Denta Dental

43rd YEAR OF PUBLICATION
,.
r
Doctor,
another unique service of your
Ticonium Laboratory.
An award-winning magazine you can
read with interest, with pleasure, and
with profit.
234,00
1984 129,
Denta
249,7
1990 155,00
Dental
An award·winning
magazine for Dentists,
Dental Assistants, and
Dental Hygienists
r
OCCUPANCY
By MORe- THAN
~ CHILDREN
IS /lIlTH /)AN~S
AND u~ LftW FilL
league, he remarked, "You seem to have lost some
weight."
"No, I haven't," I said, "It's just that I now wear
suits that are two sizes too large for me, so it gives me
that appearance. Actually, I weigh more than ever.
I've given up dieting." Then I stuffed the last piece of
chocolate whipped cream cake into my mouth to emphasize the point.
"Nonsense, there's a sure way to lose weight, keep
it off and eat all the things you like-"
"Are you kidding?" I interrupted. "I've heard that
kind of talk before. You know as well as I do that it's
all a matter of calories." Nature goofed when it came
to the distribution of calories. Why couldn't there be
plenty of calories in lettuce, tomatoes and cucumbers,
instead of in ice cream, cake and candy?"
My companion laughed. "You did hit the nail right
on the head. Ever hear of Quasimodo Kern?"
"The name rings a bell," I replied closely.
"Well, he's chief of the food and science department at the university, and that's just what he's working on-the redistribution of calories."
That was the most exciting news I'd heard since I
was told that Ted Williams got six hits in Philadelphia
on the last day of the 1941 season to finish with a batting average of .406.
The very next day I met with Dr. Quasimodo Kern.
His office and laboratory looked like a small supermarket, piled high with food and vegetables. He gave
me a rundown on his experiments, and then asked me
what I knew about calories. Remembering my college
physics, I said, "A calorie is the amount of heat required to raise the temperature of one kilogram of
water one degree centigrade."
Dr. Kern smiled. "That's the old-fashioned definition, but did you ever wonder what a calorie is really
like? What sort of personality it has?"
Then he had me peer through a special spectothermo-microscope, and for the first time I saw a cal-
16
orie. I soon learned that it's a greedy little bugger
with an overactive sex drive that is stimulated by the
chemical components of fats and starches. In the
presence of proteins, it is as impotent as a eunuch.
"The problem is actually a simple one," said Dr.
Kern. "We must 'find a way to alter the sex life of the
calorie. When we do, protein foods will be full of
calories, and all the 'goodies' will be free of them. We
shall be able to eat and enjoy the food we prefer. No
more dieting, no pills, no starvation, no frustration."
That's how SCARE began. As soon as we find a
way to control the calorie, we shall all be thin and the
term "fatso" will become obsolete. Of course, for
people who really enjoy a nice crispy salad with cottage cheese, that could present another problem.
This whole business of dieting really does kind of
scare you, doesn't it?
Here is a new diet we just came across. It's called
the Mini-Bite System. The idea is to use specially designed miniature utensils that enable one to pick up
a morsel of food no larger than a crouton. With this
technique it requires 70 minibites to eat a single slice
of toast. To get through an entire meal would seem
to be so tedious that one would probably give up half
way through.
· ... ...... ... .....
···
,
•
,,~
"
Published monthly by TlCONIUM COMPANY
Division of CMP Industries, Inc., Albany. New York
Joseph Strack
Harry Cimring. D.D.S.
Arthur H. Levine. D.D.S.
Maurice 1. Teitelbaum. D.D.S.
Assistant Edit&r Mary S. Yamin
Edward Kasper
Cover Artist
Editor
Contributing
Editors
JANUARY 1984
Vol. XLIII
No.1
Psychological
Evaluation
and Preparation
CONTENT S
DENTURE PATIENTS: PSYCHOlOGKAl
EVAlUATION AND PREPARATlOft
Beginning with this, its 43rd year, TIC will
occasionally reprint an a rticle of unusual
interest or import. Such an e xcellent feature is this statement of professional philosophy and practice by the late Keith D.
Suthe rland, D.D.S.
BRA(ING FOR ABREAKTHROUGH
A prom ising research report f rom the Unive rsity of Pennsylvania School of Denti stry
by KEITH D. SUTHERLAND, D.D.S.
6
THE WORlDS OUTSIDE
From the Gourmet Kitchen of Harry
Cimring, D.D.S...
Pearls of Something, Not Wisdom .. _
Over 9 Million Have No Jobs, 2 Million
Have 2 Jobs
State and local Taxes May Top $300
Billion _. .
Case of the Vanishing Americans ... _._
8
8
9
10
10
~
GERIATRIC DENTAL CARf
An impo rtant message from the Journal
of the American College of Dentists
11
THE fAKE DENTIST
•
·•
•
.
··
o
··
Q CJ
An amusing story from a 1910 French
12
comic strip
ANGLES AND IMPRESSIONS
A thousand new chem icals daily . . . The
aching back is back . .. Acquiring a green
thumb ... SCARE makes you thin ...
14
IB81
··.
·
··
·.... .... ··11_ .........
TIC, JANUARY, 1984
DENTURE
PATIENTS:
MEMB ER PUUATION
AM ERI CA'" ASSOClA1 JON OF OEN TAt. EDITORS
Send editor ial contr ibutions and correspondence to Joseph
St rack, Box 4()7, North Chatham, N. V. 12132; change-ofalfaress notlees to CirCUlation Manager, TIC, Box 350, Albany,
N.Y. 12201
TIC is microfilmed by University Micro! ims, Inc., 300 N. Zeeb Road,
Ann Arbor. Michigan 48106. TIC's lllternational Standard SerIal
Number Is: US 0040·6716 TIC.
Copyrig ht 1984, Tk onlum Company, Oivision of CMP Industri es,
l nc., 413 North Pearl St ., Albany, Nffl York 12207 .
