COMMENTARIES
reader to hunt for articles on similar or related topics in the MEDLINE database, but with the ability to narrow the search in just a couple of clicks, saving time and avoiding frustration. The search is conducted in a new window so that the reader never leaves the article page and can go right back to reading without any trouble. Readers can also save searches and bookmark them for later use. You’ll find ADA Precision Search in the right-hand naviga-
tion bar of every online article, right above Google Scholar and PubMed. Another new online feature is the ability to download any illustration or table from a JADA article for use in lectures or presentations, at no charge to the member or subscriber. This feature is in response primarily to the many faculty members and educators who use JADA as a teaching tool and appreciate the use of the data and excellent illustrations. The next century will continue to
LETTERS
J
ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within two months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. You may submit your letter via e-mail to [email protected]; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. 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.
LADMARK ARTICLE LAUDED
DENTISTS AND VACCINATIONS
I wish to compliment Dr. William Bowen for his excellent July JADA article, “Pointing the Way to Better Oral Health” (JADA 2013;144[7]:774-778). This was written under the JADA Landmark Series, denoting critical junctures of our history over the past 100 years. The author depicts certain individuals who were the best of us and whose altruism and constant research during the fluoridefluoridation controversy must not be forgotten. He wisely concludes that “the optimum use of fluoride in prevention of dental caries remains an elusive goal.”
On the surface, dentists giving vaccinations seems like a logical thing for them to do. However, looking beneath the surface, the procedure is a bit more involved. Papadakis and colleagues’ book titled Current Medical Diagnosis & Treatment 2013 provides helpful information on recommended immunization for dentists who decide to give shots to children or adults, including pregnant women.1 For example, the dentist would need to track down the patient’s history of previous vaccinations. The dentist then would need to convince a patient that the patient needs certain immunizations and that he or she is as qualified as the pa-
Jack M. Saroyan, DDS San Francisco
JADA 145(1)
bring a whirlwind of change in how we receive and consume information. The editors and publishers of JADA stand ready to anticipate and meet the changing demands of dentists everywhere, as we have for the last 100 years. We welcome your comments and suggestions. Q doi:10.14219.jada.2013.18 1. Pihlstrom BL, Glick M. A century of progress. JADA 2013;144(1):14-16.
tients’ physicians to administer them. In a physician’s office, nurses give the shots. That way the unpleasant procedure is associated with the nurse, not the doctor. In the dental office, the dentist would give the shots. Do dentists need another unpleasant procedure to associate with dentistry? Side effects are usually few, but patients will remember sore arms, fever and feeling out of sorts. Of course, there will always be that one patient who will experience an unusual reaction. Different needles and syringes will be needed. The payment will involve medical insurance and Medicare claims. Some vaccines are expensive. All vaccines have a shelf life. Since they are purchased only as needed, the patient would need to schedule another office visit to get the shot. Is $20 or $25 for a flu shot worth the vaccine, supplies, time, clean up and billing involved? When everything is considered, giving immunization shots is not something most dentists would be interested in doing, or so it seems to me. W. Braden Speer, DDS, MSD Dallas 1. Papadakis MA, McPhee SJ, Rabow MW. Current Medical Diagnosis & Treatment 2013. 52nd ed. New York City: McGraw-Hill Medical; 2013:1307.
SMOKELESS TOBACCO
I am writing regarding Dr. R. Constance Wiener’s August JADA article, “Association of Smokeless Tobacco http://jada.ada.org
January 2014
17
COMMENTARIES
Use and Smoking in Adolescents in the United States: An Analysis of Data From the Youth Risk Behavior Surveillance System Survey, 2011” (JADA 2013;144[8]:930-938). Our fascination with baseball reaches its zenith with the World Series. Millions of young fans follow their teams’ ups and downs to reach a final showdown for the championship. The great American pastime has its drama and its quirks. The knuckle-ball pitcher is probably the quirkiest and most unique of players, but the ubiquitous and incessant spitting by almost all players is the most disgusting quirk. The spraying of saliva gets rid of the vile juices generated by the chew. Imagine how interesting and slippery a Celtics or Knicks basketball game could be if the amount of spitting matched that of baseball? On a more serious note, the spitting in baseball probably is connected to the historical use of chewing tobacco by professional ballplayers. The association of baseball playing with tobacco use goes back a long time, as evidenced by the 1909 Honus Wagner baseball card issued by the American Tobacco Co. So the news for baseball is that the spitball is no longer allowed and that chewing tobacco is addictive and has been linked to oral cancer. When Little Leaguers come to my office wearing their uniforms, there will be jokes about spitting and baseball. In my experience, what you will learn when your child starts playing is that sunflower seeds now are a learning tool that has been provided to start them on the road to becoming competent spitters. If there is such a thing as a “gateway spitter,” the sunflower seed is the gateway to chewing tobacco. It provides the connection to the great history of baseball so that batting mechanics and spitting mechanics get ingrained in our early youth. A former college player whom I treated in the 1990s was an investment banker with four children who admitted to chewing tobacco and 18
JADA 145(1)
http://jada.ada.org
admitted to an inability to quit the addictive nicotine delivery device in spite of repeated warnings regarding cancer risks. The ADA shouldn’t advocate a ban on sunflower seeds, but perhaps the connection between baseball and spitting could start to be broken. Would parents smile and cheer for their Little League players if the coach regularly handed out candy cigarettes in the dugout? Joseph Boccuzzi, DMD, MBA Trumbull, Conn.
