- Email: [email protected]
WATERLINES REVISITED
LETTERS
OADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, doublespaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. IDIOTIC BEHAVIOR
People are idiots. I'm insensitive, I know. But people are insensitive, too. Right now I'm insensitive, but in the past I've also been an idiot; my kids think I'm an idiot now and I have no guarantees about my future sanity. For some people being an idiot is an acute, periodic thing, but for a lot, it seems chronic. For now, let me be insensitive and say people who have their tongues pierced are idiots. I notice most are teen-agers (nowadays that includes young 20-somethings, too), and most teen-agers are acute idiots. I know because I was a teen for a pretty long time and associated with quite a few others. I can assure you, things have not changed much in 30 years either, because I am now the father of three teens. Believe me, teen-agers are idiots. My problem is not with the teens. It is with the adults. When I was a teen I kind of knew I was an idiot, but always had the impression that there were wise, moral people who would eventually guide me from idiocy to newer frontiers of sane 1198 JADA, Vol. 128, September 1997
behavior. I discovered, however, that the biggest idiots are in the judicial, legislative and executive branches of government. Ask our leaders their opinion of the issue. They'll probably want to study it and consult with experts (on tongue piercing?). Then, so as not to offend anyone's unremunerated constitutional right to be an idiot, [our leaders] write legislation or legal opinions to make sure that you can be an idiot in a safe manner. You will be assured of this since our leaders all practice safe idiocy. Dentists, however, practice being doctors. That means they practice at being wise and moral. Practice. It is a frontier we never quite get to, but hey, at least we try. It is why I don't buy much of the doom and gloom about the survival of dentistry as a profession. Most dentists resist and are repulsed by the many vulgar intrusions of idiocy into the profession. To be a doctor is to attempt to make something out of life; to be an idiot is to make nothing of the gift. However, I do find that some dentists lack the courage to tell their leaders or patients bluntly, or even unbluntly, when they are acting like idiots. It may be insensitive, but it is honest. And if I remember my Plato, practicing to be honest is practicing to be moral, and practicing to be moral is practicing to be wise. Andrew Tanchyk, D.M.D. East Brunswick, N.J. INTERNATIONAL NUMBERING
Dr. Harold Slavkin of NIDR makes the point in his forensic dentistry article that international differences in recordkeeping make it extremely dif-
ficult to search dental records and identify disaster victims. Unfortunately, American dentists contribute to the problem by using a tooth-numbering system different from that of the international community. I find it very puzzling to read an American article describing the restoration of tooth no. 36, only to find halfway through the article that the author is referring to a different tooth from the one I am envisioning. The international numbering system takes about a minute to learn, and a day's use to become completely comfortable with it. Dentists need to communicate in the same scientific language. It is time for American dentists and the ADA to join the international community. Robert T. Sare, D.D.S. Thunder Bay, Ontario WATERLINES REVISITED
The number of articles in JADA dealing with waterline concerns reminds us that the dental unit waterline contamination problem is real and we do not yet have a solution for dentistry. To help expedite the process and make some movement, especially from the public's point of view, perhaps our profession should first turn its attention to procedures that cause the greatest patient contamination. Periodontal flap-osseous surgery
is
an invasive proce-
dure performed using a conventional high-speed dental drill, traditional nonsterile waterlines and filtered water. This commonly practiced surgical protocol allows for major contamination of tissue compartments and spaces that were sterile before treatment. In 1993, the Centers for Disease Control published rec-
LETTERS ommended infection-control practices for dentistry that indicated sterile saline or sterile water be used as a coolant/irrigator when surgical procedures involving the cutting of bone are performed. In 1996, the California Board of Dental Examiners passed infection control regulations in order to ensure that patients receive sterile saline/water irrigation during surgical procedures involving soft tissue or bone. These regulations were created in order to help ensure that invasive dental surgery follows the accepted standard operating procedures used for all medical surgery and dental implant surgery. Another important objective was to protect patients from foreign bacterial contamination of tissue compartments/spaces that were sterile prior to treatment.