Opinions expressed by contributors t o TIC do not necessarily refl ect
the i.ws of the publishers.
Annua l Subscript ion, $7.00. Single copies, 70¢.
Printed in U.S.A. by J ersey Print ing Co., Inc., Bayonne, N.J.
TIC, JANUARY, 1984
A
complete psychological evaluation of a potential prosthetic
patient is the most important initial service you can perform for
that person. Such a procedure is also of utmost importance to
your own well-being, health, and practice.
You may possess the finest of technical skill, have a complete
understanding of the anatomical and physiological factors involved, yet drastically fail in your service to the patient. It is only
through an established rapport with the patient that he will benefit from your skill. How do you judge whether such harmony can
be established? By a psychological diagnostic and prognostic appraisal of the prospective patient.
How many patients have you had who have been a constant
trouble throughout your treatment association with them? Patients you are sure you treated with: skill and care? They are the
ones that disturb your well· being, make you irritable at home,
mean to the children, and tend to elevate your golf score. They
are the ingredients from which coronaries develop. And they are
the components of a sickening practice. How can you avoid many
of these difficulties? By a psychological evaluation of the prospective patients and by psychologically preparing them for what is
to take place.
It has been our experience that two appointments are necessary
for complete evaluation of the prospective patient'S psydlological
classification and projected preparatory program. The first visit
acquaints the person with the operator and vice versa. The pro·
spective patient is encouraged to relate in complete detail his
dental history, his attitude toward other dentists, his present problems, and what he expects us to do for him. Many patients enjoy
OUR COVER: A six-year projection. Population data from the
Census Bureau; other data from Health Care Financing Review
(March 1983).
I
dentists, for it is estimated that eight out of 10 Americans will suffer back pain some time during their lives.
In fact, back injuries account for approximately 400,000 of all disabling work injuries each year. Once
again, here are some suggestions to help you take the
strain off your back:
(1.) Don't carry excess body weight. Even though
thin individuals also suffer from back pain, the
incidence among those who are overweight is
much higher.
(2.) Wear comfortable shoes, and never mind trying
to be taller than the little lady. Low heels are
preferable.
(3.) Don't sit on chairs or furniture that don't support your back or don't let your feet touch the
floor.
(4.) Use a firm pillow at night. A soft, feather pillow that can collapse or shift may throw your
body out of alignment, putting strain on your
back.
(5.) Try to sleep on your side, preferably with your
knees bent. Sleeping on your stomach puts
added pressure on your back, especially if your
stomach is large.
(6.) Whenever you have to bend over to lift, push,
or pull anything, bend your knees and let your
legs do the work. Exercising by touching your
toes without bending your knees can do more
harm than good-unless your body is supple
and there is no strain.
(7.) When you reach for instruments, don't use
rotating movements that twist your back.
(8.) Take a few minutes throughout the day to relax
and raise your legs. This will help reduce the
tension in your back muscles.
the girlhood picture she has brought with her. The
male will demand unreasonable retention and a
disastrous increase in vertical dimension. Both will
tell you that work is to be done at the earliest possib le moment, a t the most nominal cost, and you will
be p aid when they are completely satisfied with your
results. They will advise you that as you proceed
with construction thev will instruct vou as to their
needs and wants.
'
,
- -
--:::=:.-
"COULD YOU GIVE ME SOMeTHING TO HELP Me THINK
OF YOU AS DR. MARCUS WELBY? "
speaking of these relations and will freely give much
information to be entered on their charts. No question of total fee is answered at this time. It is explained this aspect will be discussed during the next
appointment after the case history has been studied
together with the x-rays to be made during this first
visit.
Following this initial visit, the patient's information is evaluated and he is placed in one of the following a tti tude classifications.
I.
THE OPTIMISTIC OR PHILOSOPHICAL TYPE
These people display confidence in your ability to
be of service to them, in their capability to follow
your instructions, and to wear their new dentures
with comfort and utility. Treat them with calm
courtesy and thoroughness but not too great familiarity, lest they change in their attitude of respect for
you and your ability. Cherish such patients. They
are a pleasure to serve and they will build your ego,
practice, and pocketbook.
II. THE PESSIMISTIC OR EXACTING TYPE
These individuals present problems. They demand more than you can produce and are seldom
completely satisfied. The female demands that you
remove all facial wrinkles and restore vouthful
beauty enjoyed some years before, as evid~nced by
2
III. THE IMAGINATIvE OR HYSTERICAL TYPE
The highly nervous and reactionary individuals.
These people ca nnot resign themselves to the fact
they must wear dentures. They delight in relating
the abnormali ties they are sure you will recognize
in their particular case. These preconceived notions
are the result of misconstrued information thev have
received from d enture wearers. Most of thi s 'group
will have consulted other dental practitioners before see ing you. T he experienced denture wearer in
this category will bring a number of previously constructed dentures with him . He will explain in detail the reasons [or his failure to be able to endure
each case. Such reasons are usuallv incorrectlv espoused and are presented in an inc;easingly hy;terica l manner. This patient will try your patience and
ingenuity to the utmost. Success with this type can
only be approached followin g a progressive individualized plan of education which changes his origin:ll
atti tude.
IV.
THE DISI:'\TERESTE D OR II\"DIFFERENT TYPE
These are usually older people who exhibit little
interes t in vou or what vou ca n do for them . Thev
are brough't to your office by friends, relatives, o~·
some type of agency interested in their rehabilitation to an interest in life or an occupation. Such individuals are quite satisfied with their present mouth
conditions and appearance, and content to eat their
food without teeth or with the few that remain. The
disinterest is often shown in their careless dress and
slovenly habits.
The prognosis h ere is dim beca use, after delivery.
the patient will seldom exert the effort to wear his
dentures. Here is where a carefullv followed educational program may improve th e p'atient's atti tude
before delivery of his case.
V.
