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Pdf/23/3/1/1819240/1559-2863-23-3-1.Pdf by Guest on 30 September 2021 DENTISTRY OPE TIVE Downloaded from http://meridian.allenpress.com/operative-dentistry/article-pdf/23/3/1/1819240/1559-2863-23-3-1.pdf by guest on 30 September 2021 DENTISTRY march-april 1998 • volume 23 • number 3 • 105-160 (ISSN 0361-7734) OPERATIVE DENTISTRY MAY-JUNE 1998 VOLUME 23 NUMBER 3 • 105- 160 Aim and Scope Editorial Office Operative Dentistry publishes articles that advance the University of Washington, OPERATIVE DENTISTRY, practice ofoperative dentistry. The scope of the journal Box 357457, Seattle, WA 98195-7457 includes conservation and restoration of teeth; the Telephone: (206) 543-5913, FAX (206) 543-7783 scientific foundation of operative dental therapy; URL: http:!/weber . u. washington . edu/~opdent/ dental materials; dental education; and the social, political, and economic aspects of dental practice. Subscription Manager: Judy Valela Downloaded from http://meridian.allenpress.com/operative-dentistry/article-pdf/23/3/1/1819240/1559-2863-23-3-1.pdf by guest on 30 September 2021 Review papers, book reviews, letters, and classified ads also are published. Editorial Staff Editor: Richard B McCoy Editorial Assistant: Darlyne J Bales OPERATIVE DENTISTRY (ISSN 0361-7734) is pub­ lished bimonthly for $55.00 per year in the US Editorial Associate: Kate Flynn Connolly and Canada (other countries $70.00 per year) by University of Washington, Operative Dentistry, Associate Editor: Michael A Cochran Health Sciences Bldg, Rm D-775, Seattle, WA98195- Managing Editor: J Martin Anderson 7457. Periodicals postage paid at Seattle, WA, and at additional mailing offices. POSTMASTER: Send Assistant Managing Editors: Paul Y Hasegawa and address changes to: University of Washington, Ralph J Werner OPERATIVE DENTISTRY, Box 357457, Seattle, WA 98195-7457. Editorial Board Kinley K Adams Georg Meyer Wayne W Barkmeier Michael P Molvar Subscriptions Douglas M Barnes Graham J Mount Yearly subscription in USA and Canada, $55.00; other Lawrence W Blank Jennifer Neo countries, $70.00 (sent air mail printed matter); dental Donald J Buikema John W Osborne students, $25 . 00 in USA and Canada; other countries, Larry R Camp Michael W Parker $34.00; single copy in USA and Canada, $14.00; other Timothy J Carlson Craig J Passon countries, $17.00. For back issue prices, write the Gordon J Christensen Tilly Peters journal office for quotations. Make remittances payable Kwok-hung Chung Frank E Pink (in US dollars only) to OPERATIVE DENTISTRY and Linc Conn John W Reinhardt send to the above address. Credit card payment (Visa Frederick C Eichmiller Frank T Robertello Omar M El-Mowafy Henry A St Germain, Jr or MasterCard) is also accepted by providing card type, John W Farah Gregory E Smith card number, expiration date, and name as it appears Dennis J Fasbinder W Dan Sneed on the card. Toh Chooi Gait Ivan Stangel James C Gold James B Summitt Contributions William A Gregory Edward J Swift, Jr Contributors should study the instructions for their Charles B Hermesch Van P Thompson guidance printed inside the back cover and should Harald 0 Heymann Karen Troendle follow them carefully. Richard J Hoard Richard D Tucker Ronald C House Martin J Tyas Gordon K Jones Permission Michael W Tyler Robert C Keene Joel M Wagoner For permission to reproduce material from Operative Edwina A M Kidd Charles W Wakefield Dentistry please apply to Operative Dentistry at Mark A Latta Steve W Wall ace the above address. Dorothy McComb Nairn H F Wilson Jonathan C Meiers The views expressed in Operative Dentistry do not nec­ Editorial Advisors essarily represent those of the Academies or of the Maxwell H Anderson Mark Fitzgerald Editors. Tar-Chee Aw T R Pitt Ford Patricia Bennett Walter Loesche ©1998 Operative Dentistry, Inc Ebb A Berry, ill Ivar A Mjor Printed in USA Timothy A DeRouen Marcos Vargas ©OPERATIVE DENTISTRY, 1998, 23, 105-107 GUEST EDITORIAL Coming to Terms with Terminology Downloaded from http://meridian.allenpress.com/operative-dentistry/article-pdf/23/3/1/1819240/1559-2863-23-3-1.pdf by