OOOO Volume 117, Number 2
5. 6. 7. 8. 9. 10. 11. 12.
13. 14. 15.
of Oral Surgeons. Copenhagen, Denmark: Munksgaard; 1967: 120-127. Philipsen HP, Birn H. The adenomatoid odontogenic tumour. Ameloblastic adenomatoid tumour or adeno-ameloblastoma. Acta Pathol Microbiol Scand. 1969;75:375-398. Pindborg JJ, Kramer IRH. Histological Typing of Odontogenic Tumours, Jaw Cysts, and Allied Lesions. Geneva, Switzerland: World Health Organization; 1971;5::12-13:27-28, Courtney RM, Kerr DA. The odontogenic adenomatoid tumor: a comprehensive study of twenty new cases. Oral Surg Oral Med Oral Pathol. 1975;39:424-435. Tsaknis PJ, Carpenter WM, Shade NL. Odontogenic adenomatoid tumor: report of case and review of the literature. J Oral Surg. 1977;35:146-149. Stroncek GG, Acevedo A, Higa LH. An atypical odontogenic adenomatoid tumor and review of the literature. J Oral Med. 1981;36:102-105. Precious DS, Delaire J, Wright BA, Landry P. Odontogenic adenomatoid tumor. Rev Stomatol Chir Maxillofac. 1984;85:472476 [in French]. Carr RF, Foster LD, Gilliam CH, Evans G. Odontogenic adenomatoid tumors associated with orthodontic treatment. Am J Orthod Dentofac Orthop. 1995;107:648-650. Ribeiro BF, Iglesias DPP, Nascimento GJF, Galvao HC, Medeiros AMC, Freitas RA. Immunoexpression of MMPs-1, -2, and -9 in ameloblastoma and odontogenic adenomatoid tumor. Oral Dis. 2009;15:472-477. Melrose RJ. Benign epithelial odontogenic tumors. Semin Diagn Pathol. 1999;16:271-287. Ide F. Unicystic ameloblastoma: a case of mistaken identity. Am J Orthod Dentofac Orthop. 2010;138:684-685. Ide F, Mishima K, Kikuchi K, et al. Development and growth of adenomatoid odontogenic tumor related to formation and eruption of teeth. Head Neck Pathol. 2011;5:123-132.
http://dx.doi.org/10.1016/j.oooo.2013.06.040
Professional relationships “True relations have the most unique character, like salt. Their presence is never remembered, but their absence makes all things tasteless.”
dAnonymous We were pleased to read the editorial “Relationships and our profession”1 by Dr Craig S. Miller, Editor, Oral Medicine Section, published in the Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology February 2013 issue. It was inspiring to see a leading international specialty journal emphasizing relationships and friendships at the interdisciplinary level. We would like to congratulate Dr Miller for highlighting this issue in an editorial published at the right time, in the right place, for the right reason. His words could not have come at a better time, because advancements in many areas of general and oral medicine have been occurring rapidly, and we professionals, in trying to keep up with these changes, occasionally neglect the human side. It is usually the “I, me, and myself” mindset that is key to interpersonal divisions. Every department works toward its own goals, thereby undermining the concept of departmental interdependence. The success of any treatment is determined by cordial relationships between
LETTERS TO THE EDITOR
255
departments. Very often, in the name of progress, we tend to leave our colleagues behind, often hurting them unintentionally. As Dr Miller so rightly says, “friendship flourishes on common interests”; the various disciplines in dentistry should share common interests for the cultivation of mutual bonds that will grow stronger with time. Dr Miller aptly advocates providing a common platform for building relationships. We were glad to know that the American Academy of Oral Medicine is planning a joint meeting with the American Academy of Oral and Maxillofacial Pathology in 2015. We in India have an annual symposium of Oral Medicine, Oral Surgery, and Oral Pathology, with the aim of cementing the ties among the faculties. This is the 11th year of this collaboration, which perennially provides an excellent stage to exchange views and encourage healthy relationships.2 There is no doubt that each faculty has progressed individually, but today we need the 3 faculties to progress as one. These symposia are a step ahead in the task of establishing a harmonious relationship between the 3 faculties. This task of achieving healthy relationships is not an easy one, but we are already making advances in the right direction. We would also like to point out that we need to put the larger vision ahead of our personal interests, and that this goal must be backed by design of a policy for undergraduate and postgraduate teaching that is in alignment with fostering strong human relationships, both for the development of the profession and in the best interests of our patients, who are our ultimate professional concern. It is very prudent to have an amicable atmosphere in which to develop trust and respect, which are important aspects of any relationship. Hence we would differ from the old adage of “give and take” and modify it according to the current scenario as “give and get.” With this in mind, we would like to end with the words of Henry Ford: “Coming together is a beginning; keeping together is progress; working together is success.” Pankaj M. Shirsat, MDS Assistant Professor Pooja S. Prasad, MDS Assistant Professor Shivani Bansal, MDS Associate Professor Rajiv S. Desai, MDS Professor and Department Head Department of Oral Pathology, Nair Hospital Dental College, Mumbai, Maharashtra, India REFERENCES 1. Miller CS. Relationships and our profession [editorial]. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:147.
