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Too many dentists?
L e t t e r s to t h e E d it o r
w hile “risk ” connotes danger. G iven the fear su rro u n d in g HIV in the dental office, less em otionally charged w ord choices could help us all.
C O L L E T M A SILL A M O N I, DDS YUMA, AZ
U se o f L -try p to p h a n
th a t the frequency of o ccupational expo sure has n o t been accounted for in its p rior e s tim a te s of risk a n d th a t a h ig h e r p ro p o rtio n of h ea lth care w orkers w ith AIDS have no identified risk factors w hen com pared w ith other AIDS cases. If we accept the calculated figures as reasonable, then the profession sh o u ld increase its ed u catio n al efforts w orldw ide to alert d ental health care w orkers th a t the risk is n o t “m in im a l” in certain com m unities, a n d c e rta in ly n o t in c e rta in A frican co m m u n ities w ith reported prevalence rates of u p to 30%. Recent reports of den tists’ com pliance in C alifornia1 w ith infection control procedures, after a decade of p ro m o tio n of the relevant guidelines, is n o t encouraging. R O B E R T E. M O R R IS, DDS, M P H C O N S U L T A N T IN E D U C A T IO N A N D T R A IN IN G C E N T R E F O R A D V A N C E M E N T OF O R A L H E A L T H SERV ICES SAFAT, K U W A IT P R O F . ER D O G A N T U R G U T H A C E T T E P E U N IV ER SITY FA C U L T Y O F D E N T IS T R Y ANKARA, T U R K E Y 1. G erbert, B. AIDS an d in fectio n control in dental practice: d e n tists’ a ttitu d es, know ledge, an d behavior. JA D A 1987;114:311-314.
□ E ditor’s com m ent: We appreciate the concerns an d com m ents expressed in these le tte rs. Issues on H IV in fe c tio n an d dentistry are regularly found on the pages of T h e Journal and the A D A N ew s. T he May issue of T he Journal contained “T h e d en tist an d infectious diseases: a natio n al survey of attitudes an d behavior” by Dr. A. C arl V errusio an d others. Inside this issue, “ S aliv ary in h ib itio n of HIV -1 in fectiv ity : f u n c tio n a l p ro p e rtie s a n d d istrib u tio n in m en, w om en, an d c h il d re n ” by Dr. P h ilip F ox a n d o thers expands on the ground-breaking discovery reported by the sam e authors last year in T h e Journal. As we co n tin u e to inform and educate, letters from our readers help direct future efforts. Drs. M orris an d T u rg u t’s sugges tion of th in k in g in terms of the “ p ro b ab ility ” of contracting H IV rather th an the “ risk ” of co n tra ctin g H IV has m erit. “ P ro b ab ility ” has statistical connotations 682 ■ JADA, Vol. 118, June 1989
therefore the fee sh o u ld n ot be reduced. If the foregoing is done, the p atien t w ill n ot feel any im p u lse to self-extract a tooth in the future; the dentist w ill n o t feel threatened by the p a tie n t’s actions.
□ T h e article o n the effect of L -try p to p h an supplem en tatio n (April) was a pleasure to read. My ow n experience (in no way statistical) has show n im provem ents in p ain threshold w ith L -try p to p h an an d I w ould suggest the follow ing. L -tryptop h an sh o u ld be given on an em pty stom ach, n ot after meals, to increase the percentage of L -try p to p h a n w hen com pared to other am in o acids. C arbohydrates sh o u ld be taken w ith the L -try p to p h an as in su lin is req u ired for passage across the blood-brain barrier. 5H ydroxytryptophan in the b rain requires vitam in B6 as a catalyst for the conversion to serotonin. T h a t should be taken w ith the L -tryptophan supplem ent. S u pplem en tatio n before sleep is espe cially im p o rta n t as sleep im provem ent has been show n. A dditionally, research has show n fibrositis (M PD) secondary to sleep disturbances w ith alp h a in tru sio n into delta sleep as seen on polysom nography. Is p ain reduction secondary to im proved sleep efficiency an d reduction of fibrositis? A dditional su p p lem en tatio n w ith n ia cin w ill also increase serotonin p ro d u c tion. By increasing niacinam ide in the b rain , a d d itio n a l sero to n in sh o u ld be produced. IR A L. SH A PIR A , DDS G U R N E E , IL
S elf-extractio n □ In regard to “Ethics and p atien t initative” by R. B. Stevenson (April) I w ould like to offer the follow ing advice. W hen patients extract their ow n teeth, the p atien t sh o u ld be congratulated in a h um orous m anner for “ p racticing den tistry w ith o u t a license” an d sh o u ld be generally cautioned ag ain st self-treatm ent. T h e extraction site should be checked and c u re tte d . P o s to p e r a tiv e in s tr u c tio n s should be given. T h e p atien t need n o t be w atc h ed esp e c ia lly n e x t tim e, h a n d s strapped, or oth er safeguards. T h e patien t sh o u ld be charged the full am o u n t for the em ergency exam ination, rad io g rap h , anesthesia, ex tractio n an d follow u p care. Any one can extract a very loose tooth after anesthesia. T h e fee for e x tra c tio n in c lu d e s th e e x a m in a tio n , anesthesia, extraction, and follow -up care;