Author’s response: I wish to thank Dr. Boccuzzi for addressing the idea of role models being factors in tobacco-use initiation. Substance use normalization is a public health issue.1 Dr. Boccuzzi correctly states that smokeless tobacco is connected historically to baseball. Professional baseball players are role models for many children, and smokeless tobacco use in professional baseball players is higher than in men in the general public.2 Professional baseball players had heavy marketing campaigns aimed at them for smokeless tobacco use, and their smokeless tobacco use has been high and unchanged from 1998 (35.9 percent) to 2003 (36 percent).2 Focus groups of boys and men who use smokeless tobacco indicated that they were influenced to use smokeless tobacco to emulate current smokeless tobacco users.3 Parents, coaches and health care professionals need to work together to encourage youth not to initiate smokeless tobacco use despite role model usage, marketing campaigns and peer pressure. R. Constance Wiener, DMD, PhD Department of Dental Practice and Rural Health Department of Epidemiology West Virginia University Health Sciences Center Morgantown 1. Sznitman SR, Kolobov T, Bogt TT, et al. Exploring substance use normalization among adolescents: a multilevel study in 35 countries (published online ahead of print Sept. 6, 2013). Soc Sci Med 2013;97:143-151. doi:10.1016/j.socscimed. 2013.08.038.
January 2014
2. Severson HH, Klein K, Lichtensein E, Kaufman N, Orleans CT. Smokeless tobacco use among professional baseball players: survey results, 1998-2003. Tob Control 2005;14(1):31-36. 3. Nemeth JM, Liu ST, Klein EG, Ferketich AK, Kwan MP, Wewers ME. Factors influencing smokeless tobacco use in rural Ohio Appalachia. J Community Health 2012;37(6):1208-1217.
BURNING MOUTH
We have read with great interest and would like to take this opportunity to discuss Dr. Gary Klasser and colleagues’ October 2013 article, “Defining and Diagnosing Burning Mouth Syndrome: Perceptions of Directors of North American Postgraduate Oral Medicine and Orofacial Pain Programs” (Klasser GD, Pinto A, Czyscon JM, Cramer CK, Epstein J. JADA 2013;144[10]:1135-1142). The criteria for establishing a diagnosis of “true” burning mouth syndrome (BMS) is the presence of a burning sensation on clinically healthy oral mucosa in the absence of all known local and systemic etiologic factors. However, the situation can get worse for clinicians when primary/idiopathic BMS is present in a setting of known conditions having burning sensation. Such BMS is called “complicated BMS.”1 In an Indian scenario, patients with oral submucous fibrosis (OSMF), a potentially malignant disorder2 characterized by oral epithelial atrophy leading to a burning sensation,3 routinely are seen in day-to-day practice. Often clinicians get carried away with the clinical findings and do not take a detailed history of the burning sensation, which could lead to an underdiagnosis of the conditions. We came across three patients with OSMF who were diagnosed with concomitant primary BMS. There was no evidence of ulceration, erosion, mucositis or any pathology on oral mucosa. The first patient with OSMF was diagnosed with BMS at the second visit, as we had failed to ask in detail about the burning sensation at the first visit. During the second visit, the patient revealed having a continuous burning sensation throughout the day. The burning sensation
reader to hunt for articles on similar or related topics in the MEDLINE database, but with the ability to narrow the search in just a couple of clicks, saving time and avoiding frustration. The search is conducted in a new window so that the reader never leaves the article page and can go right back to reading without any trouble. Readers can also save searches and bookmark them for later use. You’ll find ADA Precision Search in the right-hand naviga-
tion bar of every online article, right above Google Scholar and PubMed. Another new online feature is the ability to download any illustration or table from a JADA article for use in lectures or presentations, at no charge to the member or subscriber. This feature is in response primarily to the many faculty members and educators who use JADA as a teaching tool and appreciate the use of the data and excellent illustrations. The next century will continue to
LETTERS
J
ADA welcomes letters from readers on articles that have appeared in The Journal. The Journal reserves the right to edit all communications and requires that all letters be signed. Letters must be no more than 550 words and must cite no more than five references. No illustrations will be accepted. A letter concerning a recent JADA article will have the best chance of acceptance if it is received within two months of the article’s publication. For instance, a letter about an article that appeared in April JADA usually will be considered for acceptance only until the end of June. You may submit your letter via e-mail to [email protected]; by fax to 1-312-440-3538; or by mail to 211 E. Chicago Ave., Chicago, Ill. 60611-2678. By sending a letter to the editor, the author acknowledges and agrees that the letter and all rights of the author in the letter sent become the property of The Journal. Letter writers are asked to disclose any personal or professional affiliations or conflicts of interest that readers may wish to take into consideration in assessing their stated opinions. 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.
