Questions of therapy should be evaluated carefully by each teacher and student of periodontics and by every dentist who practices periodontics. Therefore it is sug gested that this urgent topic be referred to the Committee on Education, other appropriate committees of the Academy, American Board of Periodontology, and to the general membership for investigation and action.
Letter to the Editors The Committee on Ethics recently received a letter from an Academy member (Doctor X) commenting on the conduct and judgement of another member (Doctor Y). The letter stated that a female in her late twenties consulted Doctor Y for evaluation of her periodontal condition. After examination he recommended periodon tal surgery for several quadrants of her mouth, to be done under intravenous anesthesia, and other nonsurgical techniques not described in the letter. The patient then consulted Doctor X, who practices in another state and who has been exposed to a philosophy of periodontics different from that of Doctor Y. Doctor X felt that the patient should be treated with scaling, subgingival curet tage, and techniques for home maintenance.
Ira Franklin Ross, D.D.S. REFERENCES
1. Ramfjord, S. P. et al. Sub-gingival curettage versus sur gical elimination of periodontal pockets. J Periodontol 3 9 : 167, 1968. 2. Ross, I. F. et al. The results of treatment. A long term study of one hundred and eighty patients. Paradontologie 4: 126, 1971. 3. Ramfjord, S. P. et al. Longitudinal study of periodontal therapy. J Periodontol 44: 66, 1973. 4. Ramfjord, S. P. et al. Results following three modalities of periodontal therapy. J Periodontol 46: 522, 1975.
Several questions arise. Were there differences in the two treatment plans because of differences in training, experience, judgement, and other personal factors be tween the two periodontists? Did fee motivate the more extensive treatment plan by Dr. Y? Did the treatment plans differ because of personal and fee factors? The problem is an old one and is not improving with age. The problem may not be concerned primarily with ethics, unless fee is the most important factor in deter mining treatment for a patient. When a patient is treated primarily so that the therapist may collect a fee, the therapist is guilty of unethical conduct. However, differ ences in treatment are often the result of differences in education, experience, judgement, and mental and physi cal health of therapists, rather than fee. Techniques for treating periodontal diseases have become more sophisticated and complex over the past several years. However, our objectives still remain the same: to retain and preserve teeth and their support in optimum health, comfort, and appearance. These objec tives should be achieved with the least discomfort, fewest undesirable side effects, in the most efficient manner, and at a cost fairest to the patient. What are the best ways of obtaining these objectives for patients? Are newer, more complex techniques achieving these goals more successfully than less complex techniques? Are patients benefitting from more complex techniques even though there may be more discomfort, some side effects, and greater expense? Recent studies seem to question our present directions. Great changes are occurring in economic and social structures of the world. Periodontal disease is an impor tant international public health problem because of the suffering and disability of millions of people who have it, but fewer sufferers can be treated as the complexity and cost of periodontal therapy increases. If periodontics is to provide a significant service to the great mass of individuals who are in danger of losing their teeth, we as periodontists must consider changes in our treatment procedures. We must consider economic and social factors along with health factors.
Letter to the Editors In our article, Schwartz, J. and Dibblee, M., 'The Role of IgE in the Release of Histamine from Human Gingival Mast Cells", J Periodontol 46: 171, 1975, we stated that "Identification either of IgE itself or IgE antibodies in gingiva has not been accomplished". This statement was footnoted citing the article of Nisengard, et al., Ann NY Acad Sci 177: 39, 1971. We concluded that the addendum published with their article negated their findings, and that the fluorescence noted in gingiva possibly was due to nonspecific staining and not the result of an antigen-antibody reaction. (We refer the reader to page 46 of their article). In a personal communication of September, 1975, from Dr. Nisengard, he stated that the addendum published with their article, did not relate to their article per se, but did relate to a discussion period after his paper was presented at a meeting in Stockholm, and that only a part of the discussion was published by the Annals of N.Y. Academy of Science as an addendum to his article. He points out "the addendum was specifically directed to the non-specific staining seen with leukocytes and not to the IgE localized to cells in the gingiva or the in vivo IgE coating of subgingival bacteria. When labeled human IgG was applied to these structures, non-specific staining did not occur as was seen with leukocytes and that the non-specific staining of leukocytes could be reduced or eliminated by dilution of conjugates in albumin". This personal communication of Dr. Nisengard clari fies that their addendum did not relate to their article.
