“ In my opinion, it is about time to introduce some compromise in endo dontics. Why should we not do so? I have to compromise with my com munity, I have to compromise with the internal revenue office, and I have to compromise with my wife; why not compromise with endodontics? I think that between the extreme positions extraction of the tooth or a perfect exact root treatment some space is present in which we can introduce an acceptable compromise.” I should like to avoid becoming embroiled in the emotionalism of the issue and, therefore, refrain from characterizing such statements. Are we to have two standards of treat ment—the best for ourselves and our favorite patients—and a compromise form for others? How shall we com promise living with our consciences? BENJAMIN SEIDLER, DDS WEST PALM BEACH, FLA
Service well rendered m My sincere congratulations to W. B. Eames et al (“ The incisal edge re pair bonanza,” Feb jada) and you, as editor, for the service you have ren dered professional journalism and sci entific communication. Dr. Eames already has established himself as an astute observer in clin ical and laboratory research. With this article, the authors and you have dem onstrated true understanding and em pathy for the dental practitioner. The article is factual, concise, extremely readable, and thus communicated its message in a most enjoyable way. I anxiously await similar contribu tions to appear in the journal and hope you will encourage future con tributors to utilize some of the princi ples contained therein. O. DANIEL BLUTH, DDS LOGAN, UTAH
Transcendental meditation m I would like to bring to your atten tion a technique which may have very great value to our profession.
Almost four years ago, several dental colleagues persuaded me to learn transcendental meditation. With a great deal of skepticism I began, but today I must recommend it with the greatest enthusiasm. Although I am in private practice, hold a teaching position at a university, conduct re search, and have a great number of other responsibilities, I seem to have gained much energy and clarity of mind in all aspects of my work, and my leisure time as well. A great deal of clinical and exper imental research continues to be con ducted on transcendental meditation. At present, more than 300 experi ments are in progress in 18 countries. Much of this work has application to our patients and ourselves. Completed research has been pub lished in such journals as Lancet, N e w
philosophy or way of life. It is easy to learn and requires only that the prac titioner sit comfortably in a chair twice a day for 15 to 20 minutes while effortlessly performing the specific mental technique. It is taught by sev eral nonprofit educational organiza tions, including the International Meditation Society, which has more than 400 branches in the United States. I would like to hear from other den tists who are employing transcenden tal meditation. IRA M. KLEMONS, DDS PENNSYLVANIA STATE UNIVERSITY UNIVERSITY PARK, PA
Success o f implants
E n g l a n d Journal o f Medicine, A m e r ican Journal o f Physiology, Science,
and Scientific A m e r i c a n . Among the clinical benefits reported have been reductions in hypertension, anxiety, and mental depression. Other im provements have been noted in faster reaction times, greater productivity, improved memory, higher IQ, and better grades in school in practitioners of TM. Even more closely related to den tistry has been a pilot study suggesting that mild gingivitis may regress in many mediators even in the absence of training in plaque control tech niques (Klemons, I.M., “ Changes in inflammation which occur in persons practicing transcendental medita tion,” Scientific R e s e a r c h o n T r a n s cendental
Meditation:
Collected
MIU Press, 1975). Many dentists, including myself, have noticed that patients who prac tice TM tend to be more relaxed than nonmeditators, are more receptive to suggestions regarding their health, and may even heal with a relative min imum of postoperative pain. While much research still must be done to understand fully all of the changes which may occur, I strongly recom mend that my fellow dentists investi gate this simple technique. TM is intended particularly for ac tive people to help them gain more energy for activity. It involves no Papers,
204 ■ LETTERS TO THE EDITOR /JADA, Vol. 91, August 1975
m In light of all the publicity implant dentistry is receiving via the news media, I am forwarding this letter in the hope that you will publish it to encourage the teaching of implant dentistry to the undergraduates and the increased use of implants by men and women in dentistry across the country. I hope, too, that it will stimulate the need by clinicians to acquaint them selves with current concepts in anat omy, physiology, anesthesia, asep sis, surgical techniques, occlusion, and the elements of clinical medi cine. Recent comments made by the ADA Council on Dental Materials and Devices show a distinct lack of insight and understanding in the over all needs of clinical dentistry and implantology. There are many of us across the country whose interest is only in help ing the patient and furthering the oral sciences. We do not consider implants experimental; we use them simply as another tool in our clinical armamen tarium. Implants of all kinds have been used with eminent success. Success is dependent on the ability of the clini cian to bring to bear all of the disci plines of clinical practice. It is not suf ficient to do a surgical procedure, a prosthetic procedure, or a periodontal
