Navy dentist serving aboard ship in Afghan war

I would like to thank you for the great information printed in your magazine.

I would like to thank you for the great information printed in your magazine. As broad as your readership is, I want you to know that it has now extended to "the tip of the spear" of the United States Navy. I am the Dental Officer onboard USS Whidbey Island (LSD-41), presently deployed in support of Operation Enduring Freedom.

We are an Amphibious Assault Ship, meaning it is our job to get the Marines to where they are needed. We deployed from Norfolk, Va., as scheduled, on September 19th. It is no surprise that we ended up off the coast of Pakistan and successfully inserted our Marines into Afghanistan.

Presently, we have been at sea for 104 consecutive days, and we can look forward to another 50 to 60 days at sea before setting foot on land. With only 609 feet to wander – and over 1,000 patients – my dental operatory has become my second home.

As a dental department, we are small. Three technicians and myself make up the team. With an administrative, chairside, and prophylaxis technician, I can say that I run my own practice. Military dentistry is quite a bit different from its civilian counterpart. I am proud to say that we offer the highest quality of care, but are sometimes limited in the types of procedures we can offer.

Amalgam is still the treatment of choice for most of our operative patients. That does not mean that I do not have "an itch" to offer more aesthetic treatment options. After three years of service, my military commitment will be complete in July. Your magazine has kept me in tune with the most innovative treatment choices.

I am pleased to say that I now offer resin core build-ups and posterior condensable composites to the appropriate patients. Although this may seem like "small potatoes" to many of your readers, it has been a first step for me.

Your magazine has played an even larger role on the practice-management side of my department. Not having to deal with insurance companies is a true blessing of the military, but scheduling patients is a true headache! Fire drills, helicopter landings, and amphibious assaults are just a few of the scheduling snafus that I deal with daily. With every article I read on scheduling, however, I am able to streamline my appointment book and run more efficiently. Although my production level has no bearing on my income, I see how this increased efficiency will benefit me in private practice.

Once again, thanks to you and your staff members for producing such an excellent magazine. They should all take pride in knowing that they are making dentistry onboard USS Whidbey Island better. I look forward to using Dental Economics as my guide when I step into "the real world."

Andrew J. Sorkin LT, DC, USNR
USS Whidbey Island (LSD-41)
asorkin@whidbey-island.navy.mil

Terms offered for Laser usage

We enjoyed reading the "How To Profit From" articles by Dr. Michael Miyasaki and Dr. Martha Cort´es in the February issue of Dental Economics. We appreciate how the insurance article by Tom Limoli, Jr. was tied to these two features.

Mr. Limoli could not be more correct with how insurance reimburses laser procedures, in that third-party payors reimburse by procedure, not the "implement" used to accomplish the specific procedure.

We have a suggestion for future laser articles. It would be helpful if authors would, at a minimum, identify the lasing medium (which defines the laser type), the temporal emission mode (TEM), and the wavelength for the clinical applications they are describing. In so doing, it would be more educational and less confusing to the nonlaser user, while at the same time be clearer and easier for those who understand laser nomenclature to follow the author's thoughts.

For example, the diode that Dr. Miyasaki mentions most likely has an aluminum gallium arsenide (AlGaAs) semiconductor diode as its lasing medium, suggesting a wavelength of 810 nanometers operating in the continuous wave (CW) or gated-pulse TEM. A simple way to delineate this nomenclature might be "CW AlGaAs 810 nm diode laser." Since surgical semiconductor diode lasers range in lasing medium and wavelengths from AlGaAs to InGaAs, and 808 nm to 980 nm (+/- 30 nm) respectively, it can be confusing to nonlaser users if not fully described at the beginning of the article.

Dr. Cort´es discusses a laser with a lasing medium of neodymium (Nd) as the active medium, "doped" in a solid-state host crystal of yttrium aluminum garnet (YAG), operating at the 1064 nm wavelength, and with a TEM of free-running (FR) or 10-6 seconds per pulse duration. This laser could be termed as a "FR Nd:YAG 1064 nm laser."

Robert H. Gregg, DDS, Delwin K. McCarthy, DDS
Cerritos, Calif.

Composites are great, but ...

It's been quite awhile since the urge to write a letter to the Editor has been so strong. Not that I haven't read some things that generated strong feelings, it's just that nothing had hit me hard enough to trigger a letter ... until now!

In your editorial, "What's so great about composite?" (February Supplement to Dental Economics, Page 3) you say, "Please don't tell me that you bond amalgam to teeth. Test after test has proved that this does not happen." I simply cannot sit idly by and let a statement so blatantly untrue go by without comment.

What tests? What studies? Cite them, please. Do you read anything other than Dental Economics? You see, the evidence for bonding amalgam as a viable technique is overwhelming the world of testing and research. I have a database of 188 references that contradict your dictum and attest to the fact that amalgam can indeed be bonded to teeth. If anyone is interested, drop a line and I'll send the bibliography. That includes you, too, Dr. Blaes.

Nelson J. Gendusa, DDS
Director of Research
Parkell, Inc.

Editor's Reply:

Dear Dr. Gendusa: I received a number of notes about amalgam bonding to dentin, but no one mentioned the strength of the bond. Granted, amalgam bonds to dentin, but the bond strength is very low.

For your information, Dr. Gendusa, I do read a number of other journals. Since I do not live in the "world of testing and research," send me articles that show an amalgam-to-dentin bond strength that is similar to composite-to-dentin.

I am complimented that you are reading Dental Economics. Thank you for your interest.

Dr. Joe Blaes,
Editor

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