1-4
299
300
J. Periodontol May, 1976
Letters to the Editors
It should be pointed out, that while our paper was "in press", Genco et al. (J Periodontol 45: 330, 1974) reported IgE in inflamed gingiva. The studies of Nisengard, et al. and Genco et al. used direct immunofluorescent techniques to locate IgE to mononuclear cells, presumably plasma cells in inflamed gingiva. Our findings of IgE in clinically healthy human gingiva
using the "reverse anaphylaxis technique" (anti-human IgE) to release histamine indirectly from gingival mast cells, is further evidence of IgE in gingiva. Joseph Schwartz, D.D.S., M.S.D. Department of Periodontology University of Oregon Dental School
In Memoriam Lowell N. Peterson 1904-1975 News has reached us of the loss of a beloved friend and colleague, Dr. Lowell N. Peterson of San Francisco, who died unexpectedly at the age of 70. A graduate of the College of Dentistry of the University of California, Dr. Peterson served for most of his career on the faculty of the University of the Pacific, where for many years he was Chairman of the Department of Periodontology. At the time of his death he held the rank of Professor Emeritus of Periodontology. He also was a very successful private practitioner in San Francisco. Dr. Peterson was a Diplomate of the American Board of Periodontology and a Fellow of the American College of Dentists and the International College of Dentists. He was a member of the American Dental Association, the American Academy of Periodontology, the Western Society of Periodontology, the American Institute of Oral Biology, and the American Association for the Advancement of Science. He had served as chairman and member of numerous committees of the American Academy of Periodontology and was a past president of the University of California Dental School Alumni Association. Dr. Peterson was very active in the California Academy of Periodontology, where he acted as historian/librarian. He was also a member of Omicron Kappa Upsilon. Dr. Peterson was a sought-after clinician and lecturer on the local, state and national levels and a frequent consultant for telephone inquirers on radio and television programs. His dental interests, besides periodontology proper, encompassed occlusion and nutrition. He published a number of papers in state and national dental journals and served as a consultant to the Veterans Administration. In recent years he had conceived of and become very active in the development of the A. W. Ward Dental Museum at the University of the Pacific, which was opened in February 1975, largely through his efforts. The museum contains an interesting collection of historical and valuable dental artifacts; Dr. Peterson not only spent much time in the design of the museum and the collecting of items for it, but he also contributed many important items of historical value to it. Dr. Peterson was a devoted member of his fraternity, Delta Sigma Delta, and served for two terms as Grand Master of the graduate chapter in San Francisco. His hobbies included photography, philately and music. Lowell was a talented saxophonist and played in a band with several colleagues; he even worked his way through Dental School as a saxophonist. He was a member of the prestigious Bohemian Club for more than 40 years and served as chairman for this organization. In fact, he died of a cardiac arrest at the Bohemian Grove on the Russian River in the company of his best friends. Dr. Peterson is survived by his beloved wife, Mildred, and a son, Neil Bruce Peterson, both of San Francisco. To them we express our heartfelt sympathy. Their loss is shared by his many devoted friends. It is a loss for his community and for the American Academy of Periodontology.
Letter to the Editors The Committee on Ethics recently received a letter from an Academy member (Doctor X) commenting on the conduct and judgement of another member (Doctor Y). The letter stated that a female in her late twenties consulted Doctor Y for evaluation of her periodontal condition. After examination he recommended periodon tal surgery for several quadrants of her mouth, to be done under intravenous anesthesia, and other nonsurgical techniques not described in the letter. The patient then consulted Doctor X, who practices in another state and who has been exposed to a philosophy of periodontics different from that of Doctor Y. Doctor X felt that the patient should be treated with scaling, subgingival curet tage, and techniques for home maintenance.
Ira Franklin Ross, D.D.S. REFERENCES
1. Ramfjord, S. P. et al. Sub-gingival curettage versus sur gical elimination of periodontal pockets. J Periodontol 3 9 : 167, 1968. 2. Ross, I. F. et al. The results of treatment. A long term study of one hundred and eighty patients. Paradontologie 4: 126, 1971. 3. Ramfjord, S. P. et al. Longitudinal study of periodontal therapy. J Periodontol 44: 66, 1973. 4. Ramfjord, S. P. et al. Results following three modalities of periodontal therapy. J Periodontol 46: 522, 1975.
Several questions arise. Were there differences in the two treatment plans because of differences in training, experience, judgement, and other personal factors be tween the two periodontists? Did fee motivate the more extensive treatment plan by Dr. Y? Did the treatment plans differ because of personal and fee factors? The problem is an old one and is not improving with age. The problem may not be concerned primarily with ethics, unless fee is the most important factor in deter mining treatment for a patient. When a patient is treated primarily so that the therapist may collect a fee, the therapist is guilty of unethical conduct. However, differ ences in treatment are often the result of differences in education, experience, judgement, and mental and physi cal health of therapists, rather than fee. Techniques for treating periodontal diseases have become more sophisticated and complex over the past several years. However, our objectives still remain the same: to retain and preserve teeth and their support in optimum health, comfort, and appearance. These objec tives should be achieved with the least discomfort, fewest undesirable side effects, in the most efficient manner, and at a cost fairest to the patient. What are the best ways of obtaining these objectives for patients? Are newer, more complex techniques achieving these goals more successfully than less complex techniques? Are patients benefitting from more complex techniques even though there may be more discomfort, some side effects, and greater expense? Recent studies seem to question our present directions. Great changes are occurring in economic and social structures of the world. Periodontal disease is an impor tant international public health problem because of the suffering and disability of millions of people who have it, but fewer sufferers can be treated as the complexity and cost of periodontal therapy increases. If periodontics is to provide a significant service to the great mass of individuals who are in danger of losing their teeth, we as periodontists must consider changes in our treatment procedures. We must consider economic and social factors along with health factors.
