Standard procedure

Standard procedure

■ I think that it is an outrage in these times of recession-inflation not to make the many sacrifices that are necessary to stay within our means; and...

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■ I think that it is an outrage in these times of recession-inflation not to make the many sacrifices that are necessary to stay within our means; and a 37% increase in our compon­ ent dues is not the way to “ bite the bullet.” By sacrifice, I only mean a tempor­ ary curtailment or reduction of vari­ ous dental society programs and ex­ penses. Hopefully, the need for these restraints will pass in a short time and then w e can once again expand our horizons and/or programs. M y suggestion is to keep the dues where they are and accordingly cut our expenditures to stay within these perimeters. I hope that the dues increase is not already a “ fait accom pli” and there is room for considerations of my thoughts. RODNEY BLOOM, DDS TARZANA, CALIF

G enetic counseling m I wholeheartedly endorse the posi­ tion of Drs. Giansanti and Budnick in calling for an emphasis on genetically determined disease in the curriculums o f dental schools ( j a d a 90:439-442, 1975). Their experience in finding in­ adequate genetic counseling in many kindreds affected with heritable de­ fects of dental hard tissue is not unique. Such experiences are wide­ spread and are not limited to condi­ tions involving the teeth only. There are numerous heritable disorders of soft oral tissues and numerous others involving soft and hard tissues simul­ taneously. In addition to the herit­ able defects isolated to the oral cav­ ity, there are innumerable multisys­ tem disorders with consistent oral findings. In som e o f these multisystem disorders the oral findings are of ma­ jor diagnostic importance. The dentist is the only health pro­ fessional involved in diagnosis and management o f inherited defects iso­ lated to the oral cavity. Whether he is adequately prepared or ill prepared to recognize, treat, and counsel for these conditions, determines the qual­ ity o f service he renders to the afflict­

ed patient and the patient’s family. Heritable oral disorders can be seri­ ous. They can interfere with normal physiology, they can be malignant or premalignant, and they can be dis­ figuring. Treatment is important for these conditions, but is not the only consideration. Counseling about the risk for the condition recurring in the family is often as important a con­ sideration as treatment. If the dentist does not counsel for these conditions, who will? A knowledge o f genetics in multi­ system disorders and in oral disor­ ders treated by other health profes­ sionals will serve the dentist well. The oral manifestations o f a multisystem disorder may appear earlier or be more apparent than manifestations in other system s. This aspect of oral diagnosis is stressed heavily in den­ tal education for metabolic disorders but is largely ignored for genetic dis­ orders. Tw o examples o f genetic con­ ditions with early involvement of oral structures are the Gardner syndrome and osteogenesis imperfecta. In one case osteom as at the angle of the man­ dible and in the other brown, opales­ cent teeth may precede other man­ ifestations of the disorder. N ot only should the dentist recognize these conditions, but he should be prepared to counsel for them in the event that other concerned health professionals do not. The experienced dentist should be as capable to counsel and should have the same obligation to counsel as any other specialist who sees a patient for a particular com­ plaint and recognizes multiple sys­ tem involvement. Genetic counseling is of particular interest as it applies to orofacial clefting. Few patients of the multitude with this common defect receive ad­ equate counseling. The medical spec­ ialists who treat cleft lip and cleft pal­ ate do not know how to counsel these patients or do not have the interest to do so. I have heard estimates of re­ currence risk for clefting in a family that have been as much as 60% off the correct estimate! Counseling is seri­ ous business to a couple who wants to have a family but is at risk for having affected children. I contend that to counsel these patients incorrectly or to ignore genetic counseling is mal­

7 38 ■ LETTER S TO TH E EDITO R / JADA, Vol. 90, April 1975

practice by any health specialist. Dental educators are beginning to realize the importance of genetic fac­ tors in dental disease. Evidence of this realization is the fact that the most re­ cent volume of D ental Clinics o f N orth A m erica was devoted to gene­ tics and that the July 1974 volume had a chapter on genetically determined oral disorders. The goals of these edu­ cators must be to expand the offering of clinical genetics in continuing edu­ cation courses. In no other way will the general practitioner gain the expo­ sure to recognize and completely man­ age inherited disorders in his (her) of­ fice. RONALD J. JORGENSON, DDS M EDICAL UNIVERSITY OF SOUTH CAROLINA

Standard procedure ■ Along with many of our colleagues we have instituted as standard pro­ cedure in our offices the taking of blood pressure, oral facial examina­ tion, and improved health history tak­ ing. This is proving to be very reward­ ing in: —the discovery of undetected dis­ ease; —upgrading the public opinion of the dental profession; —a personal satisfaction by ren­ dering a more complete health service; and —in prevention of malpractice. After the taking of a health history, patients have been heard to say “ I wish my doctor knew as much about m e.” It appears that many physician specialists, for example, ophthalmol­ ogists, dermatologists, and psychia­ trists, are not too involved in this type of service for their patients. ALBERT C. KOPPEL, DDS WASHINGTON

On retirem ent com munity m A s one o f the many who believes that group life insurance and a journal is all that I am getting for my $100.00