To Treat or Not to Treat

To Treat or Not to Treat

L E T T E R S TO THE E DITOR JADA devotes this section to comment by readers on topics of current interest to dentistry. T he editor reserves the ...

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L E T T E R S

TO

THE

E DITOR

JADA devotes this section to comment by readers on topics of current interest to dentistry. T he editor reserves the right to edit all com m unications to fit available space and requires that all letters be typed, double-spaced, and signed. No more than ten references should be given with each letter. Printed com m u­ nications do not necessarily reflect the opinion or official policy of the Association. Your participation in this section is invited.

dentists and groups w ho give of their tim e an d their talents to those in need could n o t have been recognized.

Smoke screen

H ear, hear, for volunteers! Q C o n g ra tu la tio n s o n y o u r E m p h a sis article “V olunteerism ” (February). It was in sp irin g to read a b o u t the dedicated efforts of fellow dentists to m eet the dental needs of the poor. I look forw ard to the day w h en such actions are seen as a n o rm ative and integral p a rt of being a dentist. EDWARD J. SCHAAF, DDS DIRECTOR OF DENTAL SERVICES ST. BASIL’S HEALTH SERVICE CHICAGO

□ T h e C h ristia n M edical an d D en tal Society (CMDS) was om itted from the list of service agen cies in th e a rtic le o n volunteerism . T h e society is a 59-year-old fellow ship of physicians an d dentists. We actively conduct 2-week, short-term m is­ sions in various third-w orld countries. We also sponsor clinics in some of Am erica’s in n er cities. As a n n u a l particip an ts in these p ro ­ gram s d u rin g the past 4 years, my fam ily an d I have served in H onduras, Mexico, and Jam aica. I can attest personally to the p o sitiv e benefits o f such service. We received m ore th an we gave. JACK E. SHULER, DDS LONDONDERRY, NH

□ E d ito r’s com m ent: W hen we offer a com prehensive look at a p articular topic in dentistry, lim itations of tim e and space m ean we are g oing to leave som eone out. We regret th a t all of the countless w orthy 378 ■ JADA, Vol. 120, April 1990

□ I was q u ite distressed to receive your special su p p le m e n t (Jan u a ry ) to T h e J o u r n a l “ T h e F irs t N a tio n a l D en ta l Sym posium on Sm oking Cessation: H e lp ­ in g D ental P atients to Q u it S m oking.” D entistry has some real problem s th at need to be addressed. Sm oking is n o t one of them. I do not smoke, n o r do I especially care for people w ho do. However, I am frankly tired of one special interest g ro u p or another g oin g o u t of its way to save me from myself. . . . My staff an d I are n ot “stop sm oking p olicem en.” I believe th a t n o one expects, or even w ants his dentist to nag him ab o u t sm oking. If the A m erican D ental A ssociation w ants to spend its (my) m oney p ro d u c­ tively, it should do so by pressuring the m edia to p o rtray o u r profession in a positive light. . . . We are hig h ly trained and skilled professionals, an d are truly concerned w ith the h ealth of o u r patients. However, I believe th at in the p u b lic eye, we are no longer doctors, an d they see us as salespeople, an d themselves as consum ers. . . . Perhaps it is tim e to tell the general p u b lic th at we provide a lifesaving service, an d w ith o u t us the q u ality of their lives w ould indeed be dim inished. If individuals w ant to smoke, it is their business. But, if they refuse to believe th at dentistry is a valuable resource, th a t is a problem th a t we need to rectify. MARTIN S. SPILLER, DMD TOWNSEND, MA