C o m p u ter im a g in g system s n I have been u sin g the D enta-V ision (BIT) co m p u ter im aging system for the past 8 m onths an d I have never had such a useful tool in my practice for co m m u n icating w ith patients. D enta-V ision is lig h t years ahead of the other systems available an d you have done your readership a disservice by not m e n tio n in g it in “ D ental technology; knocking at h ig h -te ch ’s d o o r” (Em phasis, March). BARRY D. BRA CE, DMD ST . L O U IS
□ I believe th at a significant factor in dental technology was deleted. T h e item is a video com puter im ag in g system from Business Inform ation T echnologies, Inc. As a general p ractitio n er co n cen tratin g on esthetic dentistry, I th o ro ug h ly inves tigated all im ag in g systems before p u r chasing one for myself. T h e B IT system proved to be of superior resolution and it is highly m ore “user-friendly” th an the rest. H A R R Y B. PA SCAL, DDS N EW YORK
T o o m a n y dentists? □ Dr. P h ilias G a ra n t’s “o pen letter to the profession” in A pril 1989 (Letters to the Editor) was th o u g h t provoking. For m any years, dentists have co m plained th a t the dental school com m unity was p ro d u cin g too m any dentists. P racticing today is very com petitive an d substantially less rew ard ing th an in the past. T h e w ord has, therefore, gotten aro u n d —th a t’s why there is a dearth of dental school applicants. It is easy to c o m p la in a b o u t “ the university budget cutters’ ” sh o rtsig h ted ness, alth o u g h they are probably behaving rationally. Bureaucracies do n ot tend to close them selves d o w n .T h e eco n o m ic problem s facing the p racticin g dentist have gone full circle. If we use gross incom e, n um ber of em ployees, an d new p atien t in flu x as param eters for ju d g in g p ra c tic e g ro w th , m a n y p ra c tic e s are sm aller today th an they were 5 years ago. T h e dental school co m m u n ity is faced w ith restructuring. Sm aller does n ot m ean
L e t t e r s to E d it o r
the
worse. Lean an d m ean is som etim es okay. If the pow ers that be find dental school closing easy pickings, it ju s t represents society’s view of o u r im portance and where we are in society’s priorities. D entists today no longer need to raise th e ir voices u rg in g in a tte n tiv e dental educators to produce fewer practitioners. O ur problem , w hich they ignored, is now their problem . T hey did n o t listen and soon w ill be o u t of jobs. W hat goes around, comes around. ST A N L EY M ARKM AN, DDS PA LISA D ES PK, N J
□ T h e needs of dentistry today could be su p p lied w ith half the n u m ber of schools w hich now exist. T h e co n tin u ed overpro d uctio n of unneeded and unw anted d en t ists is senseless, wasteful of education
resources, un fair to young students, and detrim ental to the profession. As for the future, it’s clear th at a greatly reduced n um b er of practitioners w ill be needed to serve the co m in g generation w ho has little caries. T h e need for dentures and endodontic treatm ent w ill be neglible. N ot everyone can perform esthetic, o rth o d o n tic, an d periodontic dentistry an d survive. It’s tim e educators face the facts. You cannot co ntin u e to flood the m arket an d receiv e s u p p o r t fro m th e d e n ta l p op u latio n .
the cem entoenam el ju n c tio n an d apex, usually som ew here m id-w ay dow n the root. I reported two cases of external root resorption of b oth m axillary canines after o rth o d o n tic therapy in “Bilateral external root reso rp tio n ,” (JADA 1980;101:269-72). P erhaps “ m u ltip le external root b lu n t in g ” or “m u ltip le apical external root re so rp tio n ” w o u ld have been a m ore descriptive title. H A R O L D I. SUSSM AN, DDS, MSD N EW YORK, NY
L E E R. H R E N , DDS KEOKUK, IA
C orrection A p ica l or cervical? □ I read w ith interest the clinical report by W. Yusof an d M. G hazali “ M ultiple external root reso rp tio n ” (April). A lth o u g h th e term , “ e x te rn a l ro o t reso rp tio n ” can be used for apical or cervical resorption, the title m isled m e as a periodontist. I associate external resorp tion w ith root rad io lu cen t areas between
DENTISTRY’S
o In the article, “T h e dentist an d infec tious diseases: a n atio n al survey of a tti tudes a n d b e h a v io r” by Dr. A. C arl V errusio an d others (May), F igure 5 is in co rrect. T h e p rin te r tran sp o sed the color of the bars in m ak in g final correc tions. F ig u re 5 sh o u ld reflect the in creased n u m b er of offices in 1988 where g lo v e s a re b e in g u se d fo r sp e c ific procedures.
