LETTERS TO THE EDITOR Neurotoxic causation of paresthesia

lapse, it would be helpful if the samples were separated along these lines, and both groups were considered individually. Thank you. Jack Einhorn, DDS Brooklyn, N.Y.

To the Editor:

I recently published an article demonstrating the neurotoxic causation of paresthesia for the first time. Oral surgeons have been heavily litigated regarding this subject, and it appears it was an unexpected neurotoxicity of local anesthetic metabolites. A recent 2-year study has reduced the complication by 87% in my practice by changing the local anesthetic usage. I hope you can share this information with your orthodontic colleagues because (1) they may experience paresthesia complications with patients referred to oral surgeons and (2) paresthesia is not a matter for litigation and is a classic case of overrationalization without substance, resulting in many hurt professionals and their pocketbooks. I hope this scenario does not develop in your field of orthodontics. Alfred A. Nickel, DDS, MS Danville, CA 94526

Recommendation for postretention study To the Editor:

The University of Washington group is to be commended for their rigorously designed and objective research, conducted over the years, regarding postorthodontic relapse of lower anterior crowding. (Mandibular Arch Length During the Mixed Dentition. Little, Riedel, and Stein, [AM J ORTHOO DENTOFAC ORTHOP 1990;97:393-404]). The only objection that could be raised is that the samples studied have all been treated by graduates or associates of the orthodontic program of the University of Washington (or so I assume) and that they may have a specific treatment bias. In their findings, they do not differentiate between patients who have been treated with fixed as opposed to functional appliances. The believers in functional treatment have long claimed greater stability with their long-term archgaining efforts as opposed to fixed treatment. I therefore propose an objective 10-year postretention study, along the guidelines of the University of Washington group's studies, to be carried out on the patients of such eminent, functionally oriented clinicians as Drs. Rolf Fr&nkel and Norman Cetlin. With these patient pools, any question of the incorrect use of their appliances and theories should be factored out. In addition, since there is a belief that deep bite, low mandibular plane angle Class II, Division 1 and Class II, Division 2 cases do not behave as other malocclusions do when it comes to posttreatment lower anterior re-

Orthodontics and TMJ disorders To the Editor:

I am compelled to respond to Dr. Reynders "Review of the Literature" article entitled "Orthodontics and Temporomandibular Joint Disorders" that appeared in the June 1990 issue of the AM J ORTHODDENTOFACORTHOP. It is unfortunate that the profession continues to be burdened with material of this nature under the guise of serious scientific investigation. The author has conducted a study with a thinly veiled, predetermined conclusion involving four interrelated objectives: 1. To substantiate the denial of any relationship between temporomandibular joint disorders and dental malocclusion. 2. To attempt to dissociate orthodontic treatment, in general, from having a causal relationship to TMJ disorders. 3. To exonerate the traditionally oriented orthodontic community employing fixed appliances and retraction therapy from the charges of iatrogenically creating TMJ disorders. 4. To discredit authors whose writings and clinical experiences claim (a) a strong relation between TMJ disorders and dental malocclusion, (b) stable orthodontic results with enhanced facial and dental cosmetics and no untoward TMJ by-products resulting from their treatments, (c) routine success in the elimination of TMJ disorders by means of their "physiologic" approach to treatment, and (d) that the extraction of teeth and retractive orthodontic methods commonly employed in the treatment of dental malocclusion are primary causes of TMJ disorders. Dr. Reynders, a former research associate and clinical instructor in the Department of Orthodontics of Northwestern University, has divided 91 publications from 1966 through 1988 that are concerned with the relationship of orthodontics to temporomandibular joint disorders into three basic categories--viewpoint publications, case reports, and sample studies. Of the 91 publications, 55 are classified as viewpoint publications, a group that is discounted by the author as being unworthy of serious consideration, essentially because of an alleged lack of controls. I believe it is no accident that most of the viewpoint group is comprised of authors who hold conventional treatment to be re21A

Recommendation for postretention study.

LETTERS TO THE EDITOR Neurotoxic causation of paresthesia lapse, it would be helpful if the samples were separated along these lines, and both groups...
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