or style necessary to perform treatm ent in the m ost efficient and ergonomic m anner available. Ultimately this benefits everyone, especially the patient. I urge dentists to evaluate their priorities in light of preservation of the physical and m ental health of the dental staff. A healthy staff will radiate confidence and caring to the patient and will more than make up for a handpiece hose over the patien t’s chest or some similar “calam ity” in equipm ent positioning. Again, my thanks to Dr. Pride and to JADA for addressing these issues. John M. Young, D.D.S., M.Sc. San A ntonio, Texas THE NEW FO RM AT
I congratulate you and your staff. The Journal used to be som ething that I would briefly peruse, and more often than not, prom ptly deposit in the round file. I can unequivocally say that since your new form at and the m any changes th at have been going on with this journal, I actually find myself enjoying it. I go through it very carefully. .. not wanting to miss anything. The layouts are great—the size of the print, the spacing and the graphics. Please know th at some of us out here really do appreciate all the effort th at you and your staff are making. W.W. Wibby, D.D.S. Bangor, Maine M A L P R A C T IC E
I recently had my second encounter with a m alpractice situation. The first was throw n out of court. The second was settled out of court. The cause for my patient’s litigation was that in adm inis 14
JADA, Vol. 122, November 1991
tering an inferior alveolar nerve injection the nerve was traum a tized and the patient experienced residual paresthesia to the lip and chin. I did two innocent but not very bright things. When I h it the nerve the patient flinched and I explained th at “I had h it the bull’seye.” Secondly, I was consequently made to feel so guilty by the patient that I wound up doing her rem aining restorative services at no charge. I have no way of knowing four years later w hether this patient has any lingering paresthesia since the case was settled and I have not seen her. I would bet, however, that w hen she gets her check there will be a m iraculous spontaneous recovery. I am writing because I am angry and feel that I let this patient and the entire legal system get the best of me. I know in my m ind that I did nothing wrong and that there could not have been any negligence on my part. So why didn’t I go to court? Let me say that for the first two years that this case was pending I insisted that my attorney not settle and that I was prepared to fight in court if necessary. As the case began to gather m om entum, my insurance com pany suggested th at I have my own attorney as well as their appointed attorney consult on the case. After the two discussed the case my personal attorney called to give me the straight scoop. If I chose not to settle and lost in court I would be personally liable for any am ount above that offered by the insurance com pany to settle. I couldn’t believe this was true. After my local insurance agent confirmed this I began to reconsider my position.
The critical factor was obviously the jury. It is the capricious nature of a jury that forced me to concede and allow the settlem ent. At this point I was looking forward to the patient not accepting a settlem ent because then if we w ent to court I had nothing to lose except my pride. Or so I thought until I read the book “Jury of my Peers, a Surgeon’s Encounter with the Malpractice Crisis” by Howard C. Snider Jr., M.D. Every practitioner should make this m ust reading. The point Dr. Snider makes is that w hen we in the health professions sit in a malpractice trial we are not sitting in front of our peers. Jury selection by the attorneys seems to be directed at getting anyone but our peers selected for jury duty. Doesn’t it make sense that those who sit and make judgm ent in malpractice cases should be the people who are best able to judge the m erits of the case? An incredible point made by Dr. Snider is th at the jury has to learn all about the medical profession in a few days while it took him over a dozen years to barely begin at all! Why not put the ADA along with the AMA and other health professional associations in a unified effort to begin to effect change in the legal system? What is the ADA doing in this regard? I refuse to accept that nothing can be done. I suggest th at one association against the whole legal trade is hopeless, but unified I believe we can make a difference. Those of you who have not had to make decisions such as mine or who have not gone through an emotionally wrenching m alpractice trial such as Dr. Snider’s can consider yourselves
lucky. Unfortunately, m ost of us will go through an episode like this a t some tim e in our careers. W ouldn’t it be better, however, th at we not be judged by people who have no idea what dentistry is about? Donald M. Pomeranz, D.D.S. St. Thomas, U.S. Virgin Islands A U G U ST JA D A
Your excellent August edition which brings into proper focus the concerns about AIDS, amalgam and fluoride and attem pts to provide a reasonable and scientific basis for understanding these complex m atters has left me with mixed feelings. The issues of amalgam and fluoride are well presented. The uninform ed contention by opponents th at fluoride and the m ercury in amalgams are potential poisons (seem ingly logical to the scientifically naive) are examined thoroughly. Based on well-docu m ented research and long-term experience with amalgam and fluoride, the conclusion establish ing the efficacy and safety of these two m easures is convincing. Unfortunately, similar careful m ethodology was not employed in the AIDS analysis. In response to the hysteria generated by the transm ission of HIV by the Florida dentist to five of his patients the (also seemingly logical) presum ption by those in authority is th at if universal precautions are utilized the fear of such infection in the dental office is unsubstantiated. The scientific basis for this determ ination m ust be questioned. Careful study of the 183 articles cited in the footnotes of the AIDS articles indicate only 16