Letter to the Editors In our article, Schwartz, J. and Dibblee, M., 'The Role of IgE in the Release of Histamine from Human Gingival Mast Cells", J Periodontol 46: 171, 1975, we stated that "Identification either of IgE itself or IgE antibodies in gingiva has not been accomplished". This statement was footnoted citing the article of Nisengard, et al., Ann NY Acad Sci 177: 39, 1971. We concluded that the addendum published with their article negated their findings, and that the fluorescence noted in gingiva possibly was due to nonspecific staining and not the result of an antigen-antibody reaction. (We refer the reader to page 46 of their article). In a personal communication of September, 1975, from Dr. Nisengard, he stated that the addendum published with their article, did not relate to their article per se, but did relate to a discussion period after his paper was presented at a meeting in Stockholm, and that only a part of the discussion was published by the Annals of N.Y. Academy of Science as an addendum to his article. He points out "the addendum was specifically directed to the non-specific staining seen with leukocytes and not to the IgE localized to cells in the gingiva or the in vivo IgE coating of subgingival bacteria. When labeled human IgG was applied to these structures, non-specific staining did not occur as was seen with leukocytes and that the non-specific staining of leukocytes could be reduced or eliminated by dilution of conjugates in albumin". This personal communication of Dr. Nisengard clari fies that their addendum did not relate to their article.
1-4
299
300
J. Periodontol May, 1976
Letters to the Editors
It should be pointed out, that while our paper was "in press", Genco et al. (J Periodontol 45: 330, 1974) reported IgE in inflamed gingiva. The studies of Nisengard, et al. and Genco et al. used direct immunofluorescent techniques to locate IgE to mononuclear cells, presumably plasma cells in inflamed gingiva. Our findings of IgE in clinically healthy human gingiva
using the "reverse anaphylaxis technique" (anti-human IgE) to release histamine indirectly from gingival mast cells, is further evidence of IgE in gingiva. Joseph Schwartz, D.D.S., M.S.D. Department of Periodontology University of Oregon Dental School
In Memoriam Lowell N. Peterson 1904-1975 News has reached us of the loss of a beloved friend and colleague, Dr. Lowell N. Peterson of San Francisco, who died unexpectedly at the age of 70. A graduate of the College of Dentistry of the University of California, Dr. Peterson served for most of his career on the faculty of the University of the Pacific, where for many years he was Chairman of the Department of Periodontology. At the time of his death he held the rank of Professor Emeritus of Periodontology. He also was a very successful private practitioner in San Francisco. Dr. Peterson was a Diplomate of the American Board of Periodontology and a Fellow of the American College of Dentists and the International College of Dentists. He was a member of the American Dental Association, the American Academy of Periodontology, the Western Society of Periodontology, the American Institute of Oral Biology, and the American Association for the Advancement of Science. He had served as chairman and member of numerous committees of the American Academy of Periodontology and was a past president of the University of California Dental School Alumni Association. Dr. Peterson was very active in the California Academy of Periodontology, where he acted as historian/librarian. He was also a member of Omicron Kappa Upsilon. Dr. Peterson was a sought-after clinician and lecturer on the local, state and national levels and a frequent consultant for telephone inquirers on radio and television programs. His dental interests, besides periodontology proper, encompassed occlusion and nutrition. He published a number of papers in state and national dental journals and served as a consultant to the Veterans Administration. In recent years he had conceived of and become very active in the development of the A. W. Ward Dental Museum at the University of the Pacific, which was opened in February 1975, largely through his efforts. The museum contains an interesting collection of historical and valuable dental artifacts; Dr. Peterson not only spent much time in the design of the museum and the collecting of items for it, but he also contributed many important items of historical value to it. Dr. Peterson was a devoted member of his fraternity, Delta Sigma Delta, and served for two terms as Grand Master of the graduate chapter in San Francisco. His hobbies included photography, philately and music. Lowell was a talented saxophonist and played in a band with several colleagues; he even worked his way through Dental School as a saxophonist. He was a member of the prestigious Bohemian Club for more than 40 years and served as chairman for this organization. In fact, he died of a cardiac arrest at the Bohemian Grove on the Russian River in the company of his best friends. Dr. Peterson is survived by his beloved wife, Mildred, and a son, Neil Bruce Peterson, both of San Francisco. To them we express our heartfelt sympathy. Their loss is shared by his many devoted friends. It is a loss for his community and for the American Academy of Periodontology.
