- Email: [email protected]
TOBACCO CONCERNS
L E T T E R S
include the fact that insurance companies pay the same for porcelain-to-high-noble crowns, irrespective of the design, lab bills, potential longevity or ultimate cost to the patient if they fail early or damage other teeth. It could hardly be otherwise, since our own ADA dental codes don’t adequately differentiate between all of these different designs. In the early 1980s, gold hit $800 per ounce. I briefly substituted the perennial “lower cost crown,” porcelain/nonprecious. Subsequently, I witnessed numerous porcelain failures and a case of severe nickel allergy. If patients are financially strained, give them a discount or let them make payments. They deserve the same quality lab work we demand for ourselves. Michael Scollard, DDS Oakland, Calif. 1. American Dental Association. Code on dental procedures and nomenclature. In: CDT-2005: Current dental terminology. 5th ed. Chicago: American Dental Association; 2004:14.
Author’s response: I appreciate Dr. Scollard’s comments, especially the statement that “dentists often prefer gold.” I agree. He has added more useful information on the confounded subjects of crown type and crown quality as related to crown fees. Since crowns compose a major portion of restorative dentistry in the United States and almost every general dentist places crowns routinely, I have some suggestions. The following is a summary of my feelings on the subject: ddetermine that a crown is a legitimate and needed treatment for the patient; dinform the patient about the 152
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various types of crowns and their characteristics; dplace the preferred crown type at a high-quality level; dcharge a fee that you would feel comfortable paying if the crown were to be placed in your own mouth; dhelp the patient receive the “benefit” available from his or her third-party plan. Thank you. Gordon J. Christensen, DDS, MSD, PhD Provo, Utah
Response from the ADA Division of Dental Practice: Dr. Scollard expresses a variety of concerns Every year I see patients collectively spend thousands of dollars because they were not offered the judicious use of cast gold in requisite circumstances.
in his comments. His letter and Dr. Christensen’s response both recognize the evolution in dental procedures and materials, their influence on treatment planning and their influence on fees. Dr. Scollard also correctly points out that the number of crown procedure codes in the Code on Dental Procedures and Nomenclature (Code) does not equal the variety of porcelainfused-to-metal (PFM) crowns that are available today. The Code in its current form enables reporting of PFM crowns using the Classification of Metals established by the American Dental Association Council on Scientific Affairs:
high noble, noble and predominantly base. This classification is based on the relative percentage of precious metal in the crown’s foundation. The Code does not address the ratio of porcelain to metal in a crown, which appears to be Dr. Scollard’s concern. The Code is a living document that can change, and has changed, to reflect evolution in techniques and materials. The addition of a procedure code for titanium crowns effective Jan. 1, 2005,1 is one example of such change. The process for requesting changes to the Code is open to any dentist or interested party, and Dr. Scollard is encouraged to take advantage of the process. Information about the Code’s maintenance process is available online at “www.ada. org/goto/dentalcode”. Additional information is available from the ADA Council on Dental Benefit Programs (ADA member tollfree number, Ext. 2753; direct dial 1-312-440-2753). 1. American Dental Association. Code on dental procedures and nomenclature. In: CDT2005: Current dental terminology. 5th ed. Chicago: American Dental Association; 2004:15.
TOBACCO CONCERNS
I was dismayed to find an advertising insert for Philip Morris USA’s Youth Smoking Prevention Program in November JADA (“The Raising Kids Who Don’t Smoke Series” following page 1544). Philip Morris USA manufactures Marlboro cigarettes, the longtime leading brand among young people who smoke.1 That sales record was no accident; previously secret tobacco industry documents reveal
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.