The technology to perform periodontal flap-osseous surgery using sterile tubing, sterile saline irrigation and less-traumatic low-speed drilling is currently available and easy to use. Our practice completely converted to this technology in August 1996. We have observed many positive changes in our patients: less postoperative pain, faster healing, greater comfort during treatment and decreased immunoinflammatory response. The overall improved treatment results are well-worth the small effort made to upgrade delivery systems in order to enhance patient safety. Perhaps the periodontal community should consider taking a leadership position and make recommendations to minimize contamination risks during invasive periodontal surgical pro-
cedures. Periodontal flap-osseous surgery, as it is commonly performed today, causes far greater contamination risks than general dental procedures. Periodontists, by taking the initiative, could provide needed support for general dentistry's waterline efforts. In addition, making the effort to improve public safety would further enhance public and media opinion about the progress being made by our dental profession. George K. Merijohn, D.D.S. San Francisco SPORTS DRINKS AND TOOTH DECAY
We know that the American Dental Association and its prestigious Journal strive to inform and educate members on current scientific information affecting the profession. In that
SPECIALIZE IN DENTAL EXCELLENCE. Today's Air Force offers a challenging specialty practice...without the pain of office administration and overhead. Be the specialist you've always wanted to be. Take flight as an Air Force officer with: * great pay & benefits * well-equipped facilities * support of skilled technicians * 30 days vacation with pay per year Learn how to qualify for our worldwide dental service. You ma qualify for our $30,000 sign-on bonus. Call
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HEALTH PROFESSIONS
OADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, doublespaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated. IDIOTIC BEHAVIOR
People are idiots. I'm insensitive, I know. But people are insensitive, too. Right now I'm insensitive, but in the past I've also been an idiot; my kids think I'm an idiot now and I have no guarantees about my future sanity. For some people being an idiot is an acute, periodic thing, but for a lot, it seems chronic. For now, let me be insensitive and say people who have their tongues pierced are idiots. I notice most are teen-agers (nowadays that includes young 20-somethings, too), and most teen-agers are acute idiots. I know because I was a teen for a pretty long time and associated with quite a few others. I can assure you, things have not changed much in 30 years either, because I am now the father of three teens. Believe me, teen-agers are idiots. My problem is not with the teens. It is with the adults. When I was a teen I kind of knew I was an idiot, but always had the impression that there were wise, moral people who would eventually guide me from idiocy to newer frontiers of sane 1198 JADA, Vol. 128, September 1997
behavior. I discovered, however, that the biggest idiots are in the judicial, legislative and executive branches of government. Ask our leaders their opinion of the issue. They'll probably want to study it and consult with experts (on tongue piercing?). Then, so as not to offend anyone's unremunerated constitutional right to be an idiot, [our leaders] write legislation or legal opinions to make sure that you can be an idiot in a safe manner. You will be assured of this since our leaders all practice safe idiocy. Dentists, however, practice being doctors. That means they practice at being wise and moral. Practice. It is a frontier we never quite get to, but hey, at least we try. It is why I don't buy much of the doom and gloom about the survival of dentistry as a profession. Most dentists resist and are repulsed by the many vulgar intrusions of idiocy into the profession. To be a doctor is to attempt to make something out of life; to be an idiot is to make nothing of the gift. However, I do find that some dentists lack the courage to tell their leaders or patients bluntly, or even unbluntly, when they are acting like idiots. It may be insensitive, but it is honest. And if I remember my Plato, practicing to be honest is practicing to be moral, and practicing to be moral is practicing to be wise. Andrew Tanchyk, D.M.D. East Brunswick, N.J. INTERNATIONAL NUMBERING
Dr. Harold Slavkin of NIDR makes the point in his forensic dentistry article that international differences in recordkeeping make it extremely dif-
ficult to search dental records and identify disaster victims. Unfortunately, American dentists contribute to the problem by using a tooth-numbering system different from that of the international community. I find it very puzzling to read an American article describing the restoration of tooth no. 36, only to find halfway through the article that the author is referring to a different tooth from the one I am envisioning. The international numbering system takes about a minute to learn, and a day's use to become completely comfortable with it. Dentists need to communicate in the same scientific language. It is time for American dentists and the ADA to join the international community. Robert T. Sare, D.D.S. Thunder Bay, Ontario WATERLINES REVISITED
The number of articles in JADA dealing with waterline concerns reminds us that the dental unit waterline contamination problem is real and we do not yet have a solution for dentistry. To help expedite the process and make some movement, especially from the public's point of view, perhaps our profession should first turn its attention to procedures that cause the greatest patient contamination. Periodontal flap-osseous surgery
is
an invasive proce-
dure performed using a conventional high-speed dental drill, traditional nonsterile waterlines and filtered water. This commonly practiced surgical protocol allows for major contamination of tissue compartments and spaces that were sterile before treatment. In 1993, the Centers for Disease Control published rec-
LETTERS ommended infection-control practices for dentistry that indicated sterile saline or sterile water be used as a coolant/irrigator when surgical procedures involving the cutting of bone are performed. In 1996, the California Board of Dental Examiners passed infection control regulations in order to ensure that patients receive sterile saline/water irrigation during surgical procedures involving soft tissue or bone. These regulations were created in order to help ensure that invasive dental surgery follows the accepted standard operating procedures used for all medical surgery and dental implant surgery. Another important objective was to protect patients from foreign bacterial contamination of tissue compartments/spaces that were sterile prior to treatment.
The technology to perform periodontal flap-osseous surgery using sterile tubing, sterile saline irrigation and less-traumatic low-speed drilling is currently available and easy to use. Our practice completely converted to this technology in August 1996. We have observed many positive changes in our patients: less postoperative pain, faster healing, greater comfort during treatment and decreased immunoinflammatory response. The overall improved treatment results are well-worth the small effort made to upgrade delivery systems in order to enhance patient safety. Perhaps the periodontal community should consider taking a leadership position and make recommendations to minimize contamination risks during invasive periodontal surgical pro-
cedures. Periodontal flap-osseous surgery, as it is commonly performed today, causes far greater contamination risks than general dental procedures. Periodontists, by taking the initiative, could provide needed support for general dentistry's waterline efforts. In addition, making the effort to improve public safety would further enhance public and media opinion about the progress being made by our dental profession. George K. Merijohn, D.D.S. San Francisco SPORTS DRINKS AND TOOTH DECAY
We know that the American Dental Association and its prestigious Journal strive to inform and educate members on current scientific information affecting the profession. In that
SPECIALIZE IN DENTAL EXCELLENCE. Today's Air Force offers a challenging specialty practice...without the pain of office administration and overhead. Be the specialist you've always wanted to be. Take flight as an Air Force officer with: * great pay & benefits * well-equipped facilities * support of skilled technicians * 30 days vacation with pay per year Learn how to qualify for our worldwide dental service. You ma qualify for our $30,000 sign-on bonus. Call
1-800-423-USAF Visit us at www.airforce.com AIM HIGH
HEALTH PROFESSIONS