THE CHRO:-iICALLY ILL
These individuals will later be assigned to one of
the above classifications. For reasons relative to
their condition, we may start work on these patients
before we h ave fully considered a psychological program for them. After consulta tion with relatives
and their physicians, and watching them as we proceed, we attempt to educate them as befits their
indi vidual requirements. Success with such patients
is ordinarily in direct proportion to thei r health
TIC, JANUARY, 1984
ACQUIRING A GREEN THUMB
/
Plants in the office add color, freshness and a relaxing atmosphere. To keep your plants healthy and
alive, here are some tips from the experts:
(1.) Keep your plants near a window or with as
much light as possible.
(2.) Some plants require more water than others.
Cacti and succulent plants need little moisture
in the winter. Remember, no two plants drink
alike.
(3.) Plants in small pots need more water than those
in large pots. Newly potted plants should be
watered cautiously until they have taken firm
root.
(4.) Watering is best done in the morning with the
water at room temperature. Cold water is injurious to the roots.
(5.) Don't over-water your plants ; more plants die
from too much water than from too little.
(6.) To test the dryness of plants, rap your knuckles
outside the pot. If there is a hollow, dull sound,
the plant is too dry.
TIC, JANUARY, 1984
SCARE MAKES YOU THIN
In a few weeks, you will probably receive some information in the mail from SCARE - but don't be
frightened. SCARE is an acronym for the Society for
Calorie Adjustment, Redistribution and Evaluation.
Most of you will want to read the literature carefully,
and perhaps make a small, tax-free contribution to
this worthwhile organization, especially if you are
one of the tens of millions of Americans who have
been in the front lines of the Battle of the Bulge.
You probably haven't heard of SCARE. It is a
new organization, for which I am proud to have been
chosen as national co-chairperson. During the past
decade, there have been few subjects about which
more has been written and discussed than "dieting."
We have been -literally deluged by the written and
spoken word on how to lose weight. Who hasn't heard
about the High Protein Diet, the Drinking Man's Diet,
the Carbohydrate Diet, the Water Diet, the Banana
Diet, the Rice Diet, the Mayo Clinic Diet, the Vegetarian Diet, etc., etc. (Only the Japanese Diet makes
no such promise.)
And to help maintain these diets, there is bio-feedback, hypnosis, group therapy like Weight Watchers,
Lean Line, and Overeaters Anonymous. And, of
course, exercise regimes-all promising svelte figures
and a long life.
Unfortunately, for a majority of "chub-chubs" all
these diets and aids have proven useless. I know, because I've tried them all. Finally, I gave up trying,
and decided my only hope was to associate with people fatter than I am, so that, by comparison, I'd look
a little thinner. But that was in the past. Now, thanks
to SCARE, the thin person locked inside of me will
soon have a chance to emerge and remain on the
scene. Let me start at the beginning.
Last month, as I was finishing luncheon with a col-
15
by Maurice J. Teitelbaum, D.D.S.
THISA AND DATA
The importance of keeping dental records was
more apparent recently by the New Hampshire
legislature. They passed a law requiring dentists to
keep dental records "in sufficient detail" for seven
years. The primary purpose is for identification of
a~cident or murder victims . . . . Money Magazine
did a profile of the Alden sisters, two financial and
market analysts whose prediction about the price of
gold in 1976 was right on target as it went from $130
an ounce to $850. They predicted that it would drop
to around $300 in March of 1982 and it did dip
below $300 in June. Now hold on to your hats - or
your scrap gold - for they predict that gold will hit
$850 by mid-1984 and skyrocket to $4,000 in early
1986! They also look for silver to reach $150 an
ounce by 1986 .... Perhaps you never thought of it,
but when you enter your office you must shove against
atmospheric pressure with a force of 14 pounds on
~very square inch of your body. Then, as you step
mto the room, you must be sure of landing on a plank
traveling at 20 miles a second around the sun. No
:vonder it's sometimes difficult to take that first step
mto the office some mornings!
According to the American Council of Life Insurance, a woman reaches middle age at 40 and a man
reaches middle age at 37 . . . . While on the subject
of age, did you know that the nation's car population
is the oldest its been since the 1950's? The average
car on the road is just short of seven years, while an
estimated six to eight million cars are "senior sedanzens" of 15 years or older .... While we go on worrying about all the harmful chemicals in our food and
environment, it is estimated that 1,000 new chemicals
are registered every day! ... A spokesman at a meeting of the American Society of Anesthesiologists told
members that smokers who refrain from smoking at
least 12 hours before surgery "reduce the risk of
danger to organs and post operative complications
often caused by the lack of oxygen." It was pointed
out that the "carbon monoxide produced by smoking
combines with the blood's hemoglobin, lessening its
ability to carry oxygen, releasing it to body tissues."
ma~e
14
s
The 12-hour cessation of smoking enables the oxygen in the blood to reach its normal carrying capacity
level. Good advice for the patient who is going to
have an extraction or periodontal surgery. Which
is probably the idea of this new plan. . . . As most
philatelists know, a dentist has never been pictured
on a postage stamp, although many stamps around the
world have paid tribute to dentistry. An effort is being made to have the government issue a comemorative stamp honoring G. V. Black. The year 1986 will
mark the 150th anniversary of the birth of this remarkable man, who was a physician, attorney, scientist, inventor, draftsman, teacher, pathologist, author
and editor-as well as a dentist.
THE ACHING BACK IS BACK
The Canadian Dental Association, in a survey of
almost 500 dentists, found that the incidence of back
problems among dentists has not changed in the past
15 years. Despite the emphasis on physical fitness,
proper chair posture and special back exercise, the
same number of dentists complain of back pains. The
greatest number of sufferers were between the ages
of 30 and 50.