L E T T E R S
decades of market research by Philip Morris designed specifically to achieve that goal,2 so many people in the tobacco control and public health community are skeptical that the company is serious about reducing smoking by young people. Philip Morris’ advertising campaign focuses on peer influence, parental factors and commercial access being the primary influences on youth smoking initiation, rather than tobacco industry marketing, inaccurate risk appraisal, price and other factors known to influence youth smoking.3 The available evidence suggests that not only is this tobacco industry campaign not effective in reducing youth smoking, it was associated with lowering youths’ perceived harm of smoking.4 Tobacco industry–sponsored campaigns such as Philip Morris’ may have a harmful effect by contributing “clutter” to public health-sponsored advertising that has been shown to be
154
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effective, and by reinforcing smoking as a measure of teens’ independence from their parents.4 In actuality, the primary reasons for Philip Morris USA’s Youth Smoking Prevention Program and similar tobacco industry–produced campaigns is to allow the tobacco companies to claim in litigation that they are “serious” about attacking youth smoking, and to improve their public image. There are many excellent tobacco-use prevention and cessa-
The Code on Dental Procedures and Nomenclature is a living document that can change, and has changed, to reflect evolution in techniques and materials.
tion materials produced by reputable health agencies and organizations that would be far more appropriate.
Scott L. Tomar, DMD, DrPh Professor and Chair Department of Community Dentistry and Behavioral Science University of Florida College of Dentistry Gainesville 1. Kaufman NJ, Castrucci BC, Mowery P, Gerlach KK, Emont S, Orleans CT. Changes in adolescent cigarette-brand preference, 1989 to 1996. Am J Health Behav 2004;28(1):54-62. 2. Hafez N, Ling PM. How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control. Tob Control 2005;14(4):262-71. 3. Wakefield M, McLeod K, Perry CL. ‘Stay away from them until you’re old enough to make a decision’: tobacco company testimony about youth smoking initiation. Tob Control 2006;15(supplement 4):iv44-iv53. 4. Wakefield M, Terry-McElrath Y, Emery S et al. Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior. Am J Public Health 2006;96(12): 2154-60.
Editor’s note: Readers are encouraged to check the Jan. 8 issue of ADA News for a full-scale report on the tobacco industry and public health. The Division of Legal Affairs points out that applicable state law will govern the role of dentists in tobacco-use cessation counseling.
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.
include the fact that insurance companies pay the same for porcelain-to-high-noble crowns, irrespective of the design, lab bills, potential longevity or ultimate cost to the patient if they fail early or damage other teeth. It could hardly be otherwise, since our own ADA dental codes don’t adequately differentiate between all of these different designs. In the early 1980s, gold hit $800 per ounce. I briefly substituted the perennial “lower cost crown,” porcelain/nonprecious. Subsequently, I witnessed numerous porcelain failures and a case of severe nickel allergy. If patients are financially strained, give them a discount or let them make payments. They deserve the same quality lab work we demand for ourselves. Michael Scollard, DDS Oakland, Calif. 1. American Dental Association. Code on dental procedures and nomenclature. In: CDT-2005: Current dental terminology. 5th ed. Chicago: American Dental Association; 2004:14.
Author’s response: I appreciate Dr. Scollard’s comments, especially the statement that “dentists often prefer gold.” I agree. He has added more useful information on the confounded subjects of crown type and crown quality as related to crown fees. Since crowns compose a major portion of restorative dentistry in the United States and almost every general dentist places crowns routinely, I have some suggestions. The following is a summary of my feelings on the subject: ddetermine that a crown is a legitimate and needed treatment for the patient; dinform the patient about the 152
JADA, Vol. 138
various types of crowns and their characteristics; dplace the preferred crown type at a high-quality level; dcharge a fee that you would feel comfortable paying if the crown were to be placed in your own mouth; dhelp the patient receive the “benefit” available from his or her third-party plan. Thank you. Gordon J. Christensen, DDS, MSD, PhD Provo, Utah
Response from the ADA Division of Dental Practice: Dr. Scollard expresses a variety of concerns Every year I see patients collectively spend thousands of dollars because they were not offered the judicious use of cast gold in requisite circumstances.