Bacterem ia and dental treatm ent o C ertain form s of dental treatm ent may provoke a bacterem ia th at could result in an infection at a d istan t site such as the

en docardium or an artificial jo in t. Drs. Carson a n d R obertson1 reported several cases of infection at a p enile prosthesis (PP) site where infections had developed after dental care. T o d eterm in e th e in c id en ce of P P infections attrib u ted to previous dental care, we have conducted a survey of all of the urology train in g program s in the U nited States seeking in fo rm atio n ab o u t this m atter. We are attem p tin g to deter­ m in e w h e th e r th e re is an y g en erally accepted protocol for prophylactic a n tib i­ otic therapy to be given for these patients before dental treatm ent. We ask if any of the readers of T he Jo u rn a l w ho may be fam iliar w ith any su ch cases w o u ld co n tact us. We are especially interested in kno w in g the details o f any circum stance in w hich a P P site was infected w ith an organism attributed to a bacterem ia arisin g from a dental o peration. T h e findings of o u r survey w ill be m ade available as soon as the responses have been analyzed. ALAN J. DRINNAN, MD, DDS PROFESSOR AND CHAIRMAN CATHERINE GOGAN, DDS ASSISTANT PROFESSOR DEPARTMENT OF ORAL MEDICINE STATE UNIVERSITY OF NEW YORK AT BUFFALO 1. Carson CD, Robertson CN. Late hematogenous infection of penile prosthesis. J Urol 1988; 139:50.

T o treat or no t to treat □ I h av e a frie n d w h o h a s a w ellestablished pediatric dental practice w hich h e labored to build. H e w ants to treat a c h ild w ho is HIV-positive, b u t he has serious concerns ab o u t the effects of d o in g so o n his staff members and other patients. I have a friend w ho left his lucrative d ental practice to spend a year treatin g p atien ts in West Africa. H e visited patients w ith leprosy, com fortable in the k n o w l­ edge th at he was n ot at risk in co ntracting the disease. H e felt helpless as patien ts

periodontal treatm ent senior p atients are som ew hat “ lo n g in th e to o th .” T h is L e tt e r s to condition makes extensive sp lin tin g via th e E d ito r com plete p o rcelain to m etal coverage difficult, if n o t im possible, w ith o u t p u lp al com prom ises. T h is is further com plicated by attem p tin g to finish labial an d buccal m argins subgingivally for esthetic reasons. w ith kw ashiorkor, tetanus, an d nom a died Com plete porcelain coverage may have of their diseases. H e bristles w hen he reads its place b u t certainly n o t w hen the basic of bureaucrats w ho lecture to him about principles of good dentistry are violated to sa tisfy v a n ity . N o n m u til a ti o n of responsibility to treat the unfortunate. I have a friend w ho w atched his wife retainer teeth should always be upperm ost slowly die from an incurable disease of in the m ind of any doctor. O u r goals u n k n o w n origin. H e know s about the should be the m in im u m reduction of tooth relative safety of treatin g children w ho are structure necessary to provide excellent H IV -positive and ab o u t the sm all, yet retention, cleansable in terp ro x im al m ar­ u n k n o w n risk. H e is w illin g to treat gins, an d sufficient restorative m aterial children w ith AIDS. Yet w hen he thinks thickness to enable occlusal surfaces to be of his concern for his ow n children, he m odified as necessary. S ound teeth should not be extracted merely because they are is h u r t a n d s o m e w h a t a n g ry a t th e “ m is a lig n e d ” fo r c o m p le te co v erag e suggestion th a t referring patients w ith AIDS for treatm ent by others w ould be procedures. labeled as uneth ical or a betrayal of his T hese requirem ents can easily be met by u sing onlays w ith vertical pins. An profession. onlay w ith three or four parallel, strate­ T h e curren t reluctance to treat patients w ith AIDS has been com pared w ith the gically placed, 3-mm lo n g p in s is the general reluctance of som e p ractitioners to preferred retainer and w ill achieve m ax­ treat o ther handicap p ed persons, b u t the im um coronal retention w ith m in im al tooth reduction. “ H ig h an d dry” m argins two situ atio n s are qualitatively different. W hile we agonize, as we m ust, over the m eans the chance of an accurate im pres­ sion the first tim e is im proved, regardless p lig h t of patients w ith AIDS, we should also consider the dilem m as of those health of the num ber of abu tm en ts involved. By w orkers w ho are confronted w ith the n o t finish in g buccal o r labial m argins su b g in g iv ally , n o in c ip ie n t g in g iv itis burden of treating these patients. because of p o o r co n to u rin g is induced. M ILTON H O U PT , DDS, PhD PROFESSOR AND CHAIRMAN, It is tim e we retu rn to the p ath of DEPARTM ENT OF PEDIATRIC practicing dentistry th a t we know is rig h t DENTISTRY AND COMMUNITY HEALTH for o u r patients. UNIVERSITY OF MEDICINE AND DENTISTRY