The general popuLation doesn't fare any better than
TIC, JANUARY, 1984
problems and the amount of cooperation obtained
from them and their physicians.
vVhat has the psychological evaluation of patient
attitudes produced? Clues relative to the educational requirements needed to place each patient in
the best possible attitude to receive skilled technical
denture service. In our opinion, many difficulties
in such service are brought about by our not having
educated the patient as to what he may expect of
his new appliances. This must be done prior to
starting the work. As a matter of fact, educational
procedures should be utilized before, during, and
after the construction period.
To affect thinking relative to preparatory education, we will discLlss it in relation to the varioLls
types of patients who present themselves for denture
service. It is assumed that in most of the follo wing
types an initial visit has been made to our office for
classification of attitude.
By
APPOINTMENT ONLY
THE IXEXPERIENCED DEl'iTURE PATlEl\T
WITH REMAINING TEETH
This patient is open to a complete program of
education at our hands. His complete denture
knowledge is limited to his imagination and what
he has been told by denture wearers. Such a person
is experiencing anxiety about the surgery to be performed and is fearful of appearance change. How
do we allay these fears? Advise the patient of developments in surgery that promise little distress;
should he so desire, he may sleep through the extractions and mouth preparation. Explain that he
is fortunate he can have immediate dentures and
explain the advantages of such procedure. It is paramount the patient also be informed of the difficulties he will encounter. He is also told of the expectations relative to his case. It is better we promise
too little than too much. It must be emphasized to
the patient that when we give him correctly fitted
dentures with esthetic appearance and properly
aligned teeth, balanced occlusion, proper instructions in denture use, and periodic checkups, we are
doing our job. His job will be to give us his COIllplete confidence and cooperation. He must also be
told that continued denture success will be greatly
dependent on the health of his oral tissues, which,
in turn, depend on the maintenance of good general
health.
A simple explanation of the abO\e points is usually sufficient for the philosophical type patient. In
handling the exacting and hysterical types, educational application must be more inclusive and profound. Reasons for complete mouth examination
and health history must be expounded, results of
x-ray examination fully explained, and the mechanics of denture construction related step by step. \\'e
tllllsl inform the patients what they should expect ill
order to counteract false impressions they maY haye
TIC, JANUARY, 1984
" I HAVEN 'T BEEN IN FO R QU ITE SOME lIME. I' M AFRAID
I'M JUST A ·W HE NEV ER -IT-STA RTS -TO .ACHE' PATIENT,"
that dentures will relieve them of all future mouth
troubles. Listen patiently to all the questions these
people ask. Tactful answers will gradually improve
their attitudes previous to delivery time.
Immediate dentures are a boon to the prosthetist
in the treatment of exacting and hysterical patients.
Tissue changes are easily comprehended by the immediate denture wearer, as he is shown first hand
~o denture is a permanent one. As gradual absorptIOn takes place, he fully realizes the dentures fitted
properly when first inserted; this gives him confdence in the dentist's ability to fit his mouth after
the tissues allow construction of the second dentures.
The immediate dentures we refer to as treatment
dentures. The patient now realizes the need for replacement of his treatment dentures was not advised by the prosthetist for financial gain. These
psychological phenomena are seldom considered by
the . dentist in his thoughts
concernin bo ' I)atient edu"catIOn.
THE I:-.iEXPERlF.l\CF.D EDEl\TlJLOUS PATlE:-.iT
These patients are divided into two groups, those
having had recent extractions and patients who have
been edentulous over a long period of time.
The patient with recent extractions is educationally handled in much the same way as the inexperienced denture patient with remaining teeth. It is
3
dentures, after their delivery he will not attempt to
",ear them. It is then that the others assume his
problems.
Have the person or persons who originally
brought the patient present when you discuss details relative to his case. Explain that you will only
accept the case if full cooperation of the patient
himself can be assured. Explain the usual happenings in cases of indifferent patients and state you
will use every effort to interest the patient in wearing his dentures. But, with the exception of necessary adjustments, your responsibility as to the utility
of the dentures will end on their delivery. Such
candid oratory in the presence of the patient to his
attendant will often interest the patient to the point
of cooperation with you. It will also convince the attendant and the patient that you are experienced
with such cases.
THE EXPERIENCED DENTURE PATIENT
~VJ
" I KNOW IT'S IMPOSSI BLE BUT DON 'T EAT ANYTH ING
FOR 24 HO URS ."
necessary to explain to him that successful results
will depend on his attitude, cooperation, age, health,
size and shape of the mouth, and his expectations,
as well as the knowledge, skill, and materials used
in construction. As in other types of cases, you will
make full mouth x-rays. This is explained by your
desire to evaluate the underlying tissues for denture
prognosis. Such procedure not only provides an
evaluation of this tissue and reveals possible surgical
errors, but also impresses the patient with a sense
of confidence in your thoroughness. If preparatory
surgery relative to denture construction is in need of
any correction, ask the patient to have this done.
If your request is refused, enter this fact on the patient's chart in his presence.
The patient presenting himself with an edentulous mouth of long standing is usually an ill person
or one typed as indifferent. He will ordinarily be
accompanied by a friend, relative, or nurse. Because
of his indifference it is very difficult to reason with
or educate such a person. Should the patient be ill,
an educational program should be individually
planned with the cooperation of his physician. The
troubl~ you will experience with an indifferent patient rests not altogether with him but rather with
the friends or relatives who bring him to your office.
If his indifference is not corrected by an educational
program instigated by you, prior to delivery of his
4
There are two primary considerations concerned
with experienced denture wearers. Why the patient
desires new dentures. And, if the patient has worn
his dentures unsuccessfully, whether it was due to
his lack of cooperation or to faulty construction. We
ascertain the answers to these questions from the
patient and from examination of his dentures,
mouth, and x-rays. Prior to the patient's second
visit, we consider these factors and formulate a program to present to him during his second office visit.
The philosophical patient presents a reasonable
attitude, and his desire for new dentures is usually
due to tissue loss and a resultant loss of retention
plus a change in vertical dimension. For this patient little psychological preparation is necessary.