HERITAGE
THE PRESIDENTS D octor J o h n Bom ba of H averford T o w n sh ip , PA, becam e the 121st president of the A ssociation at the 125th an n u a l session in A tlanta. T h e H ouse of Delegates voted against a $125 per m em ber assessment to provide fu n d in g for a n atio n al advertising cam paign. D octor Bom ba successfully com bined a private dental practice w ith an academ ic career at his alm a m ater, T em ple U niversity School of Dentistry, teaching in the areas of rem ovable prosthodontics and operative dentistry. H e was professor and chairm an of the d epartm ent of operative dentistry before becom ing associate dean of the dental school in 1976. H e was a m em ber of the ADA Board of T rustees from 1977-84, an d served as the A ssociation’s treasurer in 1982-83. H e is a pastpresident of the Academy of G eneral Dentistry. D octor Bom ba represented P ennsylvania in the H ouse of Delegates for 9 years an d served on several reference com m ittees. H e was born in P hiladelphia. R o n ald R eagan was reelected in a landslide, carrying 49 states except Sen. W alter M ondale’s hom e state of M innesota. R epresentatives of the U nited States and the Soviet U n io n m et in G eneva for the first significant n egotiations in 13 m onths. T o x ic gas seeped from a U n io n C arbide p la n t in Bhopal, India, an d killed m ore th an 2,000 people. B ritain and C hina signed an accord co m m ittin g surrender of H o n g K ong to C hina in 1997. P resident R eagan an n o u n ced a sw eeping tax revision plan. Am ericans taken from a hijacked T W A flig h t were held hostage in L ebanon for 17 days.
684 ■ JADA, Vol. 118, June 1989
John Bomba
1984-1985
w hile “risk ” connotes danger. G iven the fear su rro u n d in g HIV in the dental office, less em otionally charged w ord choices could help us all.
C O L L E T M A SILL A M O N I, DDS YUMA, AZ
U se o f L -try p to p h a n
th a t the frequency of o ccupational expo sure has n o t been accounted for in its p rior e s tim a te s of risk a n d th a t a h ig h e r p ro p o rtio n of h ea lth care w orkers w ith AIDS have no identified risk factors w hen com pared w ith other AIDS cases. If we accept the calculated figures as reasonable, then the profession sh o u ld increase its ed u catio n al efforts w orldw ide to alert d ental health care w orkers th a t the risk is n o t “m in im a l” in certain com m unities, a n d c e rta in ly n o t in c e rta in A frican co m m u n ities w ith reported prevalence rates of u p to 30%. Recent reports of den tists’ com pliance in C alifornia1 w ith infection control procedures, after a decade of p ro m o tio n of the relevant guidelines, is n o t encouraging. R O B E R T E. M O R R IS, DDS, M P H C O N S U L T A N T IN E D U C A T IO N A N D T R A IN IN G C E N T R E F O R A D V A N C E M E N T OF O R A L H E A L T H SERV ICES SAFAT, K U W A IT P R O F . ER D O G A N T U R G U T H A C E T T E P E U N IV ER SITY FA C U L T Y O F D E N T IS T R Y ANKARA, T U R K E Y 1. G erbert, B. AIDS an d in fectio n control in dental practice: d e n tists’ a ttitu d es, know ledge, an d behavior. JA D A 1987;114:311-314.
□ E ditor’s com m ent: We appreciate the concerns an d com m ents expressed in these le tte rs. Issues on H IV in fe c tio n an d dentistry are regularly found on the pages of T h e Journal and the A D A N ew s. T he May issue of T he Journal contained “T h e d en tist an d infectious diseases: a natio n al survey of attitudes an d behavior” by Dr. A. C arl V errusio an d others. Inside this issue, “ S aliv ary in h ib itio n of HIV -1 in fectiv ity : f u n c tio n a l p ro p e rtie s a n d d istrib u tio n in m en, w om en, an d c h il d re n ” by Dr. P h ilip F ox a n d o thers expands on the ground-breaking discovery reported by the sam e authors last year in T h e Journal. As we co n tin u e to inform and educate, letters from our readers help direct future efforts. Drs. M orris an d T u rg u t’s sugges tion of th in k in g in terms of the “ p ro b ab ility ” of contracting H IV rather th an the “ risk ” of co n tra ctin g H IV has m erit. “ P ro b ab ility ” has statistical connotations 682 ■ JADA, Vol. 118, June 1989
therefore the fee sh o u ld n ot be reduced. If the foregoing is done, the p atien t w ill n ot feel any im p u lse to self-extract a tooth in the future; the dentist w ill n o t feel threatened by the p a tie n t’s actions.
