LETTERS T O THE EDITOR THE JOURNAL devotes this section to com m ent by readers on top ics o f current interest to dentistry. The editor reserves the right to edit all com m unications to fit available space and requires that all letters be signed. Printed com m unications do not necessarily reflect the o p in ion or official p o licy o f the Association. Your participation in this section is invited.

Fluoridation protects occlusal areas □ In the “ status report on acid etch­ ing procedures (The Journal, Sep­ tember, 1978), the Council on Dental Materials and Devices says that the occlusal area “ does not benefit sig­ nificantly from fluoridation proce­ dures.” In fact, waterborne fluoride does protect occlusal fissures (and buccal pits) significantly against dental caries, but not to the same extent that it protects proximal and other smooth surfaces. The misconception that it does not probably stems from the early studies in naturally fluori­ dated and fluoride-deficient com ­ munities where differences in mean DMF teeth were assessed without a comparison of caries prevalence for specific tooth-surface sites. Dean re­ ported outstanding protection on the proximal surfaces and increased proportions of cariesfree children among those who drank fluoridebearing water. He referred briefly to pit and fissure caries in the pion­ eering Galesburg-Monmouth Study, but did not present intercity caries prevalence data for occlusal sites. In “ The benefits of water fluorida­ tion” (Caries Res No. 2, 1974), Backer-Dirks discusses the important protective effect of water fluoridation on occlusal fissures. In a recent study o f seven cities in five states we found that water-borne fluoride exerted an important anticaries action on all surfaces recorded. Although the greatest anticaries effect was ob­ served on proximal surfaces, a slightly smaller but still important protective effect could be observed

for occlusal and buccolingual sur­ faces in each fluoridated city. When the mean DMF surface scores for 12-to-15-year-old children in one fluoridated city were compared with those for a similar group in a nonfluoridated city, there was a dif­ ference as great as 91% for proximal surfaces and 82% for occlusal sites in favor of the fluoridated city. HAROLD R. ENGLANDER. DDS. MPH SAN ANTONIO, TEX

Orthodontic goals □ Dr. Wood and his colleagues (The Journal, October 1978) are certainly

correct in advocating a team ap­ proach to complicated cases. Much space, however, was given to a dis­ cussion of centric relation and cen­ tric occlusion, and almost two full pages were devoted to the Hawley appliance and surgical splint con­ struction. Much attention also was devoted to the mechanical aspects of the restorative procedures. Although there was a reference to the problem

of “ pain in the temporomandibular joint or of the muscle pain dysfunc­ tion syndrome,” a definitive diag­ nosis was not mentioned. Pain within the joint may be indicative of degenerative joint disease whereas myofascial pain dysfunction syn­ drome involves pain in various mus­ cles of mastication. What did this pa­ tient have? I believe we should look at the pa­ tient as a whole, and particularly consider the entire face, not just the teeth, in diagnosing orthognathic problems. It appears that this patient has the long-face syndrome, not just a protrusive maxilla. Preoperatively she has more than a centimeter of lip incompetence; this has not changed much postoperatively. The postsurgical models show an irregular plane of occlusion due to hypereruption of the posterior maxillary teeth. Level­ ing of this occlusion, shortening of the face, and correction of lip incom­ petence could have been accom­ plished by a segmental Le Fort I os­ teotomy with differential impaction of maxillary segments and autorota­ tion of the mandible. The authors say, “ Argument could be made for mandibular advance­ ment.” Not if the correct diagnosis is made! Impaction of the maxilla al­ lows the mandible to autorotate, thereby providing the patient with a decreased Class II appearance. In­ termaxillary fixation may only be necessary for a short period, or not at all, and postoperative pain is no greater. BOB D. GROSS, DDS, MS SHREVEPORT, LA

A u th or’s comment; If, instead of JADA, V ol. 98, January 1979 ■ 11

Fluoridation protects occlusal areas.

LETTERS T O THE EDITOR THE JOURNAL devotes this section to com m ent by readers on top ics o f current interest to dentistry. The editor reserves the...
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