The exacting patient usually proclaims contempt
for his present dentures and for the dentist who
fabricated them. He will go on as follows: he paid
an exhorbitant price for dentures he has never been
able to use. His mouth has been ruined. Can anyone correct the terrible work of Dr. So-and-So? He
had many adjustments but nothing helped. If he
let us make him a set of dentures, he wants to check
every step; and, if at any time he does not like ,,;hat
we are doing, he will quit, as he cannot afford spending more money for nothing.
Such a person cannot be accepted as a patient in
his present attitude. 'What procedure is used to
change his attitude to the point where we can accept
him? There is one thing we should never do and
that is blame the construction of the old dentures.
Not only because of the ethics involved; such procedure is also psychologically unsound. If his present dentures are of the immediate type, explain they
were treatment appliances, that his tissues have
changed but dentures are made of materials that do
not alter with tissue change. If the tissues were allowed to heal before denture construction, point out
TIC, JANUARY, 1984
TIC, JANUARY, 1984
13
THE
FAKE
DENTIST
•
by Cyril B. Kanterman, D.D.S.
Remember when New York City's Mayor Fiorello
La Guardia used to read the Sunday funnies to the
kiddies over the radio? We, too, are going to read the
comics - not because Tic readers are illiterate (which
they assuredly are not) but because this comic strip
happens to be in French.
Titled "The Fake Dentist," it was published in the
Parisian humor magazine Images amusantes in 1910
- a time when the funnies were really funny and
intended primarily for an adult readership. Le Faux
Dentiste comes from the National Library of Medicine's dental print collection and tells, with typical
Gallic humor, a credible story, one that could have
actually happened.
TOP ROW: A man enters a cafe and seats himself
at a table. Holding his face, he is obviously in distress.
He explains to the sympathetic patrons that he has a
severe toothache. Enters a professional-looking gentleman carrying a medical bag.
SECOND ROW: The newcomer asks the waitress
what's the commotion about at the next -table. She
informs him that the fellow over there is afflicted with
mal de dents. By coincidence, the gentleman happens
to be a dentist. He offers the toothache sufferer a pill
from his bag. Lo and behold, the toothache instantly
disappears!
12
THIRD ROW: The cost of this miraculous medication is a mere five francs , which the grateful patient
is most happy to pay. Naturally, the bystanders are
anxious to acquire this wondrous remedy. The dentist
does a brisk business, quickly selling out his wares.
BOTTOM ROW: What's this? The "dentist" and
the "patient" gleefully meet outside. It turns out they
are a pair of swindlers who staged this scenario to
peddle worthless pills. Meanwhile, back at the cafe
the people discover they have been fleeced and take
off after the crooks. The two polissons (rascals) get a
deserved dunking in the river. As they are fished out
of the water, they conclude that maybe their dental
scam wasn't such a great idea after all.
Cute story that it is, "The Fake Dentist" has a universality that transcends time and place. Instead of in
a bistro in Paris in 1910, this little tale could have
happened in Archie Bunker's Place in Queens in
1983. Why? Whatever the environment, people are
still basically the same. We have our hopes, our fears
- and our greed.
Besides providing a few laughs, comics often make
a serious point. This one is no exception. The lesson
here is take nothing at face value. It also confirms
P . T. Barnum's observation that there is one born
every minute.
N'est-ce pas?
TI C, JANUARY, 1984
that he was the type of patient whose tissues, at first,
did not take to the h ard material replacements. Otherwise, he would not have had to have as many adjustments as he reported to us. Point out the unfavorable conditions you find in his mouth. Tell him
how some of these conditions can be improved. Put
the full emphasis of your explanations on the unfavorable physical conditions. If you are persistent
in this approach, you will find an awakening interest in the patient. You have not minimized the construction efforts or results of the other dentist. You
are telling him facts he h eard from the other man,
and his subconscious thoughts about how complex
he believes his particular case to be, are slowly entering his conscious mind. You will recognize this
metamorphosis in the patient's attitude. Now is the
time to assert that you will only accept his case if he
will give you his entire cooperation. If he agrees t.o
this, enter it on his chart in his presence. Also, at thIS
time, quote your fee. Explain that you will require
at least one half of the fee at the start of the case
and the remainder on delivery of the case. Enter this
fact on his chart in his presence. Do not swerve from
this procedure.
The prepara tory handling of hysterical patients
follows the same line as used with exacting patients;
however, there are some added features. It is good
practice in the case of highly emotional and reactionary pa tients to obtain as much information as
possible relative to medical history. If possible, consult with his physician for information and planning. With h ysterical patients, as is sometimes the
case with indifferent patients, you can use family
members to great advantage. Explain to the family
member all you have told the p atient and explain
TI C, JANUARY, 19 84
"YOU WANT AN APPOINTMEN T TO LOOK AT THE DOC.
TOR'S BOO KS" WHAT'S WRONG WITH THE MAGAZINES?"
wha t you can and cannot do. Often this procedure
will decide whether or not your further service to the
individual is warranted.
There are other types of trouble to avoid. One is
making a n ew immediate lower denture to an old
upper that has been articulated to lower natural
teeth . Another is constructing a new upper denture
to oppose a lower old partial denture. In such cases
a balanced occlusion is impossible. Many patients
present themselves for denture ser vice and demand
of us all types of unprincipled service. Unless these
patients can be educated by us to proper dentistry,
then they should not be accepted as patients.
Another point relates to the fee for the work.
When you figure your fee , take into consideration
not only your technical work and the laboratory
costs but also the psychological evaluation and prepara tory work involved. If you do not, you will lose
all interest in the psychological preparation of your
patients, which is just inviting trouble.
In conclusion, the above is certainly not all-inclusive of the psychological evaluation and preparation
problems you will meet in denture practice. But if
this information tends to bolster your thinking in
this direction, then it will not have failed in its
purpose.
