Letters from Readers

Dr. Kanca did not introduce total etch!
Dear Dr. Jameson: After receiving several emails concerning your interview with Dr. Rosenthal (June 2001 Dental Economics), I read it. Apparently, he does not know who introduced total etch in this country; it was not Dr. Kanca.

Dr. Kanca did not introduce total etch!
Dear Dr. Jameson: After receiving several emails concerning your interview with Dr. Rosenthal (June 2001 Dental Economics), I read it. Apparently, he does not know who introduced total etch in this country; it was not Dr. Kanca.

Interested in more?

Dr. Ray Bertolotti
RBertolott@aol.com

One huge mistake
Dear Dr. Jameson: I read your interview with Dr. Larry Rosenthal in June 2001 Dental Economics. While most of the interview is very on-target, there is one huge mistake. Perhaps Dr. Rosenthal does not know the whole story, so please forward this letter to him.

I will quote from Fusayama's textbook, A Simple Pain-Free Adhesive Restorative System: "The curious taboo against dentin etching, which was the main barrier for our system to be internationally recognized, was recently finally broken by Dr. Raymond L. Bertolotti."

It is well-known that Dr. Bertolotti was teaching total etch well before Dr. John Kanca, who was mistakenly given this credit in the interview.

I personally first heard Dr. Bertolotti's presentation on "total etch" in 1986, about three years before Dr. Kanca made his now-famous total-etch presentation at the AACD meeting. As I understand it, Dr. Kanca, in fact, had listened to Dr. Bertolotti's "Adhesive Monomers" presentation at the ADA/FDI meeting in 1988, which is what inspired him to rethink the taboo against etching. Dr. Kanca went on to invent a materials concept that is now All Bond and is, of course, responsible for wet-field bonding.

You might also want to note that Dr. Bertolotti, not Dr. Kanca, was the one invited to present total etch at the landmark conference in 1991 in Omaha — the International Symposium on Adhesives in Dentistry. This is the conference that changed dentistry forever.

Perhaps you would like to interview Dr. Bertolotti on the subject of dentin etching. He is also the first to introduce self-etching primers into the United States, beginning in 1992. I am sure he could fill you in on the correct history of total etch and self-etch in the United States. His email address is rbertolott@aol.com.

Russell J. Beggs, DMD
RJBeggs@pacbell.net

Prudent editing or oversight?
I read with interest Bill Rossi's article, "Cutting Out the PPOs" (March 2001 Dental Economics). I wonder whether it was prudent editing on the part of Dental Economics or an uncharacteristic oversight of Mr. Rossi's that the article wasn't simply called, "Cutting Out Delta."

That headline would have fit Mr. Rossi's piece, as he mentions our name almost as often as he mentions his supposed subject, PPOs.

PPOs comprise the fastest growing segment of the dental benefits business, and it is no surprise that Dental Economics would cover issues relating to PPOs. But, Mr. Rossi's bias was distracting. Since PPOs continue to grow in response to customer needs and market demands, Mr. Rossi could have found plenty of actual PPOs to use as illustrations, instead of concluding that Delta Dental® is like a PPO, then bending over backward to link it with PPOs generally.

Most Delta Dental® plans in the country offer clients PPOs and a range of other service models as well. About 7 percent of Delta's subscribers are in PPOs. The remaining are in either traditional fee-for-service plans or dental HMO models, a fact that frustrates Mr. Rossi's attempt to use Delta Dental® as a synonym for PPO.

If Mr. Rossi intended to counsel dentists on decreasing their association with PPOs, he might have done better to use the general description "XYZ PPO," which he introduces about two-thirds of the way through his article. Instead, he chose to go out of his way to single out Delta Dental® when something generic was called for.

Kim E. Volk
President and CEO
Delta Dental®

Bill Rossi responds
Dear Ms. Volk: Maybe you are right; I should have titled the article, "Cutting Out Delta." I didn't, though, for two reasons:

• Mr. Jay White, a colleague of mine, was sued by Delta Dental® of Minnesota for telling dentists to stop by his booth at the Northstar meeting (Minnesota's dental convention) "because it's the Drop Delta Booth." One-and-a-half years and thousands of dollars in legal fees later, Delta dropped the suit. It's easy for a big company with a staff of lawyers to hassle a small businessman. So, until I'm convinced that Delta believes in the first amendment, I'm going to be cautious about what I put in writing (even if everybody is thinking it anyway).

• The advice in the article really does apply to any third-party programs in which the participating dentists are susceptible to a fee reduction.

The truth is, dentists don't need any encouragement from me to dislike or to drop Delta. My recent poll of over 325 Minnesota dentists found their number one issue was "third-party encroachment," of which Delta was the most-often-cited aggravation. Fifteen percent of the respondents said they seriously plan on dropping Delta in the coming year, and 33 percent had dropped a PPO in the past year.

Having said that, I don't generally recommend to my clients that they part with Delta. But, when they do decide to become an unrestricted provider, I want them to do so in such a way that there's a minimum of disruption to all parties involved — the dentist, the patients, and even Delta.

Bill Rossi
President
Advanced Practice Management
Edina, Minn.

Dentistry — an undervalued service
I enjoyed Dr. Kauffman's insights into providing quality service quickly and efficiently. (See "Letters From Readers" section in June 2001 Dental Economics.) His comments about the patient who complained about the speed and efficiency with which an extraction was done in relationship to the fee brings to mind another story that I have often thought about while practicing dentistry.

In James Michener's book, Chesapeake, a couple of explorers are unsuccessfully attempting to upright a capsized boat. After much frustration and no success, a riverman happens upon them. He offers to solve their problem for $50. They heartily agree and, within a couple of minutes, with some rope and a bit of finesse, the boat is floated. Seeing the simplicity of the solution, they attempt to negotiate a reduction of the fee. The riverman replies, "That's $45 for knowin' and $5 for doin'."

As dentists, we tend to undervalue the experience and education that we have spent many years and much effort developing. The skills we so easily wield today are the result of much practice and no small amount of stress and frustration. Certainly, the amount of time that a procedure takes is but one small measure of the value and service we provide.

I have often said that one of the reasons dental fees are low is that our patients are awake during treatment. When a physician operates with general anesthesia, no one asks, "Doctor, you only spent two hours in surgery. How come you're charging me $5,000?"

Yet dentistry is surgery as well. We operate on living tissue in a safe, relatively low-cost office setting, with a skilled staff and in a timely and efficient manner. Our work is aesthetic, long-lasting, and restores health and function. Dentistry is truly an undervalued, low-priced health-care service.

Henry Pinkney, DDS
Canton, Mich.

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