaper co lu m nist recently said that the three greatest lies told in the English lan guage are: “ I put the check in the mail yesterday” ; “ Yes, o f course I’ll respect you in the m orning” ; and, “ I’m from the governm ent and I’m here to help y o u .” W e have been w ell advised that government is a dangerous servant and a fearful master. W hether w e take this as a stern warning or as a joke, w e dentists are w ell advised not to seek the governm ent’s help in our quest for quality. JO H N G. W H IN E R Y , D D S A M A R IL L O , T E X
A n t ib io tic a lle r g ie s
□ The article “ M ultiple antibiotic allergies” (The Journal, Decem ber 1978) does w ell to alert the profes sion to the dangers o f antibiotic al lergies. The therapy described, h o w ever, violates principles o f the treatment o f infections. The patient underwent in cision
and drainage o f a purulent extrac tion site on three different occasions, and yet no culture was perform ed nor were bacterial sensitivity studies done. In spite o f this, four different antibiotics were prescribed. By the time the case was finally resolved, the organisms involved were proba bly resistant to all the antibiotics that had been used for short periods and in rather indifferent doses. P enicillin and erythromycin are frequently used em pirically to treat dental infections, and they may have considerable success. The patient with an extensive history o f allergy, however, should not be subjected to other antibiotics without definite indications from culture and sen sitivity reports. From the description o f the infections, it may be that no antibiotics were necessary, inas m uch as open surgical drainage, if adequately performed, often negates the need for antibiotics. It worked w ell in the era before antibiotics. M O R T O N H. G O L D B E R G , D M D , M D H A R T F O R D , CO N N
□ “ M ultiple antibiotic allergies” (The Journal, December 1978) de scribes a patient w h o should have been treated with clindam ycin rather than lincom ycin. Clinda m ycin has fewer side effects and bet ter absorption than the parent co m pou n d ,1 and is more active against anaerobic bacteria. The cause o f diarrhea in this patient is not totally
clear since “ her menstrual period had recently started, w h ich usually caused diarrhea.” T he onset of diarrhea reportedly began with nausea, itching, and a rash approxi mately 48 hours after institution of lin com ycin therapy. The lin com ycin was appropriately stopped. Proctos cop y is not m entioned. . . . A lthough proctoscopy and h istologic findings are not pathognom onic in this dis order, they are helpful in supporting the diagnosis and should always be done.2 The patient was observed for 48 hours and then was treated with cholestyram ine 9 g three times a day. Seven days after the lin com ycin was discontinued, the diarrhea per sisted and the cholestyram ine was increased to four times d a ily .. . . The con clu sion from this patient’s clin i cal course and the reference from the 1977 Physicians’ Desk Reference that cholestryramine is the preferred treatment is not warranted. . . . the only recom m ended uses are as an adjunct to dietary management of elevated cholesterol levels or for pruritus or partial biliary obstruc tion. . . . A ntibiotic-associated diarrhea can probably occu r with almost any orally administered an tibiotic. N eu1 reports m ultiple in fec tions treated w ith clindam ycin after surgery for cancer o f the head and neck, dental abscess, and actino m ycosis of the jaw in patients w h o were allergic or unresponsive to JADA, V o l. 98, A p ril 1979 ■ 525
T h o s e ly in g lip s
□ In the article on quality assurance (The Journal, February), Hine and Bishop use the follow in g phrase in the summary, referring to the crea tion o f a dental quality assurance system: “ . . . with the ever present and helpful assistance o f the gov ernment.” A syndicated newspaper co lu m nist recently said that the three greatest lies told in the English lan guage are: “ I put the check in the mail yesterday” ; “ Yes, o f course I’ll respect you in the m orning” ; and, “ I’m from the governm ent and I’m here to help y o u .” W e have been w ell advised that government is a dangerous servant and a fearful master. W hether w e take this as a stern warning or as a joke, w e dentists are w ell advised not to seek the governm ent’s help in our quest for quality. JO H N G. W H IN E R Y , D D S A M A R IL L O , T E X
A n t ib io tic a lle r g ie s
□ The article “ M ultiple antibiotic allergies” (The Journal, Decem ber 1978) does w ell to alert the profes sion to the dangers o f antibiotic al lergies. The therapy described, h o w ever, violates principles o f the treatment o f infections. The patient underwent in cision
and drainage o f a purulent extrac tion site on three different occasions, and yet no culture was perform ed nor were bacterial sensitivity studies done. In spite o f this, four different antibiotics were prescribed. By the time the case was finally resolved, the organisms involved were proba bly resistant to all the antibiotics that had been used for short periods and in rather indifferent doses. P enicillin and erythromycin are frequently used em pirically to treat dental infections, and they may have considerable success. The patient with an extensive history o f allergy, however, should not be subjected to other antibiotics without definite indications from culture and sen sitivity reports. From the description o f the infections, it may be that no antibiotics were necessary, inas m uch as open surgical drainage, if adequately performed, often negates the need for antibiotics. It worked w ell in the era before antibiotics. M O R T O N H. G O L D B E R G , D M D , M D H A R T F O R D , CO N N
□ “ M ultiple antibiotic allergies” (The Journal, December 1978) de scribes a patient w h o should have been treated with clindam ycin rather than lincom ycin. Clinda m ycin has fewer side effects and bet ter absorption than the parent co m pou n d ,1 and is more active against anaerobic bacteria. The cause o f diarrhea in this patient is not totally
clear since “ her menstrual period had recently started, w h ich usually caused diarrhea.” T he onset of diarrhea reportedly began with nausea, itching, and a rash approxi mately 48 hours after institution of lin com ycin therapy. The lin com ycin was appropriately stopped. Proctos cop y is not m entioned. . . . A lthough proctoscopy and h istologic findings are not pathognom onic in this dis order, they are helpful in supporting the diagnosis and should always be done.2 The patient was observed for 48 hours and then was treated with cholestyram ine 9 g three times a day. Seven days after the lin com ycin was discontinued, the diarrhea per sisted and the cholestyram ine was increased to four times d a ily .. . . The con clu sion from this patient’s clin i cal course and the reference from the 1977 Physicians’ Desk Reference that cholestryramine is the preferred treatment is not warranted. . . . the only recom m ended uses are as an adjunct to dietary management of elevated cholesterol levels or for pruritus or partial biliary obstruc tion. . . . A ntibiotic-associated diarrhea can probably occu r with almost any orally administered an tibiotic. N eu1 reports m ultiple in fec tions treated w ith clindam ycin after surgery for cancer o f the head and neck, dental abscess, and actino m ycosis of the jaw in patients w h o were allergic or unresponsive to JADA, V o l. 98, A p ril 1979 ■ 525