LADMARK ARTICLE LAUDED
DENTISTS AND VACCINATIONS
I wish to compliment Dr. William Bowen for his excellent July JADA article, “Pointing the Way to Better Oral Health” (JADA 2013;144[7]:774-778). This was written under the JADA Landmark Series, denoting critical junctures of our history over the past 100 years. The author depicts certain individuals who were the best of us and whose altruism and constant research during the fluoridefluoridation controversy must not be forgotten. He wisely concludes that “the optimum use of fluoride in prevention of dental caries remains an elusive goal.”
On the surface, dentists giving vaccinations seems like a logical thing for them to do. However, looking beneath the surface, the procedure is a bit more involved. Papadakis and colleagues’ book titled Current Medical Diagnosis & Treatment 2013 provides helpful information on recommended immunization for dentists who decide to give shots to children or adults, including pregnant women.1 For example, the dentist would need to track down the patient’s history of previous vaccinations. The dentist then would need to convince a patient that the patient needs certain immunizations and that he or she is as qualified as the pa-
Jack M. Saroyan, DDS San Francisco
JADA 145(1)
bring a whirlwind of change in how we receive and consume information. The editors and publishers of JADA stand ready to anticipate and meet the changing demands of dentists everywhere, as we have for the last 100 years. We welcome your comments and suggestions. Q doi:10.14219.jada.2013.18 1. Pihlstrom BL, Glick M. A century of progress. JADA 2013;144(1):14-16.
tients’ physicians to administer them. In a physician’s office, nurses give the shots. That way the unpleasant procedure is associated with the nurse, not the doctor. In the dental office, the dentist would give the shots. Do dentists need another unpleasant procedure to associate with dentistry? Side effects are usually few, but patients will remember sore arms, fever and feeling out of sorts. Of course, there will always be that one patient who will experience an unusual reaction. Different needles and syringes will be needed. The payment will involve medical insurance and Medicare claims. Some vaccines are expensive. All vaccines have a shelf life. Since they are purchased only as needed, the patient would need to schedule another office visit to get the shot. Is $20 or $25 for a flu shot worth the vaccine, supplies, time, clean up and billing involved? When everything is considered, giving immunization shots is not something most dentists would be interested in doing, or so it seems to me. W. Braden Speer, DDS, MSD Dallas 1. Papadakis MA, McPhee SJ, Rabow MW. Current Medical Diagnosis & Treatment 2013. 52nd ed. New York City: McGraw-Hill Medical; 2013:1307.