LETTERS TO THE EDITOR
256
OOOO February 2014
2. Indian Academy of Oral Medicine and Radiology. The 11th National Triple “O” Symposium 2013. Available at http://www. tripleo2013.com
usefulness of jaw tracking devices in dental practices that diagnose and manage temporomandibular disorders”!
http://dx.doi.org/10.1016/j.oooo.2013.07.022
(2) Even if the authors’ study design were valid, they would not have been able to reach a meaningful scientific conclusion, simply because the K6 instrument used in this study, purchased in January 1992, has never been calibrated. The K6 was announced to owners as requiring calibration every 3 years. Myotronics and its Italian distributor have no record of calibration or of any type of service since the instrument was purchased 21 years ago. The authors described the K6 as “a commercially available device,” even though the K6 was discontinued and replaced by the K7 in 2001. Interestingly, lack of calibration of this device is evidenced in Figure 3 of the article. When such a pattern is obtained, the device is nearly always in need of calibration or its sensor array is not placed symmetrically on the patient’s face. This is another example of the authors’ lack of understanding of our technology, at best, or their intentional disregard of our device’s instructions for use, at worst. (3) The authors created an imaginary and false performance standard and subjected the measurement equipment to tests based on their own test standard. It is no surprise that the authors have concluded that the measurement equipment has failed to meet the test standard! (4) The title of the article by Manfredini et al. is misleading, because it was selected to include a Myotronics device’s trade name, to imply farreaching conclusions regarding the “usefulness” of the device, and to provide a convenient reference for future anti-instrumentation authors, evident in the references, to perpetuate their campaign to undermine the value of diagnostic aid devices. Again, the authors’ use of the K6 device was grossly contrary to the device’s indications for use. (5) If the authors’ objective was to undertake a legitimate study of joint function, it is puzzling why our electrosonogram joint vibration measurement device was not used. Even an electrosonogram device cannot classify TMJ dysfunction in the narrow categories diagnosed by the authors.
The study by Manfredini et al. used the Myotronics K6 device contrary to the device’s published indications for use In the article by Manfredini et al. titled “Kinesiographic recordings of jaw movements are not accurate to detect magnetic resonance-diagnosed temporomandibular joint (TMJ) effusion and disk displacement: findings from a validation study,”1 the authors used a K6 device manufactured by Myotronics Inc (Kent, WA, USA) to record the jaw movement of 31 patients with temporomandibular disorders (TMDs). The authors then “interpreted” the “jaw movement” recordings and reached conclusions not only in the differentiation of a normal joint from an abnormal joint but also in the further classification of the abnormal joint group into subgroups of DDR (disk displacement with reduction), DDNR (disk displacement without reduction), and effusion. In short, the study by Manfredini et al. fails to meet the most minimum standards for acceptable science and peer-reviewed publication. Specific points are discussed in the following paragraphs. (1) The study’s design is flawed, and its conclusions are false and misleading, because the authors used the K6 jaw tracking device in a manner grossly contrary to the manufacturer’s published indications for use to reach diagnosis and specific classification of TMJ disease. Myotronics Inc (myotronics.com) has not promoted the use of its jaw tracking devices to diagnose joint disease, nor are we aware of a dentist who uses the information obtained from a jaw tracking device for such a purpose. Indications for use are clearly documented in the device’s promotional literature and on our website. To design and publish a study that is grossly contrary to a device’s intended use, to reach a conclusion regarding the clinical usefulness of the device, can be explained only by the authors’ political agenda to intentionally disparage the product and deceptively deny its valid utility in a dental practice. Incredibly, the authors compared the sensitivity and specificity of their arbitrarily and inaccurately reached diagnosis from their interpretation of jaw tracking measurements to the diagnosis reached from the magnetic resonance imaging data obtained from the patients and concluded as follows: “The findings do not support the
Dr Manfredini, the leading author of this article, is a recognized proponent of psychosocial model of TMD and has been publishing against the use of occlusal evaluation devices as aids in the assessment of TMD. Dr Manfredini has been using the same 21-year-old, noncalibrated device to publish articles that attack the valid utility of Myotronics devices since as early as 2007.2 He is the editor and a principal coauthor of the book Current Concepts on
5. 6. 7. 8. 9. 10. 11. 12.