Bracing for a
Bflmkthrough
Geriatric
Dental Care
Electrical stimulation of the gums may help
straighten teeth in half the time.
by John Hayden, Editor
Health Affairs,
University of Pennsylvania
ot
(Dr. Blair is the distinguished editor of .the J?urn~l
t~e
American College of Dentists, from which hiS edltonal IS
reprin ted. )
T
wo investigators at the University discovered
that it is possible to move teeth of cats in half the time
using electrical currents applied at very low levels.
They are now using this new technique on a group of
human patients in a clinical trial.
Before their joint project got underway, both of
these investigators were pursuing the same goal independently, unaware of the other's research interest.
Dr Zeev Davidovitch an orthodontist at the Dental
School, was trying to' find a way to reduce the time
required for orthodontic treatment by studying the
effeots of the cells responsible for tooth movement.
Dr. Edward Korostoff, a professor of restorative dentistry, materials science and engineering and bio~n­
gineering, had been doing research on the generatIOn
of electricit:y in bones that are undergoing mechanical
force since 1966 and on the use of applied electricity
to cause bone to grow. He had worked on the development of the now-accepted method for healing certain bone fractures that refused to knit in any other
way, which was pioneered clinically by a group at the
School of Medicine headed by Dr. Carl T. Brighton,
Paul B. Magnuson Professor of Bone and Joint Surgeryand chairman of Orthopaedic Surgery.
In 1969 Dr. Korostoff proposed in a symposium
that electrical stimulation would accelerate orthodontic tooth movement. This was paralleled in 1975 by
Dr. Davidovitch's pIan to initiate experiments on
electrical stimulation to accomplish the same purpose.
Dr. James Ackerman, then chairman of the Department of Orthodontics at the School of Dental Medicine, brought them together to pursue their joint research.
Their work was aided significantly when Dr.
Davidovitch, using a technique he developed, was
able to identify active cells in bone under the microscope. This subsequently enable.d the two investi~a­
tors to examine tissues to determme whether electncity could stimulate cells to an active state.
The idea of using electricity to stimulate bone
growth began with the discovery nearly 30 years ago
that bone develops its own electricity when bent. It
6
Keith P. Blair
Dr. Davidovitch evaluates a patient's malocclusion.
develops positive charges on the outwardly curved
side and negative charges on the inwardly curved side.
Bone tends to grow on that inward curve when
stressed and resorbs, or disappears, on the outward
curve. According to Dr. Korostoff, people began to
wonder whether applying electric current might not
do the same thing.
Orthodontic tooth movement takes place by a
process of bone remodeling in which the tooth moves
into the place where the bone has resorbed and then
bone builds up behind the spot where it had been.
"We thought it would be useful to see if we could
accelerate the movement of teeth that way," Dr.
Davidovitch said.
It had already been discovered before their work
began that it takes about 20 millionths of an ampere
to stimulate bone to grow and resorb. Therefore,
they placed two wires connected to a power pack on
either side of the tooth they wanted to move. The
positive lead, or anode, was placed in the direction
they wanted to move the tooth because that would
cause the bone to resorb and the tooth could move
into the space more rapidly. The negati~e, or cathodic, electrode was on the rear of that motIon so as to
build up bone where the tooth had been.
Over the next several years, they experimented on
a large number of cats in a project funde? by the
National Institute for Dental Research, WIth some
additional support for investigating the m~chanisms
involved by the National Science Fou!1d~tIon. T~e
result of those experiments was a defirute Illc~ease III
the rate at which teeth moved under orthodontIc force
when electrically stimulated. This was acco~p~ished
with very low electrical currents, 10 to 20 ~rulhonths
of an ampere-too low to be felt by the aruma!.
TIC, JANUARY, 1984
One of the fastest growing segments of our national
popUlation is the elderly. It is time that the d~nt~l
profession learns more and does more about genatnc
dental care.
Neglect, not age, is the main cause of tooth loss,
as every dentist knows, and when people have less
neglect in middle-age they prevent unnecessary loss
of teeth as they approach their later years.
Contrary to the frequent image that unfortunately
type-casts most elderly people as senile and incompetent, the great majority of our present ol?er,populatIon
lead very productive lives. They have Improved general health and better oral health, as compared wirth
a generation ago. As an increasing number of middleaged people seek regular dent~l. car~, the~e same
people have better dental condItIons In theIr older
years.
The dental care needs of the elderly are no different
than that of people in younger age groups. SeniOrs'
need a full range of dental services including oral
hygiene, restorative procedur~s, period~ntal treatment endodontic care, fixed bndges, partIal dentures
and full dentures. There will be an increasing need
in all phases of dental care for the elderly, except for
full dentures where the need is decreasing as people
preserve more of their teeth.
These senior citizens have as much concern for
their health comfort and appearance as do people of
any other 'age category. Their chronological a~e
should not interfere with having the care they need, If
they are physically able to have the treatment.
We should begin geriatric dental care early by i~­
forming our patients about the need to save theIr
teeth, not only for appearance and mastication, but
TIC, JANUARY, 1984
also to preserve alveolar bone, whi~h gives SUPP?rt
to the face and preserves the dimenSIOns of the entIre
lower third of the face. Dentists know that the restriction of sugars and the use of proper oral hygiene
will result in healthy dentition for the lifetime of most
people. There is no cure as good as pre.vention though
that simple message seems to be so dIfficult to communicate to the public.
Recent government statistics show that 45 percent
of the elderly live on pensions they have earned and
another 33 percent are still earning incomes. Only a
small minority of the elderly receive public ~ssistance.
Generally, they are becoming more finanCIally comfortable. But for those seniors who cannot afford
regular fees, we should arrange low-cost facilities
where they can receive adequate treatm~nt.
Certain steps need to be taken, also, If the elderly
are to have better dental care and improved oral
health. Community health organizations must infort?
the public, including senior citizens, a~out good nutntion and preventive dental care. NurSID? homes need
to train their staffs to improve oral hYgIene.