treatment; the clinician must be com petent in all clinical concepts. All are necessary for successful implant den tistry. An estimate of the success or fail ure of implants depends on two pri mary factors—the definition of failure as it applies in clinical dentistry and the training and clinical competence of the doctor. In restorative dental procedures—with some exceptions— alloys, plastic fillings, and gold inlays begin to fail or fail within a few years unless margins are resealed, surfaces refinished, occlusions equilibrated. In partial denture prosthesis, where free-end saddles are used, damage to the underlying alveolar bone begins almost at once unless care is contin ued to maintain the prosthesis in proper physiologic balance. In full denture prosthesis, perhaps one case in a thousand is carefully considered, planned, and construct ed. Most are “ run through” by a com mercial laboratory, the case seated, three adjustments made, and the pa tient goes on his merry way. In many instances, the technician is called in “to advise” the doctor on clinical problems, or to make adjustments. At this point, the destruction of the bony mandible is well launched, fed by reline upon reline, all out of phys iologic balance. Based on current concepts of suc cessful operative, prosthetic, endo dontic, and periodontal procedures, it hardly seems rational to call an im plant a failure if it must be replaced in 3, 5, 7, or 20 years. It seems the yardstick used for measuring success or failure is based entirely upon: —the total knowledge of implants of the committee, none of whom has adequate personal clinical experi ence; —reports of failure by untrained or poorly trained clinicians who had hoped to find a clinical panacea in implantology to cover a lack of knowl edge and ability ; —reports by clinicians who have a financial interest in one kind of im plant or another; and —a prejudicial view of successful dental procedures. If the training of the clinician has
been poor, he commits a series of clinical errors which result in a re markable number of needless implant failures. One-day courses, where clin ical participation on the patient is not part of the program, should be con sidered poor. Any two or three day program is a poor one. I urged the Council, in its report for publication, to emphasize the posi tive aspect of implantology. Empha sizing the negative aspect may well open a Pandora’s box of malpractice suits which could ruin the standing of dentistry in the community, dental research, and the image of dentistry as a specialty of medicine for years to come. I hope further published conclu sions will read: “ Because implants of all kinds have been successful, further investigations must be conducted to learn the reasons for the failures. Then perhaps we will have developed one of the most useful prostheses in the history of man.” A statement such as this would en courage research, clinical effort, and stimulate the clinician to seek good training for the betterment of himself and dentistry. It would encourage the dental schools to establish adequate programs for training the student in all phases of clinical dentistry (with out regard to the so-called specialties), and it would open the door to better clinical understanding by the doctor in behalf of his patient. AVERY S. KRASHEN, DDS CHICAGO
Questions validity o f premise
■ The article, “ A descriptive survey of signs and symptoms associated with the myofascial pain dysfunction syndrome” (March jada), is an ex cellently written, well-documented scientific paper. However, after care fully studying the data, one cannot but question the validity of the prem ise or supposition that these patients were suffering an equivalent dysfunc tion. For example, 48% of the patients had clicking joints and 34% had crep itus. These observations should be
sufficient to differentiate the patients into four groups: those who exhibited no clicking or crepitus, those who had crepitus only, those with clicking only, and those with both clicking and crepitus. On the basis of these criteria, it does not appear logical that these patients were suffering similar prob lems. The article reports that 39% of the patients had tenderness in the region of the joint. It is then only logical to assume that 61% did not have joint tenderness and therefore differed from those who did. While the superficial masseter mus cle was tender to palpation in 33% of the patients, there was a wide dispar ity of tenderness among the other masticatory muscles examined. It should be noted that 7% of the patients exhibited no significant muscular ten derness. It does not seem reasonable to assume that patients with tender ness in different muscles should be considered to have identical dysfunc tions. Also, there is no basis what ever to equate patients who had mus cular tenderness with those who had none. Most of the patients (62%) were able to open beyond the minimal nor mal range (40 mm), while 38% were not able to open beyond 40 mm. Of the latter, 11% could not open be yond 30 mm and 4% were restricted to a maximal opening of less than 20 mm. Surely, these differences in the range of jaw opening movement indi cate that some of the patients were suffering problems different from the others. The article points out the previous ly described heterogeneity of the pa tient population with the myofascial pain dysfunction syndrome. On the basis of the data, is it not logical to likewise point out the heterogeneity of the signs and symptoms? The dissimilarity of signs and symp toms among the patients calls into question the criteria under which they were designated to be suffering a par ticular syndrome—the myofascial pain dysfunction syndrome—because a syndrome is defined as a concur rence of signs and symptoms, and it is obvious that the signs and symp toms of the patients were markedly
LETTERS TO THE EDITOR /JADA, Vol. 91, August 1975 ■ 205
Service well rendered m My sincere congratulations to W. B. Eames et al (“ The incisal edge re pair bonanza,” Feb jada) and you, as editor, for the service you have ren dered professional journalism and sci entific communication. Dr. Eames already has established himself as an astute observer in clin ical and laboratory research. With this article, the authors and you have dem onstrated true understanding and em pathy for the dental practitioner. The article is factual, concise, extremely readable, and thus communicated its message in a most enjoyable way. I anxiously await similar contribu tions to appear in the journal and hope you will encourage future con tributors to utilize some of the princi ples contained therein. O. DANIEL BLUTH, DDS LOGAN, UTAH
Transcendental meditation m I would like to bring to your atten tion a technique which may have very great value to our profession.