13. 14. 15.
of Oral Surgeons. Copenhagen, Denmark: Munksgaard; 1967: 120-127. Philipsen HP, Birn H. The adenomatoid odontogenic tumour. Ameloblastic adenomatoid tumour or adeno-ameloblastoma. Acta Pathol Microbiol Scand. 1969;75:375-398. Pindborg JJ, Kramer IRH. Histological Typing of Odontogenic Tumours, Jaw Cysts, and Allied Lesions. Geneva, Switzerland: World Health Organization; 1971;5::12-13:27-28, Courtney RM, Kerr DA. The odontogenic adenomatoid tumor: a comprehensive study of twenty new cases. Oral Surg Oral Med Oral Pathol. 1975;39:424-435. Tsaknis PJ, Carpenter WM, Shade NL. Odontogenic adenomatoid tumor: report of case and review of the literature. J Oral Surg. 1977;35:146-149. Stroncek GG, Acevedo A, Higa LH. An atypical odontogenic adenomatoid tumor and review of the literature. J Oral Med. 1981;36:102-105. Precious DS, Delaire J, Wright BA, Landry P. Odontogenic adenomatoid tumor. Rev Stomatol Chir Maxillofac. 1984;85:472476 [in French]. Carr RF, Foster LD, Gilliam CH, Evans G. Odontogenic adenomatoid tumors associated with orthodontic treatment. Am J Orthod Dentofac Orthop. 1995;107:648-650. Ribeiro BF, Iglesias DPP, Nascimento GJF, Galvao HC, Medeiros AMC, Freitas RA. Immunoexpression of MMPs-1, -2, and -9 in ameloblastoma and odontogenic adenomatoid tumor. Oral Dis. 2009;15:472-477. Melrose RJ. Benign epithelial odontogenic tumors. Semin Diagn Pathol. 1999;16:271-287. Ide F. Unicystic ameloblastoma: a case of mistaken identity. Am J Orthod Dentofac Orthop. 2010;138:684-685. Ide F, Mishima K, Kikuchi K, et al. Development and growth of adenomatoid odontogenic tumor related to formation and eruption of teeth. Head Neck Pathol. 2011;5:123-132.
http://dx.doi.org/10.1016/j.oooo.2013.06.040
Professional relationships “True relations have the most unique character, like salt. Their presence is never remembered, but their absence makes all things tasteless.”
dAnonymous We were pleased to read the editorial “Relationships and our profession”1 by Dr Craig S. Miller, Editor, Oral Medicine Section, published in the Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology February 2013 issue. It was inspiring to see a leading international specialty journal emphasizing relationships and friendships at the interdisciplinary level. We would like to congratulate Dr Miller for highlighting this issue in an editorial published at the right time, in the right place, for the right reason. His words could not have come at a better time, because advancements in many areas of general and oral medicine have been occurring rapidly, and we professionals, in trying to keep up with these changes, occasionally neglect the human side. It is usually the “I, me, and myself” mindset that is key to interpersonal divisions. Every department works toward its own goals, thereby undermining the concept of departmental interdependence. The success of any treatment is determined by cordial relationships between
LETTERS TO THE EDITOR
255
departments. Very often, in the name of progress, we tend to leave our colleagues behind, often hurting them unintentionally. As Dr Miller so rightly says, “friendship flourishes on common interests”; the various disciplines in dentistry should share common interests for the cultivation of mutual bonds that will grow stronger with time. Dr Miller aptly advocates providing a common platform for building relationships. We were glad to know that the American Academy of Oral Medicine is planning a joint meeting with the American Academy of Oral and Maxillofacial Pathology in 2015. We in India have an annual symposium of Oral Medicine, Oral Surgery, and Oral Pathology, with the aim of cementing the ties among the faculties. This is the 11th year of this collaboration, which perennially provides an excellent stage to exchange views and encourage healthy relationships.2 There is no doubt that each faculty has progressed individually, but today we need the 3 faculties to progress as one. These symposia are a step ahead in the task of establishing a harmonious relationship between the 3 faculties. This task of achieving healthy relationships is not an easy one, but we are already making advances in the right direction. We would also like to point out that we need to put the larger vision ahead of our personal interests, and that this goal must be backed by design of a policy for undergraduate and postgraduate teaching that is in alignment with fostering strong human relationships, both for the development of the profession and in the best interests of our patients, who are our ultimate professional concern. It is very prudent to have an amicable atmosphere in which to develop trust and respect, which are important aspects of any relationship. Hence we would differ from the old adage of “give and take” and modify it according to the current scenario as “give and get.” With this in mind, we would like to end with the words of Henry Ford: “Coming together is a beginning; keeping together is progress; working together is success.” Pankaj M. Shirsat, MDS Assistant Professor Pooja S. Prasad, MDS Assistant Professor Shivani Bansal, MDS Associate Professor Rajiv S. Desai, MDS Professor and Department Head Department of Oral Pathology, Nair Hospital Dental College, Mumbai, Maharashtra, India REFERENCES 1. Miller CS. Relationships and our profession [editorial]. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:147.
