Where's the evidence?

June 1, 2002
I read with concern the article, "Building Your Practice With Lasers," by Martha Cort?s, DDS (February 2002 Dental Economics), regarding the use of lasers in the treatment of periodontal disease.

I read with concern the article, "Building Your Practice With Lasers," by Martha Cort , DDS (February 2002 Dental Economics), regarding the use of lasers in the treatment of periodontal disease. The article cites the benefits of laser ENAP (excisional new attachment procedure), including elimination of periodontal disease and promotion of gingival reattachment. However, the article fails to cite any evidence or scientific literature to substantiate these claims.

Such unsubstantiated claims led the American Academy of Periodontology (AAP) to issue a statement regarding the use of laser ENAP for periodontal treatment in 1999. It is available on our Web site at www.perio.org. At that time, the Food and Drug Administration (FDA) warned a dental laser manufacturer against marketing a laser for ENAP or indicating that the laser treatment would eliminate or prevent bacterial infections. The FDA cited a lack of supporting clinical data for these claims. As noted in our 1999 statement, the AAP is not aware of any randomized, blind, controlled, longitudinal, clinical trials; cohort or longitudinal studies; or case-controlled studies indicating that laser ENAP or laser curettage offer any advantages over traditional periodontal therapy.

The dentist is indispensable in the partnership among patient, hygienist, dentist, and periodontist. With the care of their patients hanging in the balance, your readers should be given the best available evidence so they can make an informed decision about dental lasers.

Kenneth W. Bueltmann, DDS
President, American Academy of Periodontology
Chicago, Ill.

Profitable, but not proven

After reading the article "Building Your Practice With Lasers," by Martha Cort , DDS (February 2002 Dental Economics), I have some concerns I must air:

The laser has not been approved by the FDA for a Modified Widman Flap or ENAP.

A No one has demonstrated that removal of the sulcular tissue alone with or without the laser leads to new attachment.

If you bring laser energy into the intrabony defects, you are asking for serious collateral damage beyond what is most likely already being caused to the pulp and adjacent hard tissues with your curettage procedure (especially at the 2.5 to 3.0 watt setting). No matter how much you and your patients enjoy the laser or how much profit it brings to your office, your first responsibility is to do no harm. A scientific review of the procedures you are advocating brings into question whether you are fulfilling that obligation.

For further information, please visit the California Society of Periodontists' Web site at www.calperio.com and click on "news."

Gerald I. Drury, DDS
Hermosa Beach, Calif.

Editor's Note: In defense of the author, Dr. Cort did supply references. They were not published with the article; however, a reader can request a copy by sending an email to [email protected]. To expedite the sending of the references, please submit a fax number.

I call it "GDchild neglect"

With the current emphasis in our dental environment on aesthetics and practice management, I'm pleasantly pleased to see your concern about rampant caries in children ("Editor's Note," April 2002 Dental Economics).

I'm a 49-year-old general dentist who has been in practice for 22 years in rural North Carolina. For the last 10 years I've provided dental care for about 450 children in our local hospital operating room. All but two have been Medicaid patients. We term their dental condition "ECC" (early childhood caries), but I call it "GDchild neglect" (gross dental child neglect). No one seems to want to listen to my views and solutions. Any suggestions?

Dr. Clyde Douglas Peedin
Roanoke Rapids, N.C.

Distribution, not accumulation

For more than 30 years, I practiced the formula of earn, defer, save, and invest ... repeatedly since graduation day. In the last couple of years, I have become very interested in the art and science of "distribution," rather than accumulation.

I honestly believe that careful distribution is every bit as important, if not more so, than accumulation. When Dr. Hugh Doherty began his series, "Making the Most of Your Money," I mailed him a note, asking for some consideration of the distribution side of things in Dental Economics. I have noticed that over the past few years there has been more and more on distribution showing

up in various publications - Money, Smart Money, Kiplinger's, Mutual Funds, etc. I was prompted to write and thank you for including two more such articles in the April 2002 issue of Dental Economics.

In our profession, we work hard for what we get. It behooves us to learn as much as we can about the tax ramifications of distribution from various asset pools, as well as the order in which to time and make such distributions. I guess the key is to not end up depleting the retirement kitty before we end this life.

Thanks again for including this important information in Dental Economics. I believe there will be more baby boomers in our profession who become increasingly interested in this interesting and fun process as they wind down their earning potential at the chair.

Daniel D. Schiefelbein, DDS
San Clemente, Calif.;Torrey, Utah

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