Almost four years ago, several dental colleagues persuaded me to learn transcendental meditation. With a great deal of skepticism I began, but today I must recommend it with the greatest enthusiasm. Although I am in private practice, hold a teaching position at a university, conduct re search, and have a great number of other responsibilities, I seem to have gained much energy and clarity of mind in all aspects of my work, and my leisure time as well. A great deal of clinical and exper imental research continues to be con ducted on transcendental meditation. At present, more than 300 experi ments are in progress in 18 countries. Much of this work has application to our patients and ourselves. Completed research has been pub lished in such journals as Lancet, N e w
philosophy or way of life. It is easy to learn and requires only that the prac titioner sit comfortably in a chair twice a day for 15 to 20 minutes while effortlessly performing the specific mental technique. It is taught by sev eral nonprofit educational organiza tions, including the International Meditation Society, which has more than 400 branches in the United States. I would like to hear from other den tists who are employing transcenden tal meditation. IRA M. KLEMONS, DDS PENNSYLVANIA STATE UNIVERSITY UNIVERSITY PARK, PA
Success o f implants
E n g l a n d Journal o f Medicine, A m e r ican Journal o f Physiology, Science,
and Scientific A m e r i c a n . Among the clinical benefits reported have been reductions in hypertension, anxiety, and mental depression. Other im provements have been noted in faster reaction times, greater productivity, improved memory, higher IQ, and better grades in school in practitioners of TM. Even more closely related to den tistry has been a pilot study suggesting that mild gingivitis may regress in many mediators even in the absence of training in plaque control tech niques (Klemons, I.M., “ Changes in inflammation which occur in persons practicing transcendental medita tion,” Scientific R e s e a r c h o n T r a n s cendental
Meditation:
Collected
MIU Press, 1975). Many dentists, including myself, have noticed that patients who prac tice TM tend to be more relaxed than nonmeditators, are more receptive to suggestions regarding their health, and may even heal with a relative min imum of postoperative pain. While much research still must be done to understand fully all of the changes which may occur, I strongly recom mend that my fellow dentists investi gate this simple technique. TM is intended particularly for ac tive people to help them gain more energy for activity. It involves no Papers,
204 ■ LETTERS TO THE EDITOR /JADA, Vol. 91, August 1975
m In light of all the publicity implant dentistry is receiving via the news media, I am forwarding this letter in the hope that you will publish it to encourage the teaching of implant dentistry to the undergraduates and the increased use of implants by men and women in dentistry across the country. I hope, too, that it will stimulate the need by clinicians to acquaint them selves with current concepts in anat omy, physiology, anesthesia, asep sis, surgical techniques, occlusion, and the elements of clinical medi cine. Recent comments made by the ADA Council on Dental Materials and Devices show a distinct lack of insight and understanding in the over all needs of clinical dentistry and implantology. There are many of us across the country whose interest is only in help ing the patient and furthering the oral sciences. We do not consider implants experimental; we use them simply as another tool in our clinical armamen tarium. Implants of all kinds have been used with eminent success. Success is dependent on the ability of the clini cian to bring to bear all of the disci plines of clinical practice. It is not suf ficient to do a surgical procedure, a prosthetic procedure, or a periodontal
treatment; the clinician must be com petent in all clinical concepts. All are necessary for successful implant den tistry. An estimate of the success or fail ure of implants depends on two pri mary factors—the definition of failure as it applies in clinical dentistry and the training and clinical competence of the doctor. In restorative dental procedures—with some exceptions— alloys, plastic fillings, and gold inlays begin to fail or fail within a few years unless margins are resealed, surfaces refinished, occlusions equilibrated. In partial denture prosthesis, where free-end saddles are used, damage to the underlying alveolar bone begins almost at once unless care is contin ued to maintain the prosthesis in proper physiologic balance. In full denture prosthesis, perhaps one case in a thousand is carefully considered, planned, and construct ed. Most are “ run through” by a com mercial laboratory, the case seated, three adjustments made, and the pa tient goes on his merry way. In many instances, the technician