L E T T E R S
has been covered much more ex-
tensively in a host of previous
scientific articles.
The intent here is to raise
dentists’ consciousness of the
impending risks of ignoring oral
cancer, and its posttreatment
considerations.
Having said that, I still be-
lieve that Dr. Bench’s comments
are well-founded to aid our col-
leagues in recognizing the full
extent of diagnostic procedures
available today.
Charles P. Hapcook Sr.,
DDS
President and
Chief Executive Officer
Eastern Dentists Insurance
Westborough, Mass.
MINIMALLY INVASIVE
DENTISTRY
Six cheers, not just three, to Dr.
Gordon Christensen for his
November JADA column, “The
Advantages of Minimally
Invasive Dentistry” (JADA
2005;136:1563-5). It is a won-
derfully crafted call for modera-
tion in treatment that should
always put our patients’ inter-
ests first: their clinical inter-
ests, their emotional interests
and their financial interests.
We are of the same genera-
tion, he and I, and have lived
through the emerging high-tech
age of dental care of the mid-
20th century to see so many of
the wonderful advances that
have made our profession more
efficient and more productive,
both for the practitioner and the
patient. However, as members
of a trusted and honored profes-
sion, we dentists must strive to
avoid creating our patients’ per-
ception that we are providing
“dentistry for the dentist,”
rather than “dentistry for the
patient.”
Dr. Christensen’s column
296 JADA, Vol. 137 http://jada.ada.org March 2006
Copyright ©2006 American Dental Association. All rights reserved.
should be kept in the forefront
of thinking of all who are graced
with the privilege with the
sponsorship and trust of their
patients.
Richard M. Hochman,
DDS (retired)
Savannah, Ga.
RESPONSE FROM THE AAP
The American Academy of
Periodontology read with inter-
est Dr. Gordon Christensen’s
November JADA column, “The
Advantages of Minimally
Invasive Dentistry” (JADA
2005;136:1563-5). On behalf of
the Academy and the members
and patients we serve, I find the
anecdotal statements related to
the dental community’s in-
creased interest in “accomplish-
ing more treatment than re-
quired” and “placing implants,”
as well as “a decline in interest
in periodontal therapy,” insult-
ing to my periodontist and gen-
eral practitioner colleagues.
Research shows that oftentimes
patients’ level of disease, or
damage caused by disease,
requires more extensive
treatment.1
These insinuations of inap-
propriate or overtreatment vio-
late the essential trust that con-
stitutes the core of the
doctor-patient relationship. As
health care practitioners, we
have taken a vow to recommend
any treatment that has proven
to be effective in improving the
health of our patients, and that
meets their needs and interests.
As it relates to periodontal dis-
ease, we know that it is a chron-
ic inflammatory condition that
requires careful monitoring and
treatment throughout a pa-
tient’s life.
This is especially important
for patients with inflammatory-
related risk factors common to
periodontal disease and general
health conditions such as dia-
betes, cardiovascular disease
and pregnancy. Oftentimes,
these patients’ care requires
careful comanagement between
the periodontist and referring
dentist, so to suggest that most
cases can be “easily” treated
without tried and true “conven-
tional periodontal therapy” is ir-
responsible and could negative-
ly affect the health of our
patients.
The Academy’s mission, as
supported by our periodontist
and general practitioner mem-
bers, is to advance the oral
health and well-being of pa-
tients through expertise in peri-
odontics, implants, periodontal
medicine, periodontal plastic
surgery and oral reconstructive
surgery. Helping all patients
achieve periodontal health is
the keystone of this mission,
with the supporting elements
offering options for patients who
wish to correct damage caused
by the disease or to improve
appearance.
I suggest that Dr.
Christensen review the ADA
Principles of Ethics and Code of
Professional Conduct before he
implies that the dental profes-
sion is in violation of these guid-
ing principles. Of particular in-
terest might be the principle of
patient autonomy that states:
“[T]he dentist’s primary obliga-
tions include involving patients
in treatment decisions in a
meaningful way, with due con-
sideration being given to the pa-
tient’s needs, desires and abili-
ties.”2 This is a standard, I
believe, that most of us feel com-
fortable achieving every day.
Kenneth A. Krebs, DMD
President
American Academy of
Periodontology
Chicago