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Letters: Identifying with Dr. Davidson

March 16, 2015 I want to thank Dr. Martin Kolinski (“In Defense of Dentists,” Letters, Feb.16) for bringing my attention to the letter by Dr. Joshua Davidson (“Promote Prevention,” Letters, Jan. 5). After reading Dr. Kolinski’s rebuttal to both Dr. Davidson and the editor’s response in support of Dr. Davidson’s call for greater emphasis on prevention within the dental profession, I looked up the original ADA News publication online.

I am a 2007 dental school graduate and current president of my county dental association, president-elect of my district dental society and member of the Pennsylvania Dental Association New Dentist Committee. The most urgent issue we face in organized dentistry is declining participation among the next generation of dentists entering the workforce. As a fellow “new dentist,” I believe we should take Dr. Davidson seriously for his viewpoints, and for reaching out to his colleagues on a subject he obviously feels very strongly about, and I thank the editor of ADA News for supporting him.

Dr. Davidson’s letter was strongly worded, but I identify with his frustration. As a pediatric dentist with a very middle-class, mostly suburban clientele, I see a shocking rate of caries among my young patients. Truly, the rampant decay I dealt with during my training in blighted areas of Philadelphia and Buffalo was only marginally worse. Here in my hometown I have networked with many excellent family dentists, who in most cases are excellent professionals. Still, a unified emphasis on preventive care is sorely lacking. Many dentists are not instructing parents on the Age One Dental Visit, using fluoride toothpaste from the time teeth first erupt, flossing as soon as adjacent teeth touch or even giving basic dietary guidance.

And this is where I agree most strongly with Dr. Davidson. Calls for bans on big sodas or fatty foods make me squirm, and in the end I think they are destined to fail no matter how good the intentions. However, I have conversations on a daily basis with intelligent, well-educated parents who have no idea that just limiting candy and soda in their children’s diets does not ensure a cavity-free future. According to the U.S. Department of Agriculture, the average American consumes about 130 pounds of sugar each year, most of it as “added sugars” in processed foods. The average child is taking in something like 30 teaspoons of sugar each day, which is more than three times the American Heart Association’s recommendation. And even if a consumer takes the time to look at a nutrition label, there are more than 50 names used as aliases for sugar by the companies “that give people some of the great pleasures in life,” as Dr. Kolinski puts it.

Consumers should be entitled to choice in this country, and individuals should be held accountable for the choices they make. But let’s not act like we and our patients are on a level playing field with massive food corporations who are spending untold millions to hook consumers with enticing advertising, poorly regulated labeling practices and research and development to make their brands irresistible on a neurological level.

I don’t know about the specific ideas that Dr. Davidson put forward, but I like the conversation that he wants to start. I applaud the ADA’s ongoing public health campaigns. The ADA should use its voice and resources to lobby for changes in the food industry that can be shown to make good economic as well as public health sense and continue to press its membership to adopt the preventive strategies that it has deemed to be the standard of care. This shows that we are continuing to care for our patients in good faith, only falling back on a surgical option after failing to prevent disease progression. Here in Pennsylvania, a program called “Age One Connect the Dots” is teaching dentists and dental hygienists about the problem of early childhood caries and training them how to give an infant lap exam, apply fluoride varnish and provide parental dietary and hygiene guidance. I for one don’t anticipate being able to hang up my hand piece in my lifetime. But if that day comes, I won’t shed a tear.

Drew J. Carlin, D.M.D.
Erie, Pennsylvania