■— [[TIERS
experts Cottone and Molinari
(JADA, August 1991).
Our purpose was to generate
scientific data to provide
additional support for that
recommendation, which was
based on the assumption that
reduction of microbial back-
spray in a safe and cost-effect-
ive m anner is a valid consid­
eration for dental professionals.
Our study determined the
effect of pre-procedural use of
an antiseptic mouthrinse on
reduction of aerosolized
bacteria derived from an
ultrasonic scaling. We designed
a well-controlled study, carried
it out under the conditions
stated and analyzed the data.
Based on the study design
and the data presented, it is up
to each practitioner to decide on
the usefulness of this procedure
in his or her office protocol.
D aniel H. Fine, D.M.D.
New York
WHAT’S NEW?
I’m writing about “Modern
M anagement of Dental Caries”
(June JADA) by Dr. Maxwell H.
Anderson and others. As
interesting as this article is, I
was astonished to read this
approach to caries management
being referred to as new.
The excavation of all carious
lesions (in ram pant caries) even
before restorations are placed,
and the application of anti­
bacterial strategies, was
advocated in the ’50s when I
was in school. Indeed, treating
caries as a bacterial disease
with its own characteristic and
unique conditions was what we
were taught.
The authors have incorporated
state-of-the-art modalities, but
the basic approach is not new.
M ichael Gelb, D.D.S.
R iverdale, N.Y.
18 JADA, Vol. 124, October 1993
A u th o r ’s response: Dr. well-established th at non-
Gelb’s comments regarding the
excavation of caries are well-
taken. If we gave the impression
th a t caries-control restorations
were “new,” then we cited the
procedures poorly. Indeed, these
procedures have been advocated
since before the ’50s.
However, the remainder of
Dr. Gelb’s comments are
puzzling. In the ’50s we were not
sure of the relationship between
mutans streptococci, Lacto­
bacilli, or Actinomyces species
and dental caries. In fact, many
of these relationships are still
being clarified. The major
difference between the knowl­
edge of the ’50s and our current
understanding is th at this
disease is an infection caused by
specific organisms and not the
plaque biomass, per se.
Additionally, if Dr. Gelb’s
response suggests th a t we used
toothbrushing and flossing as
“anti-bacterial strategies,” then
we did not clearly convey the
message th a t mechanical
cleansing alone is not effective
in the control of this disease.
Rather, we need specific strate­
gies aimed a t reduction and
elimination of the
odontopathogens.
M axwell H. A nderson,
D.D.S., M.S., M.Ed.
U niversity o f W ashington
Seattle
RIDGE AUGMENTATION
AND THE ELDERLY
Dr. Ronald L. Ettinger’s article
“Managing and Treating the
Atrophic Mandible” (July
JADA) reports negative
prosthetic experience following
hydroxylapatite ridge augmen­
tation for “elderly patients.” He
refers to a 1983 article in which
porous hydroxylapatite was
used for th a t purpose. It is now
resorbable HA is the material of
choice. He fails to explain the
criteria used to classify patients
as “elderly.”
Granules trapped between
the periosteum and mucosa
usually result from poor
surgical technique and may be
corrected surgically. Follow-up
(1983-93) of my 52 Michigan
patients between ages 62 to 89
fails to reveal “a pattern of pain
associated with slow healing of
the surgical site and chronic
periostitis or dehiscences in the
mucosa resulting in discomfort
and the continuous loss of
granules.”
My cases indicate th a t the 62
and older do as well surgically
and prosthetically as the
younger patients, and th at the
HA augmentation is of signif­
icant help to most of them.
Proper case selection and
meticulous surgical technique
with HA augmentation are
imperative. It is one of many
surgical approaches th at may
help the patient with an
atrophic mandible. Certainly it
has limitations. However, in my
experience, being “elderly” does
not, in and of itself, result in
negative prosthetic results.
Arnold B. Schaffer, D.D.S.
Flint, Mich.
WHERE’S THE INDEX?
I would like to see the indexes
of authors and subject m atter
back in The Journal of the
American Dental Association.
It would make The Journal
much more valuable and
usable.
Robert E. L. M iller Jr.,
D.D.S.
Front Royal, Va.
E ditor’s note: An index to
articles published this year in