□ T h e article o n the effect of L -try p to p h an supplem en tatio n (April) was a pleasure to read. My ow n experience (in no way statistical) has show n im provem ents in p ain threshold w ith L -try p to p h an an d I w ould suggest the follow ing. L -tryptop h an sh o u ld be given on an em pty stom ach, n ot after meals, to increase the percentage of L -try p to p h a n w hen com pared to other am in o acids. C arbohydrates sh o u ld be taken w ith the L -try p to p h an as in su lin is req u ired for passage across the blood-brain barrier. 5H ydroxytryptophan in the b rain requires vitam in B6 as a catalyst for the conversion to serotonin. T h a t should be taken w ith the L -tryptophan supplem ent. S u pplem en tatio n before sleep is espe cially im p o rta n t as sleep im provem ent has been show n. A dditionally, research has show n fibrositis (M PD) secondary to sleep disturbances w ith alp h a in tru sio n into delta sleep as seen on polysom nography. Is p ain reduction secondary to im proved sleep efficiency an d reduction of fibrositis? A dditional su p p lem en tatio n w ith n ia cin w ill also increase serotonin p ro d u c tion. By increasing niacinam ide in the b rain , a d d itio n a l sero to n in sh o u ld be produced. IR A L. SH A PIR A , DDS G U R N E E , IL
S elf-extractio n □ In regard to “Ethics and p atien t initative” by R. B. Stevenson (April) I w ould like to offer the follow ing advice. W hen patients extract their ow n teeth, the p atien t sh o u ld be congratulated in a h um orous m anner for “ p racticing den tistry w ith o u t a license” an d sh o u ld be generally cautioned ag ain st self-treatm ent. T h e extraction site should be checked and c u re tte d . P o s to p e r a tiv e in s tr u c tio n s should be given. T h e p atien t need n o t be w atc h ed esp e c ia lly n e x t tim e, h a n d s strapped, or oth er safeguards. T h e patien t sh o u ld be charged the full am o u n t for the em ergency exam ination, rad io g rap h , anesthesia, ex tractio n an d follow u p care. Any one can extract a very loose tooth after anesthesia. T h e fee for e x tra c tio n in c lu d e s th e e x a m in a tio n , anesthesia, extraction, and follow -up care;
C o m p u ter im a g in g system s n I have been u sin g the D enta-V ision (BIT) co m p u ter im aging system for the past 8 m onths an d I have never had such a useful tool in my practice for co m m u n icating w ith patients. D enta-V ision is lig h t years ahead of the other systems available an d you have done your readership a disservice by not m e n tio n in g it in “ D ental technology; knocking at h ig h -te ch ’s d o o r” (Em phasis, March). BARRY D. BRA CE, DMD ST . L O U IS
□ I believe th at a significant factor in dental technology was deleted. T h e item is a video com puter im ag in g system from Business Inform ation T echnologies, Inc. As a general p ractitio n er co n cen tratin g on esthetic dentistry, I th o ro ug h ly inves tigated all im ag in g systems before p u r chasing one for myself. T h e B IT system proved to be of superior resolution and it is highly m ore “user-friendly” th an the rest. H A R R Y B. PA SCAL, DDS N EW YORK
T o o m a n y dentists? □ Dr. P h ilias G a ra n t’s “o pen letter to the profession” in A pril 1989 (Letters to the Editor) was th o u g h t provoking. For m any years, dentists have co m plained th a t the dental school com m unity was p ro d u cin g too m any dentists. P racticing today is very com petitive an d substantially less rew ard ing th an in the past. T h e w ord has, therefore, gotten aro u n d —th a t’s why there is a dearth of dental school applicants. It is easy to c o m p la in a b o u t “ the university budget cutters’ ” sh o rtsig h ted ness, alth o u g h they are probably behaving rationally. Bureaucracies do n ot tend to close them selves d o w n .T h e eco n o m ic problem s facing the p racticin g dentist have gone full circle. If we use gross incom e, n um ber of em ployees, an d new p atien t in flu x as param eters for ju d g in g p ra c tic e g ro w th , m a n y p ra c tic e s are sm aller today th an they were 5 years ago. T h e dental school co m m u n ity is faced w ith restructuring. Sm aller does n ot m ean
L e t t e r s to E d it o r
the