Dental schools should include courses on geriatric
dentistry in undergraduate studies. Mor~ continuing
education classes are needed on the speCIal problems
of the elderly and recommended methods of treatment.
With our declining birth rate and the lower number
of school~aged persons, our population ~ge-groups
are noticeably changing. As the great mIddle-aged
QTOUp moves steadily into the senior classification,
fhere will be an ever-increasing demand for dental
care for the elderly.
Will we be prepared for it?
Keith P . Blair
II
State and Local Taxes
May Top $300 Billion
S
tate and local general tax collections will probably
exceed $300 billion in the 1983 calendar year, for the
first time in history, according to Tax Foundation
analysts. This would follow in short order the passing
of the $200 billion mark in 1979.
For the years 1977-1982, state-local taxes rose by
amounts averaging 8.4% annually, even with persistent recessionary conditions in the private economy. The cumulative five-year increase was 50%56% for states and 42% for localities.
Growth has been especially rapid for the more
"broadly based" taxes. State and local units collected
$52.7 billion in individual income taxes in 1982, 71 %
more than five years earlier.
General sales and gross receipts tax collections, at
$61.9 billion in 1982, rose by 60% for the 19771982 period. One-fourth of the total dollar increases
in general state-local taxes during these five years was
attributable to general sales.
General tax collections of local governments passed
the $100 billion mark in 1982, owing primarily to a
sudden resurgence in property tax growth. In an unexpectedly high rebound from the "Prop 13" slowdown of the late 1970s, property taxes jumped by
$10.5 billion between 1981 and 1982, accounting for
better than half of the year's net increase of $19.6
billion in general state-local collections.
Our 82,688 Local Governments
Reach R'ecord Deficits
Governments in the United States ran a record
deficit of $117.4 billion in calendar year 1982, topping the previous peak red-ink year of 1975, when
they spent $63.8 billion more than they received in
revenues.
There were 82,688 government units in the United
States in 1982.
On general accounts, states and localities ran a $4.1
billion deficit in 1982, up from $75 million the previous year. Deficits as such do not show up in most
official state-local budgets, however, because of budgeting methods that provide separate accounting for
current and capital spending.
The Federal deficit amounted to $149.5 billion in
calendar year 1982. It was partly offset by a $32.1
billion surplus in state-local operations that resulted
from a buildup of balances in social insurance accounts, largely pension funds.
10
•
"He said his recovery was a miracle, so he sent the
check to his minister instead of you."
The Case of
Vanishing Americans
Large numbers of Americans seem to be disappearing every day. And the nation's life insurance
companies are looking for them.
It's part of a multimillion-dollar lost and found operation. These "lost" Americans are the beneficiaries
of insurance policies and they've moved without leaving a forwarding address.
Many aren't aware they are beneficiaries; some
have paid up annuities they've forgotten; some simply
never knew the deceased had a policy.
In most cases, insurance companies make regular,
often elabora:te efforts to locate beneficiaries using
investigators, sales representatives, even newspaper
ads to do the job.
Sometimes a letter to a postmaster or a simple
reference to a telephone directory will locate the missing party. Often the search leads across the country,
sometimes across oceans.
But if they're not located within three to seven
years, depending on state law, the money goes to the
state for safe keeping, This is known as "escheat,"
meaning the state is entitled to custodial care of the
unclaimed property.
Still, if the beneficiary shows up with proof of his
claim, the insurance company will either pay directly
or arrange for the state to repay - possibly with
interest.
TIC, JANUARY, 1984
When working on human' subjects, the electrical
device is used in addition to regular orthodontic
brackets and wires attached to the teeth. The power
pack is placed between the lip and the gum and is
connected to electrodes similar to the way it was used
in experimental animals.
Orthodontic practice was once confined mainly to
children, but Dean D. Walter Cohen pointed out that
in recent years some orthodontists say that about 40
percent of their practice is on adults who require correction of malocclusions. Since it takes much longer
for treatment on adults, one of the important objectives of using electric current as an adjunct in orthodontic treatment is that it shortens the time needed
to move teeth. Since a patient would be wearing the
devices for a shorter time, discomfort would be reduced and patient cooperation, which is usually high
in the early period of treatment, could be more easily
maintained throughout the treatment period. In addition the potential damage to oral tissue is also reduced.
Since the electric charge is so minute as not to be
felt, complaints from patients are mainly about the
bulkiness of the battery pack, which the patient attaches and wears only at night. To be sure the battery
pack is working, the subject has a device that measures the current output.
When the investigators saw their positive results on
experimental animals, the University of Pennsylvania
applied for a U.S. patent, which was granted in 1979.
The potential for widespread use of the device was
recognized by Mr. Nathaniel Lieb of Venture Technology, Incorporated (VTI). This led to the formation of a research and development limited partnership, Ortho-A-Associates. Mr. Richard Smith is the
General Partner of Ortho-A-Associates, which has the
funds for the clinical trials on human subjects. It has
been agreed that VTI will assist in the development,
manufacturing, and distribution of the device in the
future.
The clinical study on human subjects will last approximately two years and will involve 60 females
and three age groups: 12-to-15; 20-to-30; and 31-to40 years-of-age, corresponding to adolescents, young
adults and middle-age adults. Females were chosen
because they are the predominant group of individuals seeking orthodontic treatment at the University
of Pennsylvania School of Dental Medicine. By using
females only, the research team was able to remove
one of the variables in their research project.
The clinical tests are being directed by Dr. Robert
Sanford, an orthodontist with general experience in
electronics, who received his orthodontics certificate
from the School of Dental Medicine in 1982.
The patent for the device also covers other applications which are in various stages of development. One
is the electrical treatment for periodontal disease,
which would counteract problems caused by bone
loss. Another application being studied by these investigators is the use of electrical stimulation to treat
cleft palates. Finally, in patients with dentures, bone
growth under the denture base may be stimulated
electrically, which will improve the retention of the
denture.
