m anufacturers, it is appalling to those who understand th a t it is medically more valid to restrict th eir use. Older, less expensive and equally as useful antibio­ tics, such as penicillin and te tra ­ cycline, should be the drugs of choice, even for refractory perio­ dontal disease (unresponsive to m echanical therapy). M orton H. G oldberg, D.M.D., M.D. H artford, Conn. A u th or’s com m ents: Dr. Goldberg has raised th e issue of the cost of antibiotics for the use in treatm en t of periodontal dis­ ease, and has also questioned the overuse of antibiotics to di­ m inish th eir value and efficacy. Both points are im portant and need to be addressed. The issue of cost is of considerable concern. I feel th a t my article does point out th a t the use of antibiotics is reserved for unique situations, and I did not suggest th a t they be used to tre a t chronic periodontal infections in “millions” of patients, as Dr. Goldberg has m isinterpreted. These antibiotics were suggested for use only in refractory patients. Although we do not have a good estim ate of the num ber of such patients, they are probably a very small percentage of periodontal patients who are treated w ith m echanical therapy. The realization th a t organism s such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia are serious pathogens is a fairly new concept based on hum an and anim al studies. Elim ination of these pathogens from the hum an oral cavity, w here they are associated w ith periodontal 16

JADA, Vol. 123, February 1992

lesions and can also cause more serious infections in m an, is clearly justified. Form er concepts of periodontal disease as a low grade, smoldering infection, as Dr. Goldberg feels, have been supplanted by our new understanding th a t periodontal pathogens are often of high virulence and can cause serious infections. I t is clear th a t anti-infective approaches to suppression of these m organisms are m feasible and reasonable when 1 ^ they are identified 1 in refractory cases of periodontal disease. W hen their antibiotic susceptibilities are known, it is reasonable to select an effective antibiotic to reduce their num bers. Microbial diagnostic services are available for identifying periodontal pathogens, determ ining th eir antibiotic susceptibility and m onitoring th eir suppression or elim ination after therapy. R obert J. G enco, D.D.S., Ph.D . B u ffalo, N.Y. NATIONAL HEALTH CARE SYSTEM

O ur health care system certainly is a mess. No one will deny th at. Now w ith an election on the horizon, we have the awful opportunity to quickly m ake it worse. Please, for the sake of organized dentistry, let's not get on the bandwagon to be a part of the medical health care program, but let's wait to see how it "sugars out." We can in sert ourselves later if th e system ever works. The socialistic approach of pouring public money into the issue is causing the economies of

England and C anada to crumble. Government inefficiency and bureaucracy in the Medicaid program is perhaps one of the most significant reasons why private health care is so expensive. Medicaid pays betw een 40 percent and 60 percent of the tru e cost for th e services ft received. This discount m eans ■ th a t the private sector m ust H m ake up the difference plus A pay 100 percent of its share. T hat is why the am ount is staggering. Blame has been shifted to disguise the tru e reasons for the m ess to unethical and overpaid providers. The fact is th a t if we were to cut doctors' salaries in h a lf we would only reduce the total health care cost by 8 percent! Unethical providers are present but rare. The m ost im portant issue is the concept of personal responsibility for health. A "big brother" approach will only lead us fu rth er away from it. If one leads a lifestyle of excessive eating, drinking, drugs, ab erran t sex and a disregard for personal fitness, whose problem is it? Sadly, m any people frequently get w hat they deserve. For the vast m ajority of Americans, health is (or was) a choice, regardless of income. Let's help people to m ake better choices. D ale R. N eil, D.D.S. S tow e, Vt. CORRECTION

In th e report “Sterilization required for infection control” (December), the second tem ­ p erature reading labeled Dry heat should be 160 C (320 F), not 340 F.

National health care system.

m anufacturers, it is appalling to those who understand th a t it is medically more valid to restrict th eir use. Older, less expensive and equally as...
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