Oral Health Group

Letters To The Editor

March 1, 2012
by Oral Health

Re: We Are What We Drink, Jan. 2012, page 3

Thank you for the timely editorial written by Dr. Farkouh regarding water fluoridation. He rightly points out that for society to preserve this essential public health measure, the dental profession must become active with our patients and with our local governments. But, it goes farther than this.


We are actually doing quite well when this issue becomes active locally. In the last several years, besides the one close defeat in Waterloo, fluoridation has been preserved in Ontario in Halton, Hamilton, Atikokan, Norfolk, Tottenham, Sarnia, London, Toronto, Peel. This has occurred because of a true collaborative effort among individuals as well as the Ontario Dental Association, the RCDSO, local public health and dental public health.

We are facing a frequent questioning of the validity of fluoridation by reasonable people wanting to be reassured that policy-makers are abreast of the current evidence on safety and efficacy of fluoridation; and this is their right and responsibility. Our task of presenting the science is made more difficult by the extremist tactics used by anti-fluoride organi­zations who are not interested in an objective assessment of the evidence but rather prefer the fear-mongering that seems to work so well in politics these days.

I would encourage all in the oral health community to become familiar with the evidence. There is lots available as a start on the ODA website www.youroralhealth.ca. Dr. Farkouh is right in calling on us to engage our patients in dialogue about the success of fluoridation, about what it has meant to their health and that of their children. Together we can protect the people of Ontario.

Ian McConnachie, DDS, MS
Ottawa, ON

(copy of a letter sent to the Royal College of Dental Surgeons of Ontario)
Attention: Dr. Peter Trainor, President of the Board

Dear Dr. Trainor:

I am writing to comment on the proposed By-law respecting CT Scanners.

I am profoundly disappointed that the Bylaw as proposed seems to make it extremely difficult for all but a few to make this wonderful technology easily available to the people of Ontario. By listening only to the few who wish to minimize the availability of this equipment for personal gain, the RCDSO has forgotten to serve the people of Ontario.

The RCDSO is charged with protecting the public first and foremost. This misguided Bylaw will isolate the vast majority from this advance by limiting access. Think for a minute. This machine is nothing but a PANOREX with a brain. The actual machines are almost identical except for the sensors. Why are we making such a fuss? Why are we making this machine different from the rest of our equipment?

I am a licensed dentist in Ontario and have been for 35 years. I take my responsibility to be absolutely current with my knowledge of our profession and my abilities with the new technologies very, very seriously. And yet this machine requires the RCDSO to create a NEW LEVEL of licensure. Is this equipment licensure not already the responsibility of the Director of Xray Safety and the Ministry of Health? Why not create the licensure for Nitrous Oxide machines, CEREC milling machine, or the lasers that we use, or the electric handpieces that have been introduced or the LED curing light? Where does the RCDSO wish to begin and end this fiasco?

Members of the profession have an ABSOLUTE responsibility to be competent with the equipment that they use during their profession performance. To expect that a legislative body needs to exercise some bureaucratic muscle to control this technology is to expose a gross misunderstanding of the relationship between a licensing body and a professional. It debases that relationship to an elementary school level.

It is shocking that the College abandons it own directive of “Evidence-based decision making” to appease those that lobby for exclusivity of this equipment. There is absolutely no reason that the “equipment must be new and manufactured within 12 months”. Technical specifications are absolute and without time limits. Equally absurd is that the beam diameter that is in use in the rest of North America must be reduced in Ontario alone. Where is the evidence that this improves the experience? Or is this designed to make the equipment less available?

Let us return to the balance between legislation and professionalism that is identified in law. The RCDSO should be creating equipment standards, competency levels and utilization standards. Responsible professionals should respect those standards and provide the same wonderful care that has been enjoyed in the past in Ontario. The introduction of new technology should not be an excuse for bureaucratic self-propagation.

John H. Pate, BSc, DDS
Guelph, ON

Re: Editorial, Crazy, Oral Health,
February, 2012

Bringing the topic of mental illness to the forefront of our dental publications will, in my opinion, go a long way to reducing the discriminatory barriers that we as dentists tend to put up towards those individuals who are suffering throughout their lifetime with any one of the various mental illness diagnoses. Or even to those individuals caring for another with such an illness.

It is generally the lack of any true understanding and lack of a desire to learn more about these medical conditions that, as described by Dr. Nkansah, is our attempt at a coping mechanism.

I too have been a part-time clinical demonstrator at the University of Toronto for the past 24 years and have often witnessed the use of the “crazy” euphemism by our dental colleagues.

Psychiatric disease and dental disease are in fact, viewed as two of the most prevalent health problems in society today. As common as mental illness is, in many cases it remains unrecognized, misunderstood and generally undertreated. Ignorance, silence, fear, disbelief, and blame are just some of the more common reactions of people to those they encounter having a particular psychiatric illness. These attitudes can all be condensed into one word: “stigma” — from family members who are embarrassed, friends who simply turn away, health professionals who remain judgmental, and employers who are concerned only about the bottom line of productivity and profit margins. Stigma is worse than the disease itself, and is nourished through the misconceptions that sadly, still exist in society today surrounding a diagnosis of any psychiatric illness. Such misconceptions include the acceptability of treating people with psychiatric disorders differently since they are supposedly getting what they deserve as a result of their own inadequacies. They must therefore lack the motivation to do things or overcome their problems, and by “being lazy” give into their emotions and stresses instead of simply ‘getting on with the program”.

Both the stigma and these misconceptions comprise part of the ‘double-burden” that patients with psychiatric illness must endure and as such, often jeopardize an already compromised quality of life leading to diminished self-esteem, isolation, sense of hopelessness all of which provide fertile ground for increased substance abuse and sadly, suicide.

The ability of the dental team to contribute to increased feelings of self-worth and self-esteem within the overall psychotherapeutic management of patients suffering from mental illness can be an extremely rewarding experience. The role of the dentist in partnership with a patient’s physician/psychiatrist further enhances our position in the provision of “total health care”.

This is an extremely timely discussion on the topic of mental illness and from my clinical dental perspective in treating patients with various psychiatric illnesses in a tertiary care facility
for the past 24 years, I would like to offer my sincerest “congratulations” to the editorial staff of Oral Health for putting Dr. Nkansah’s thoughts into print. This discussion must however continue.

“Labels belong on soup cans and not on people.”1

David Clark, BSc., DDS,
MSc(Oral Path), FRCDC
Director, Dental Services, Ontario Shores Centre for Mental Health Sciences
Whitby, ON

1. Nunes J, Simmie S. Beyond Crazy. Journeys through mental illness. Toronto: McClelland & Stewart; 2002.