a general p ractitio n er and n o t an ADArecognized o rth o d o n tic specialist. BRUCE A. GUSTAFSON, DDS, MScO N O R TH CAROLINA ASSOCIATION OF O RTHODO N TISTS

□ E ditor’s com m ent: In the rep o rt of this case in the Jan u ary 1990 issue, all refer­ ences to the accused read “d en tist” (not “o rth o d o n tist” ) because he is a general dentist. Also, the first sentence (which reads: “T h e dentist m ain tain ed an o rth ­ o d o n tic practice in N o rth C a ro lin a”) is based o n the co u rt’s description w hich states: Dr. ----------------- is licensed to practice dentistry in N o rth C arolina. H e has an o rth o d o n tic practice i n __________ an d at the tim e of his h earin g before the Board h a d a p p r o x im a te ly 200 o r th o d o n tic patients.

ED GILBERG, DDS SO U TH PASADENA, FL

□ In the letter to the editor by Dr. Fred M. Medwedeff “ R ad iatio n reduction in c h ild p an o ram ic rad io g rap h y ” (February), the last p arag rap h sh o u ld read: An earlier developm ent, the Precision in trao ral sy stem ,17 has dem onstrated that in c re a se d c o llim a tio n w ith in tr a o ra l shield in g n o t only reduces dose in the 80% to 90% range d ep en d in g on w hether the X ray is a bitew ing, periapical, or occlusal, a n d w hether the p atien t is an ad u lt or sm all child. T h e low er doses are obtained on ch ild ren 2 or w henever the occlusal in stru m e n t3 is used. Im age q u ality is u pgraded by clearing the film of fog from scatter.13-6’7 Therefore, it is anticipated th a t this co llim atio n w ill upgrade the p an o ram ic im age in ad d itio n to reducing dose.

n I w rite to clarify your report in the Jan u ary Legislation and L itig a tio n sec­ tion concerning a N orth C aro lin a dentist w ho m aintain ed an o rth o d o n tic practice and was disciplined by the N o rth C arolina State Board of D ental Exam iners. Because of th e m is le a d in g te x t, m an y N o rth C arolina dentists have been asking w hich orthodontist was involved. It was in fact

□ T h e D epartm ent of M em bership has received two more corrections regarding th e O b itu a ry c o lu m n (J a n u a ry ). Dr. H arley J. T u rn e r III, S p artanburg, SC, was m istakenly listed as deceased. Dr. T u rn e r is a 1978 g raduate of the U niversity of Tennessee. Dr. H aro ld A. M orris, M ount D ora, Fla, was also m istakenly listed as deceased. Dr. M orris is a 1939 graduate of th e U n iv ersity of Iow a. T h e Jo u rn a l regrets these errors.

OF NEW JERSEY

D entistry and the graying of America Corrections □ In M egatrends 1980, J o h n N aisbittcorrectly predicted the g ray in g of America as an increased percentage of our p o p u ­ latio n is getting older. M ore and m ore people are reaching 70 an d can anticipate liv in g a n o th e r 20 years. T h e clinical problem s of the senior p o p u la tio n are p rim arily periodontal an d req u ire extraction o r need treatm ent to e lim in a te the disease. H ow ever, after

380 ■ JADA, Vol. 120, April 1990