in his comments. His letter and Dr. Christensen’s response both recognize the evolution in dental procedures and materials, their influence on treatment planning and their influence on fees. Dr. Scollard also correctly points out that the number of crown procedure codes in the Code on Dental Procedures and Nomenclature (Code) does not equal the variety of porcelainfused-to-metal (PFM) crowns that are available today. The Code in its current form enables reporting of PFM crowns using the Classification of Metals established by the American Dental Association Council on Scientific Affairs:
high noble, noble and predominantly base. This classification is based on the relative percentage of precious metal in the crown’s foundation. The Code does not address the ratio of porcelain to metal in a crown, which appears to be Dr. Scollard’s concern. The Code is a living document that can change, and has changed, to reflect evolution in techniques and materials. The addition of a procedure code for titanium crowns effective Jan. 1, 2005,1 is one example of such change. The process for requesting changes to the Code is open to any dentist or interested party, and Dr. Scollard is encouraged to take advantage of the process. Information about the Code’s maintenance process is available online at “www.ada. org/goto/dentalcode”. Additional information is available from the ADA Council on Dental Benefit Programs (ADA member tollfree number, Ext. 2753; direct dial 1-312-440-2753). 1. American Dental Association. Code on dental procedures and nomenclature. In: CDT2005: Current dental terminology. 5th ed. Chicago: American Dental Association; 2004:15.
TOBACCO CONCERNS
I was dismayed to find an advertising insert for Philip Morris USA’s Youth Smoking Prevention Program in November JADA (“The Raising Kids Who Don’t Smoke Series” following page 1544). Philip Morris USA manufactures Marlboro cigarettes, the longtime leading brand among young people who smoke.1 That sales record was no accident; previously secret tobacco industry documents reveal
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.
L E T T E R S
decades of market research by Philip Morris designed specifically to achieve that goal,2 so many people in the tobacco control and public health community are skeptical that the company is serious about reducing smoking by young people. Philip Morris’ advertising campaign focuses on peer influence, parental factors and commercial access being the primary influences on youth smoking initiation, rather than tobacco industry marketing, inaccurate risk appraisal, price and other factors known to influence youth smoking.3 The available evidence suggests that not only is this tobacco industry campaign not effective in reducing youth smoking, it was associated with lowering youths’ perceived harm of smoking.4 Tobacco industry–sponsored campaigns such as Philip Morris’ may have a harmful effect by contributing “clutter” to public health-sponsored advertising that has been shown to be
154
JADA, Vol. 138
effective, and by reinforcing smoking as a measure of teens’ independence from their parents.4 In actuality, the primary reasons for Philip Morris USA’s Youth Smoking Prevention Program and similar tobacco industry–produced campaigns is to allow the tobacco companies to claim in litigation that they are “serious” about attacking youth smoking, and to improve their public image. There are many excellent tobacco-use prevention and cessa-
The Code on Dental Procedures and Nomenclature is a living document that can change, and has changed, to reflect evolution in techniques and materials.
tion materials produced by reputable health agencies and organizations that would be far more appropriate.
Scott L. Tomar, DMD, DrPh Professor and Chair Department of Community Dentistry and Behavioral Science University of Florida College of Dentistry Gainesville 1. Kaufman NJ, Castrucci BC, Mowery P, Gerlach KK, Emont S, Orleans CT. Changes in adolescent cigarette-brand preference, 1989 to 1996. Am J Health Behav 2004;28(1):54-62. 2. Hafez N, Ling PM. How Philip Morris built Marlboro into a global brand for young adults: implications for international tobacco control. Tob Control 2005;14(4):262-71. 3. Wakefield M, McLeod K, Perry CL. ‘Stay away from them until you’re old enough to make a decision’: tobacco company testimony about youth smoking initiation. Tob Control 2006;15(supplement 4):iv44-iv53. 4. Wakefield M, Terry-McElrath Y, Emery S et al. Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior. Am J Public Health 2006;96(12): 2154-60.
Editor’s note: Readers are encouraged to check the Jan. 8 issue of ADA News for a full-scale report on the tobacco industry and public health. The Division of Legal Affairs points out that applicable state law will govern the role of dentists in tobacco-use cessation counseling.
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.