worse. Lean an d m ean is som etim es okay. If the pow ers that be find dental school closing easy pickings, it ju s t represents society’s view of o u r im portance and where we are in society’s priorities. D entists today no longer need to raise th e ir voices u rg in g in a tte n tiv e dental educators to produce fewer practitioners. O ur problem , w hich they ignored, is now their problem . T hey did n o t listen and soon w ill be o u t of jobs. W hat goes around, comes around. ST A N L EY M ARKM AN, DDS PA LISA D ES PK, N J
□ T h e needs of dentistry today could be su p p lied w ith half the n u m ber of schools w hich now exist. T h e co n tin u ed overpro d uctio n of unneeded and unw anted d en t ists is senseless, wasteful of education
resources, un fair to young students, and detrim ental to the profession. As for the future, it’s clear th at a greatly reduced n um b er of practitioners w ill be needed to serve the co m in g generation w ho has little caries. T h e need for dentures and endodontic treatm ent w ill be neglible. N ot everyone can perform esthetic, o rth o d o n tic, an d periodontic dentistry an d survive. It’s tim e educators face the facts. You cannot co ntin u e to flood the m arket an d receiv e s u p p o r t fro m th e d e n ta l p op u latio n .
the cem entoenam el ju n c tio n an d apex, usually som ew here m id-w ay dow n the root. I reported two cases of external root resorption of b oth m axillary canines after o rth o d o n tic therapy in “Bilateral external root reso rp tio n ,” (JADA 1980;101:269-72). P erhaps “ m u ltip le external root b lu n t in g ” or “m u ltip le apical external root re so rp tio n ” w o u ld have been a m ore descriptive title. H A R O L D I. SUSSM AN, DDS, MSD N EW YORK, NY
L E E R. H R E N , DDS KEOKUK, IA
C orrection A p ica l or cervical? □ I read w ith interest the clinical report by W. Yusof an d M. G hazali “ M ultiple external root reso rp tio n ” (April). A lth o u g h th e term , “ e x te rn a l ro o t reso rp tio n ” can be used for apical or cervical resorption, the title m isled m e as a periodontist. I associate external resorp tion w ith root rad io lu cen t areas between
DENTISTRY’S
o In the article, “T h e dentist an d infec tious diseases: a n atio n al survey of a tti tudes a n d b e h a v io r” by Dr. A. C arl V errusio an d others (May), F igure 5 is in co rrect. T h e p rin te r tran sp o sed the color of the bars in m ak in g final correc tions. F ig u re 5 sh o u ld reflect the in creased n u m b er of offices in 1988 where g lo v e s a re b e in g u se d fo r sp e c ific procedures.
HERITAGE
THE PRESIDENTS D octor J o h n Bom ba of H averford T o w n sh ip , PA, becam e the 121st president of the A ssociation at the 125th an n u a l session in A tlanta. T h e H ouse of Delegates voted against a $125 per m em ber assessment to provide fu n d in g for a n atio n al advertising cam paign. D octor Bom ba successfully com bined a private dental practice w ith an academ ic career at his alm a m ater, T em ple U niversity School of Dentistry, teaching in the areas of rem ovable prosthodontics and operative dentistry. H e was professor and chairm an of the d epartm ent of operative dentistry before becom ing associate dean of the dental school in 1976. H e was a m em ber of the ADA Board of T rustees from 1977-84, an d served as the A ssociation’s treasurer in 1982-83. H e is a pastpresident of the Academy of G eneral Dentistry. D octor Bom ba represented P ennsylvania in the H ouse of Delegates for 9 years an d served on several reference com m ittees. H e was born in P hiladelphia. R o n ald R eagan was reelected in a landslide, carrying 49 states except Sen. W alter M ondale’s hom e state of M innesota. R epresentatives of the U nited States and the Soviet U n io n m et in G eneva for the first significant n egotiations in 13 m onths. T o x ic gas seeped from a U n io n C arbide p la n t in Bhopal, India, an d killed m ore th an 2,000 people. B ritain and C hina signed an accord co m m ittin g surrender of H o n g K ong to C hina in 1997. P resident R eagan an n o u n ced a sw eeping tax revision plan. Am ericans taken from a hijacked T W A flig h t were held hostage in L ebanon for 17 days.
684 ■ JADA, Vol. 118, June 1989
John Bomba
1984-1985