LETTERS TO THE EDITOR
256
OOOO February 2014
2. Indian Academy of Oral Medicine and Radiology. The 11th National Triple “O” Symposium 2013. Available at http://www. tripleo2013.com
usefulness of jaw tracking devices in dental practices that diagnose and manage temporomandibular disorders”!
http://dx.doi.org/10.1016/j.oooo.2013.07.022
(2) Even if the authors’ study design were valid, they would not have been able to reach a meaningful scientific conclusion, simply because the K6 instrument used in this study, purchased in January 1992, has never been calibrated. The K6 was announced to owners as requiring calibration every 3 years. Myotronics and its Italian distributor have no record of calibration or of any type of service since the instrument was purchased 21 years ago. The authors described the K6 as “a commercially available device,” even though the K6 was discontinued and replaced by the K7 in 2001. Interestingly, lack of calibration of this device is evidenced in Figure 3 of the article. When such a pattern is obtained, the device is nearly always in need of calibration or its sensor array is not placed symmetrically on the patient’s face. This is another example of the authors’ lack of understanding of our technology, at best, or their intentional disregard of our device’s instructions for use, at worst. (3) The authors created an imaginary and false performance standard and subjected the measurement equipment to tests based on their own test standard. It is no surprise that the authors have concluded that the measurement equipment has failed to meet the test standard! (4) The title of the article by Manfredini et al. is misleading, because it was selected to include a Myotronics device’s trade name, to imply farreaching conclusions regarding the “usefulness” of the device, and to provide a convenient reference for future anti-instrumentation authors, evident in the references, to perpetuate their campaign to undermine the value of diagnostic aid devices. Again, the authors’ use of the K6 device was grossly contrary to the device’s indications for use. (5) If the authors’ objective was to undertake a legitimate study of joint function, it is puzzling why our electrosonogram joint vibration measurement device was not used. Even an electrosonogram device cannot classify TMJ dysfunction in the narrow categories diagnosed by the authors.
The study by Manfredini et al. used the Myotronics K6 device contrary to the device’s published indications for use In the article by Manfredini et al. titled “Kinesiographic recordings of jaw movements are not accurate to detect magnetic resonance-diagnosed temporomandibular joint (TMJ) effusion and disk displacement: findings from a validation study,”1 the authors used a K6 device manufactured by Myotronics Inc (Kent, WA, USA) to record the jaw movement of 31 patients with temporomandibular disorders (TMDs). The authors then “interpreted” the “jaw movement” recordings and reached conclusions not only in the differentiation of a normal joint from an abnormal joint but also in the further classification of the abnormal joint group into subgroups of DDR (disk displacement with reduction), DDNR (disk displacement without reduction), and effusion. In short, the study by Manfredini et al. fails to meet the most minimum standards for acceptable science and peer-reviewed publication. Specific points are discussed in the following paragraphs. (1) The study’s design is flawed, and its conclusions are false and misleading, because the authors used the K6 jaw tracking device in a manner grossly contrary to the manufacturer’s published indications for use to reach diagnosis and specific classification of TMJ disease. Myotronics Inc (myotronics.com) has not promoted the use of its jaw tracking devices to diagnose joint disease, nor are we aware of a dentist who uses the information obtained from a jaw tracking device for such a purpose. Indications for use are clearly documented in the device’s promotional literature and on our website. To design and publish a study that is grossly contrary to a device’s intended use, to reach a conclusion regarding the clinical usefulness of the device, can be explained only by the authors’ political agenda to intentionally disparage the product and deceptively deny its valid utility in a dental practice. Incredibly, the authors compared the sensitivity and specificity of their arbitrarily and inaccurately reached diagnosis from their interpretation of jaw tracking measurements to the diagnosis reached from the magnetic resonance imaging data obtained from the patients and concluded as follows: “The findings do not support the
Dr Manfredini, the leading author of this article, is a recognized proponent of psychosocial model of TMD and has been publishing against the use of occlusal evaluation devices as aids in the assessment of TMD. Dr Manfredini has been using the same 21-year-old, noncalibrated device to publish articles that attack the valid utility of Myotronics devices since as early as 2007.2 He is the editor and a principal coauthor of the book Current Concepts on
