evaluation that the tooth was reamed beyond the apex, and that, as a result, the tooth was grossly overfilled. We have been informed by Bernard J. Conway, Secretary o f the A D A Council on Legislation, that informa­ tion on legal cases is received by A D A from only three states. Mr. Conway says that his information in this case cam e from Jury Verdicts Weekly, a California publication. We question the judgment used in publishing infor­ mation on an out-of-court settlement, without including all the facts___ This case concerns an individual abuse of the Sargenti technique that resulted in a malpractice suit; it should not be used as a criticism o f the correctly used method. RAMON WERTS, DDS FULLERTON, CALIF

E d it o r ’s n ote: In a su bseq uen t letter, D r. Werts m a d e the follow in g c o m ­ ment:

O f further interest is the article in the January 1978 issue o f The Jou rn al entitled “ Endodontic problems result­ ing from surgical fistulation: report of two ca ses.” Figures 8 and 9 on page 104 are radiographs o f the same case reported in the Legislation and Litiga­ tion section of the September 1977 is­ sue, although no mention o f the surgi­ cal fistulation was included. This pro­ cedure could well have caused the paresthesia. I repeat that the true facts o f the case were never adjudicated. Therefore, the allegations of the plain­ tiff remain just that— allegations, not facts.

M issing teeth m Several points in “ Congenital ab­

sence o f teeth: a review with emphasis on inheritance patterns” ( The J o u r ­ nal, February) prompt comment. First, there is a lack o f definition o f the clinical and radiographic criteria to diagnose congenital absence o f teeth; radiographic criteria are particularly important for premolars and third mo­ lars. . . . The author fails to give a definition o f the terms, and the reader is left to guess the meaning o f partial anodon-

tia, oligodontia, and hypodontia.. . . it seem s desirable to use more universal terms— anodontia for the total ab­ sence o f teeth and hypodontia for con­ genital absence o f one or more teeth. The idea that man is evolving a smaller jaw that will accommodate fewer and fewer teeth is not new. . . . Several authors agree, however, that there are no good grounds for believ­ ing this theory. Another objection to the paper is the obsolete and confused phraseology used to explain inher­ itance . . . This is especially evident in one o f the closing statements: (Hypodontia is) “ the result o f one or more point mutations in a closely linked polygenic system , most often transmitted in an autosomal dominant pattern with incomplete penetrance and variable expressivity.” . . . For clinical purposes, the genetic condi­ tions have been divided into chromosomal, monogenic, and mul­ tifactorial, according to the primary cause. Thus, monogenic conditions have no close relation with polygenic conditions in their mode o f inher­ itance. It is regrettable that M cKusick’s catalogs are not cited in this review, or Rao and Witkop’s work on classifica­ tion o f genetic disorders o f interest to dentists. . . . CARLOS F. SALINAS, DDS CHARLESTON, SC

■ “ Congenital absence o f teeth” did nothing to clarify the concept of hypodontia, and the valid points that were made about the importance o f a proper appraisal o f hypodontia were lost in the confusion o f the paper as a whole. It is true that genetic factors are more important than environmental factors in causing hypodontia, but the genetic basis for this condition has not been proved. Phrases such as “ broad spectrum of cultural significance” and “ social and man-made environmental overlay on the evolutionary process” are mean­ ingless. . . . The meaning o f “ consis­ tent variation in the arrangement of missing dental units, when correlated to the total number o f teeth congeni­ tally absent, might imply different ge­ netic mechanisms as etiologic factors

978 ■ LETTERS TO THE EDITOR / JADA, Vol. 96, June 1978

for the variable tooth loss patterns” is unclear after several dozen readings. The statement that “ the data is insuf­ ficient to support a ‘sex-linkage’ in any o f the other hypothesized transmis­ sion m echanism s” is equally unclear. It appears that ‘sex-linkage’ may be referring to sex-limitation or sexinfluence, but again, this is not clear after several readings. . . . A lso, I question the meaning o f the phrase “ high penetrance o f first generation inheritance (as it) appears to eliminate a polygenic hypothesis.” I cannot understand why the dental clinician would have a difficult time in establishing a pattern o f inheritance for patients with hypodontia that is a manifestation o f a multiple system syndrome. If hypodontia is consistent, a pattern o f inheritance is apparent whether or not the dentist recognizes associated defects. RONALD J. JORGENSON, DDS CHARLESTON, SC

■ AH the genes that participate in den­ tal development have not been iden­ tified, nor are they likely to be in the near future. Thus, there is no evidence that they are “ closely linked” as Dr. Graber says, and no evidence to dis­ tinguish point mutations from frameshift mutations. Such knowledge will com e only after biochemical characterization o f the relevant gene products. Furthermore, to consider dysmorphogenesis as a polygenic trait obfuscates the significance of single gene regulation in embryogenesis and adds nothing to our understanding of the dysmorphogenetic event itself. . . . The entire paper can best be described as naive and unacceptable to those familiar with oral-facial genet­ ics. MICHAEL MELNICK, DDS, PhD L. STEFAN LEVIN, DDS, MSD NATIONAL INSTITUTES OF HEALTH BETHESDA, MD

W eath erbea ten w idow s m In response to Dr. Futterman’s criticism ( The Journal, April), it seem s to me that w ido w provides suit­ able and not necessarily gratuitous in-