Just as it was possible several years ago for orthopedicsurgeons to use electrical stimulation to aid in
bone growth, dentists may be using a battery pack to
assist and speed up corrective orthodontics within the
next few years.
Dr. Korostoff displays the model of the electrical device
(shown at right) for faster movement of teeth in orthodontics. Dr. Sanford, left, is conducting the clinical tests.
(Photos. The DailY Pennsylvanian)
(Copyright by Health Affairs. Reprinted by permission.)
tiC, JANUARY, 1984
1
Over 9 Million Have No Job,
2 Million Hold 2 Jobs
Ithant isninedifficult
to believe that at a time when more
million unemployed Americans are looking
Ik qtuPuHei K~ '"
Harry Cimring, D.D.S.
IfJ.IUUn
Pearls of Something,
Not Wisdom
BROILED HALIBUT WITH FRESH GINGER
2lbs. halibut steaks
Juice of one-half1emon
Vz c. soy sauce
Vz tsp. fresh grated ginger
Butter or margarine
. Cut halibut into six serving pieces.
Sprinkle fish lightly with the lemon juice.
Put them in a shallow broiling pan.
Pour soy sauce over fish and let set for Vz hour.
Dot fish with butter and sprinkle ginger over each piece.
Broil 10 minutes or until fish is tender.
Baste several times.
Serves 6.
GUACAMOLE
2 avocados
2 hard-cooked eggs
3 small tomatoes
6 stuffed olives
1 small onion or 2 scallions with greens
Juice of one lemon
Season salt and pepper to taste
Few drops Tabasco sauce.
Mash avocados and eggs and dice tomatoes;
slice olives and mince onion.
Mix and add lemon juice and Tabasco sauce.
Season with salt and pepper.
Serve with crackers, pita bread, chips or fresh
vegetables.
SHRIMP NICOISE
2 lbs. uncooked shrimp, shelled and cleaned
Y4 c. butter, margarine or oil
Pinch of salt
Dash of pepper
3 cloves garlic, minced
3 Tbsp. dried parsley
Saute shrimp in butter. Cook quickly until pink,
about 5 minutes. Stir frequently.
Season with salt and pepper.
Add minced garlic and parsley, mix well, and serve
immediately.
Serves 6.
8
and it's constitutional, which is even better."
• "Some of our friends wanted it in the bill, some
of our friends wanted it out, and Jerry and I are
going to stick with our friends."
• "I'm not only for capital punishment, I'm also for
for the preservation of life."
• "From now on, I'm watching everything you do
with a fine-toothed comb."
• "The chair would wish the members would refrain from talking about the intellectual levels of
other members. That always leads to problems."
• "Mr. Chairman, fellow members and guests. That's
a goddamn lie."
• "I don't think people appreciate how difficult it is
to be a pawn of labor."
• "This state's atypical. We've got some real
weird ducks, and I think
that's reflected in this
Senate, with all due respect."
• "Let's violate the law one
more year."
• "Mr. Speaker, what bill
did we just pass?"
There was more, of
course. Much more. But
you get the point, even
though all the politicians together - or separatelydon't.
So, let's be careful on
election days. The voting
booth levers can be danger"
ous to our community
"It's a new disco called 'The Politican.' One step forward, two
health.
steps backward, then sidestep."
Political leaders make use of ghost writers, public
relations specialists and many others who have talent
at the typewriter to create the phrases which make
headlines and paint a public image of eruditeness.
But, alas, left on their own, on the debating floor
of a government body, such as a state legislature,
what comes forth is far from the Churchillian standards too often associated with lawmakers.
Michigan reporters have documented some choice
political malaprops. They have compiled some of the
pithiest quotes of Michigan lawmakers. They post the
chosen ones. But before making it to the wall of honor,
the words must have been spoken in a public forum
and heard by at least two reporters.
Here is a sampling of their "roll of honor"--each
spoken by a different elected official:
• "Before I give you the
benefit of my remarks,
I'd like to know what
we're talking about."
• "There comes a time to
put principle aside and
do what's right."
• "I don't see anything
wrong with saving human life. That would be
good politics, even for
us."
• "This bill goes to the
very heart of the moral
fiber of human anatomy."
• "It's a step in the right
direction, it's the answer,
TIC, JANUARY, 1984
TIC, JANUARY, 1984
to get one job, two million of their neighbors are holding down two.
The faot that the great American tradition of moonlighting is prospering while the rest of the workforce
struggles in search of a single paycheck is an American paradox, for it is spawned as much by the economic distress that has lifted the jobless rate to double
digits as by American ingenuity.
Who are those Americans who have not only been
able to hold on to their own job, but a second as
well?
The names are different, but the reasons are the
same:
• Some are hobbyists who have managed to turn a
favorite pasttime into a second source of income;
• Some are entrepreneurs seeking to launch their
own businesses while clinging to the security of a
recession-proof job;
• Some are saving for something special, a college
education, a summer home, a vacation lost to a
depressed work week.
More typically, however, the American moonlighter is a family man or woman seeking little more
than to make the mortgage and car payments, get
the children through school, and have a little something left over for retirement.
One factory manager, who supplements his salary
by working weekends for a caterer, reasons his two
jobs this way: "I just want my children to grow up
in an atmosphere' of as little want as possible."
The reluctance of many moonlighters to reveal a
second source of income and the loss of federal funding for gathering labor statistics have hampered government efforts to pinpoint the number of multiple
jobholders.
But the last time it surveyed workers, the U.S.
Bureau of Census found 3.2 million Americans working more than 40 hours on at least two job. And
while the recession has undoubtedly cost some of
these workers at least one of these jobs, the Bureau
of Labor Statistics conservatively estimates that more
than 2.2 million workers continue to moonlight.
The moonlighter is not likely to be taking a job
away from one of the unemployed, experts in labor
say, explaining that the typical person who holds a
second job has some type of specialized skill and that's
not generally where the unemployment is coming.
9