is called in “to advise” the doctor on clinical problems, or to make adjustments. At this point, the destruction of the bony mandible is well launched, fed by reline upon reline, all out of phys iologic balance. Based on current concepts of suc cessful operative, prosthetic, endo dontic, and periodontal procedures, it hardly seems rational to call an im plant a failure if it must be replaced in 3, 5, 7, or 20 years. It seems the yardstick used for measuring success or failure is based entirely upon: —the total knowledge of implants of the committee, none of whom has adequate personal clinical experi ence; —reports of failure by untrained or poorly trained clinicians who had hoped to find a clinical panacea in implantology to cover a lack of knowl edge and ability ; —reports by clinicians who have a financial interest in one kind of im plant or another; and —a prejudicial view of successful dental procedures. If the training of the clinician has
been poor, he commits a series of clinical errors which result in a re markable number of needless implant failures. One-day courses, where clin ical participation on the patient is not part of the program, should be con sidered poor. Any two or three day program is a poor one. I urged the Council, in its report for publication, to emphasize the posi tive aspect of implantology. Empha sizing the negative aspect may well open a Pandora’s box of malpractice suits which could ruin the standing of dentistry in the community, dental research, and the image of dentistry as a specialty of medicine for years to come. I hope further published conclu sions will read: “ Because implants of all kinds have been successful, further investigations must be conducted to learn the reasons for the failures. Then perhaps we will have developed one of the most useful prostheses in the history of man.” A statement such as this would en courage research, clinical effort, and stimulate the clinician to seek good training for the betterment of himself and dentistry. It would encourage the dental schools to establish adequate programs for training the student in all phases of clinical dentistry (with out regard to the so-called specialties), and it would open the door to better clinical understanding by the doctor in behalf of his patient. AVERY S. KRASHEN, DDS CHICAGO
Questions validity o f premise
■ The article, “ A descriptive survey of signs and symptoms associated with the myofascial pain dysfunction syndrome” (March jada), is an ex cellently written, well-documented scientific paper. However, after care fully studying the data, one cannot but question the validity of the prem ise or supposition that these patients were suffering an equivalent dysfunc tion. For example, 48% of the patients had clicking joints and 34% had crep itus. These observations should be
sufficient to differentiate the patients into four groups: those who exhibited no clicking or crepitus, those who had crepitus only, those with clicking only, and those with both clicking and crepitus. On the basis of these criteria, it does not appear logical that these patients were suffering similar prob lems. The article reports that 39% of the patients had tenderness in the region of the joint. It is then only logical to assume that 61% did not have joint tenderness and therefore differed from those who did. While the superficial masseter mus cle was tender to palpation in 33% of the patients, there was a wide dispar ity of tenderness among the other masticatory muscles examined. It should be noted that 7% of the patients exhibited no significant muscular ten derness. It does not seem reasonable to assume that patients with tender ness in different muscles should be considered to have identical dysfunc tions. Also, there is no basis what ever to equate patients who had mus cular tenderness with those who had none. Most of the patients (62%) were able to open beyond the minimal nor mal range (40 mm), while 38% were not able to open beyond 40 mm. Of the latter, 11% could not open be yond 30 mm and 4% were restricted to a maximal opening of less than 20 mm. Surely, these differences in the range of jaw opening movement indi cate that some of the patients were suffering problems different from the others. The article points out the previous ly described heterogeneity of the pa tient population with the myofascial pain dysfunction syndrome. On the basis of the data, is it not logical to likewise point out the heterogeneity of the signs and symptoms? The dissimilarity of signs and symp toms among the patients calls into question the criteria under which they were designated to be suffering a par ticular syndrome—the myofascial pain dysfunction syndrome—because a syndrome is defined as a concur rence of signs and symptoms, and it is obvious that the signs and symp toms of the patients were markedly
LETTERS TO THE EDITOR /JADA, Vol. 91, August 1975 ■ 205