JADA, Vol. 122, November 1991
one 1981 reference of a practitioner to patient trans m ission of disease, hepatitis, in w hich faulty procedures played a role. Investigating the literature further, I was able to identify 20 such outbreaks of hepatitis, which are also dated and not all occur ring in dental offices. Sixty percent w ere attributable to the lack of aw areness at the time by those carrying the disease of the need to use gloves during treatm ent. I can find no other docum ented cases of dentist to patient transm ission of any disease at any time during dental treatm ent. With our history of 150 years of dental treatm ent prior to universal precautions why are there no significant reports of patient to patient transm ission of infectious disease during dental treatm ent? Clusters of disease, easily traceable to dental offices, should by now have been well docum ented. We reject the anti-fluoridationists and anti-amalgamists because research and experience do not substantiate their position. Why are we so willing to accept the imposition of extrem e infection control procedures for our offices w ithout definitive scientific docum entation? A thorough rethinking of the need for an efficacy of all currently recom m ended infection control procedures m ust be started w ithout delay and a new modified scientifically based standard promulgated. Arthur L. Yeager, D.D.S. W estwood, N.J. M O D E S T PROPOSAL
“Public policy should be driven by the need to protect community
welfare and safety, not by the exigencies of public opinion.” This quote is from the last paragraph of Drs. Marshall, Thomasma, and O’Keefe’s article on disclosing HIV status (August). I couldn’t agree m ore w holeheartedly with this sentim ent; and, as such, I have been continually and increasingly concerned that public policy thus far regarding AIDS has been designed to accomplish exactly the opposite. One of the most glaring characteristics of our current “Age of Enlightenm ent” has been the complete abandonm ent of the idea th at individuals are in any way responsible for their own actions or their consequences. Thus, no one will even consider putting the blame for the spread of AIDS where it belongs, on homosexuals and drug addicts, for fear of being shouted down and ostracized by the “politically correct” who are terrified of offending any m em ber of a very vocal and strident m inority interest group. The concern for the “rights and welfare” of those afflicted with this disease has completely over powered the “right” of society as a whole not to be exposed to a deadly, contagious sexually transm itted disease, which is exactly w hat AIDS is! AIDS is no more a “handicap” than syphilis or gonorrhea. What does all this have to do with dentistry? Nothing, until the powers that be attem pt to legislate or regulate a political agenda to make hom osexuality acceptable to the masses. Redefining mode of locales of treatm ent so as not to offend the victims of this disease is not a sound scientifically or medically defensible position. It’s
I congratulate you and your staff. The Journal used to be som ething that I would briefly peruse, and more often than not, prom ptly deposit in the round file. I can unequivocally say that since your new form at and the m any changes th at have been going on with this journal, I actually find myself enjoying it. I go through it very carefully. .. not wanting to miss anything. The layouts are great—the size of the print, the spacing and the graphics. Please know th at some of us out here really do appreciate all the effort th at you and your staff are making. W.W. Wibby, D.D.S. Bangor, Maine M A L P R A C T IC E
I recently had my second encounter with a m alpractice situation. The first was throw n out of court. The second was settled out of court. The cause for my patient’s litigation was that in adm inis 14
JADA, Vol. 122, November 1991
tering an inferior alveolar nerve injection the nerve was traum a tized and the patient experienced residual paresthesia to the lip and chin. I did two innocent but not very bright things. When I h it the nerve the patient flinched and I explained th at “I had h it the bull’seye.” Secondly, I was consequently made to feel so guilty by the patient that I wound up doing her rem aining restorative services at no charge. I have no way of knowing four years later w hether this patient has any lingering paresthesia since the case was settled and I have not seen her. I would bet, however, that w hen she gets her check there will be a m iraculous spontaneous recovery. I am writing because I am angry and feel that I let this patient and the entire legal system get the best of me. I know in my m ind that I did nothing wrong and that there could not have been any negligence on my part. So why didn’t I go to court? Let me say that for the first two years that this case was pending I insisted that my attorney not settle and that I was prepared to fight in court if necessary. As the case began to gather m om entum, my insurance com pany suggested th at I have my own attorney as well as their appointed attorney consult on the case. After the two discussed the case my personal attorney called to give me the straight scoop. If I chose not to settle and lost in court I would be personally liable for any am ount above that offered by the insurance com pany to settle. I couldn’t believe this was true. After my local insurance agent confirmed this I began to reconsider my position.