SMOKELESS TOBACCO
I am writing regarding Dr. R. Constance Wiener’s August JADA article, “Association of Smokeless Tobacco http://jada.ada.org
January 2014
17
COMMENTARIES
Use and Smoking in Adolescents in the United States: An Analysis of Data From the Youth Risk Behavior Surveillance System Survey, 2011” (JADA 2013;144[8]:930-938). Our fascination with baseball reaches its zenith with the World Series. Millions of young fans follow their teams’ ups and downs to reach a final showdown for the championship. The great American pastime has its drama and its quirks. The knuckle-ball pitcher is probably the quirkiest and most unique of players, but the ubiquitous and incessant spitting by almost all players is the most disgusting quirk. The spraying of saliva gets rid of the vile juices generated by the chew. Imagine how interesting and slippery a Celtics or Knicks basketball game could be if the amount of spitting matched that of baseball? On a more serious note, the spitting in baseball probably is connected to the historical use of chewing tobacco by professional ballplayers. The association of baseball playing with tobacco use goes back a long time, as evidenced by the 1909 Honus Wagner baseball card issued by the American Tobacco Co. So the news for baseball is that the spitball is no longer allowed and that chewing tobacco is addictive and has been linked to oral cancer. When Little Leaguers come to my office wearing their uniforms, there will be jokes about spitting and baseball. In my experience, what you will learn when your child starts playing is that sunflower seeds now are a learning tool that has been provided to start them on the road to becoming competent spitters. If there is such a thing as a “gateway spitter,” the sunflower seed is the gateway to chewing tobacco. It provides the connection to the great history of baseball so that batting mechanics and spitting mechanics get ingrained in our early youth. A former college player whom I treated in the 1990s was an investment banker with four children who admitted to chewing tobacco and 18
JADA 145(1)
http://jada.ada.org
admitted to an inability to quit the addictive nicotine delivery device in spite of repeated warnings regarding cancer risks. The ADA shouldn’t advocate a ban on sunflower seeds, but perhaps the connection between baseball and spitting could start to be broken. Would parents smile and cheer for their Little League players if the coach regularly handed out candy cigarettes in the dugout? Joseph Boccuzzi, DMD, MBA Trumbull, Conn.
Author’s response: I wish to thank Dr. Boccuzzi for addressing the idea of role models being factors in tobacco-use initiation. Substance use normalization is a public health issue.1 Dr. Boccuzzi correctly states that smokeless tobacco is connected historically to baseball. Professional baseball players are role models for many children, and smokeless tobacco use in professional baseball players is higher than in men in the general public.2 Professional baseball players had heavy marketing campaigns aimed at them for smokeless tobacco use, and their smokeless tobacco use has been high and unchanged from 1998 (35.9 percent) to 2003 (36 percent).2 Focus groups of boys and men who use smokeless tobacco indicated that they were influenced to use smokeless tobacco to emulate current smokeless tobacco users.3 Parents, coaches and health care professionals need to work together to encourage youth not to initiate smokeless tobacco use despite role model usage, marketing campaigns and peer pressure. R. Constance Wiener, DMD, PhD Department of Dental Practice and Rural Health Department of Epidemiology West Virginia University Health Sciences Center Morgantown 1. Sznitman SR, Kolobov T, Bogt TT, et al. Exploring substance use normalization among adolescents: a multilevel study in 35 countries (published online ahead of print Sept. 6, 2013). Soc Sci Med 2013;97:143-151. doi:10.1016/j.socscimed. 2013.08.038.
January 2014
2. Severson HH, Klein K, Lichtensein E, Kaufman N, Orleans CT. Smokeless tobacco use among professional baseball players: survey results, 1998-2003. Tob Control 2005;14(1):31-36. 3. Nemeth JM, Liu ST, Klein EG, Ferketich AK, Kwan MP, Wewers ME. Factors influencing smokeless tobacco use in rural Ohio Appalachia. J Community Health 2012;37(6):1208-1217.
BURNING MOUTH
We have read with great interest and would like to take this opportunity to discuss Dr. Gary Klasser and colleagues’ October 2013 article, “Defining and Diagnosing Burning Mouth Syndrome: Perceptions of Directors of North American Postgraduate Oral Medicine and Orofacial Pain Programs” (Klasser GD, Pinto A, Czyscon JM, Cramer CK, Epstein J. JADA 2013;144[10]:1135-1142). The criteria for establishing a diagnosis of “true” burning mouth syndrome (BMS) is the presence of a burning sensation on clinically healthy oral mucosa in the absence of all known local and systemic etiologic factors. However, the situation can get worse for clinicians when primary/idiopathic BMS is present in a setting of known conditions having burning sensation. Such BMS is called “complicated BMS.”1 In an Indian scenario, patients with oral submucous fibrosis (OSMF), a potentially malignant disorder2 characterized by oral epithelial atrophy leading to a burning sensation,3 routinely are seen in day-to-day practice. Often clinicians get carried away with the clinical findings and do not take a detailed history of the burning sensation, which could lead to an underdiagnosis of the conditions. We came across three patients with OSMF who were diagnosed with concomitant primary BMS. There was no evidence of ulceration, erosion, mucositis or any pathology on oral mucosa. The first patient with OSMF was diagnosed with BMS at the second visit, as we had failed to ask in detail about the burning sensation at the first visit. During the second visit, the patient revealed having a continuous burning sensation throughout the day. The burning sensation