The critical factor was obviously the jury. It is the capricious nature of a jury that forced me to concede and allow the settlem ent. At this point I was looking forward to the patient not accepting a settlem ent because then if we w ent to court I had nothing to lose except my pride. Or so I thought until I read the book “Jury of my Peers, a Surgeon’s Encounter with the Malpractice Crisis” by Howard C. Snider Jr., M.D. Every practitioner should make this m ust reading. The point Dr. Snider makes is that w hen we in the health professions sit in a malpractice trial we are not sitting in front of our peers. Jury selection by the attorneys seems to be directed at getting anyone but our peers selected for jury duty. Doesn’t it make sense that those who sit and make judgm ent in malpractice cases should be the people who are best able to judge the m erits of the case? An incredible point made by Dr. Snider is th at the jury has to learn all about the medical profession in a few days while it took him over a dozen years to barely begin at all! Why not put the ADA along with the AMA and other health professional associations in a unified effort to begin to effect change in the legal system? What is the ADA doing in this regard? I refuse to accept that nothing can be done. I suggest th at one association against the whole legal trade is hopeless, but unified I believe we can make a difference. Those of you who have not had to make decisions such as mine or who have not gone through an emotionally wrenching m alpractice trial such as Dr. Snider’s can consider yourselves
lucky. Unfortunately, m ost of us will go through an episode like this a t some tim e in our careers. W ouldn’t it be better, however, th at we not be judged by people who have no idea what dentistry is about? Donald M. Pomeranz, D.D.S. St. Thomas, U.S. Virgin Islands A U G U ST JA D A
Your excellent August edition which brings into proper focus the concerns about AIDS, amalgam and fluoride and attem pts to provide a reasonable and scientific basis for understanding these complex m atters has left me with mixed feelings. The issues of amalgam and fluoride are well presented. The uninform ed contention by opponents th at fluoride and the m ercury in amalgams are potential poisons (seem ingly logical to the scientifically naive) are examined thoroughly. Based on well-docu m ented research and long-term experience with amalgam and fluoride, the conclusion establish ing the efficacy and safety of these two m easures is convincing. Unfortunately, similar careful m ethodology was not employed in the AIDS analysis. In response to the hysteria generated by the transm ission of HIV by the Florida dentist to five of his patients the (also seemingly logical) presum ption by those in authority is th at if universal precautions are utilized the fear of such infection in the dental office is unsubstantiated. The scientific basis for this determ ination m ust be questioned. Careful study of the 183 articles cited in the footnotes of the AIDS articles indicate only 16
JADA, Vol. 122, November 1991
one 1981 reference of a practitioner to patient trans m ission of disease, hepatitis, in w hich faulty procedures played a role. Investigating the literature further, I was able to identify 20 such outbreaks of hepatitis, which are also dated and not all occur ring in dental offices. Sixty percent w ere attributable to the lack of aw areness at the time by those carrying the disease of the need to use gloves during treatm ent. I can find no other docum ented cases of dentist to patient transm ission of any disease at any time during dental treatm ent. With our history of 150 years of dental treatm ent prior to universal precautions why are there no significant reports of patient to patient transm ission of infectious disease during dental treatm ent? Clusters of disease, easily traceable to dental offices, should by now have been well docum ented. We reject the anti-fluoridationists and anti-amalgamists because research and experience do not substantiate their position. Why are we so willing to accept the imposition of extrem e infection control procedures for our offices w ithout definitive scientific docum entation? A thorough rethinking of the need for an efficacy of all currently recom m ended infection control procedures m ust be started w ithout delay and a new modified scientifically based standard promulgated. Arthur L. Yeager, D.D.S. W estwood, N.J. M O D E S T PROPOSAL
“Public policy should be driven by the need to protect community
welfare and safety, not by the exigencies of public opinion.” This quote is from the last paragraph of Drs. Marshall, Thomasma, and O’Keefe’s article on disclosing HIV status (August). I couldn’t agree m ore w holeheartedly with this sentim ent; and, as such, I have been continually and increasingly concerned that public policy thus far regarding AIDS has been designed to accomplish exactly the opposite. One of the most glaring characteristics of our current “Age of Enlightenm ent” has been the complete abandonm ent of the idea th at individuals are in any way responsible for their own actions or their consequences. Thus, no one will even consider putting the blame for the spread of AIDS where it belongs, on homosexuals and drug addicts, for fear of being shouted down and ostracized by the “politically correct” who are terrified of offending any m em ber of a very vocal and strident m inority interest group. The concern for the “rights and welfare” of those afflicted with this disease has completely over powered the “right” of society as a whole not to be exposed to a deadly, contagious sexually transm itted disease, which is exactly w hat AIDS is! AIDS is no more a “handicap” than syphilis or gonorrhea. What does all this have to do with dentistry? Nothing, until the powers that be attem pt to legislate or regulate a political agenda to make hom osexuality acceptable to the masses. Redefining mode of locales of treatm ent so as not to offend the victims of this disease is not a sound scientifically or medically defensible position. It’s