guest on 30 September 2021 J A WARREN, Jr It might be successfully argued that a discipline cannot be surgically removed. Only cariously such as operative dentistry can be no more rigorous damaged tissue(s), a tangible ill effect evidenced than its terminology. Accuracy of definition and use during and after the caries process, can be surgically of terms is essential to clear thinking and communi­ removed. cation. To the extent that this misuse goes undetected, it I have more than just an academic concern about fosters the flawed, often subconscious, predisposition some of our terms as they are currently defined and that caries is somehow tangible. From this flawed used. My suspicion is that terminological errors are predisposition, certain faulty assumptions usually an unrecognized source of some frequently held, follow. though often subconscious, flawed predispositions First, it is not unusual to encounter the faulty that have a negative impact on the study and practice assumption that caries can be diagnosed with "cer­ of our discipline. Due to space limitations, only two tainty." After all, can't we see it and feel it intra­ such errors will be presented here: the first is an ex­ orally? Can't we view it on our radiographs? Abso­ ample of inaccurate use, and the second an example lutely not! What we are seeing, feeling, and viewing of inaccurate definition. is not caries, but a lesion, a result of the caries Caries [dental]. Caries is a disease process. process. Sometimes we inaccurately refer to this Unfortunately, in the use of our terminology, we lesion as a carious lesion when, in fact, at that time often confuse the disease process with the damaged we have no information about its disease activity. tissue(s) evidenced during and after the disease pro­ We should more accurately refer to it as a caries cess. An example of this is found in the frequently lesion (Dawes, 1984 ), a lesion resulting from the heard or asked question, "Have you removed all of caries process. the caries?" Only in a probabilistic sense, and always with less Caries, being a process, is intangible and, therefore, than certainty, can caries ever be diagnosed. Such probability estimates and our confidence in them can be substantially strengthened by observations (vis­ University of Florida, College of Dentistry, ible, tactile, radiographic, and bacteriological) Department of Operative Dentistry, Gainesville, repeated over appropriate time intervals (e g, 3-6 FL 32610-0415 months). Yet, owing in part to the prevalence of this faulty "certainty" assumption, such techniques are J A Warren, Jr, DMD, associate professor seldom employed in our discipline, and many 106 OPERATIVE DENTISTRY practitioners base their diagnosis and treatment plan­ composite resin, class 2 inlay, etc) fabricated in the ning on the extremely limited information available act of restoring a tooth. Occasionally, though from single-session evidence. inappropriately, it refers to the dental restorative Second, it is not unusual to encounter the faulty as­ material (e g, as in "to do an amalgam, composite sumption that surgical removal of all caries lesions resin, etc") used to fabricate the prosthesis (Interna­ in a particular patient is equivalent to at least tempo­ tional Organization for Standardization, 1989; rary eradication of the disease. To the contrary, even Manhold & Balbo, 1985; Jablonski, 1992; Zwemer, after the most meticulous and complete surgery, the 1993). By any usage standard other than dental, the disease may still be ongoing, still producing ill results of the restorative act to which this term refers effects, the evidence of which is as yet undetectable appear inaccurate. Such inaccurate reference again by our senses or technology. leads to flawed predispositions usually followed by Surgery is at best only symptomatic treatment for faulty assumptions. Downloaded from http://meridian.allenpress.com/operative-dentistry/article-pdf/23/3/1/1819240/1559-2863-23-3-1.pdf by guest on 30 September 2021 caries. Other therapies (e g, pharmacologic, physi­ The photograph presented is that of a maxillary first ologic, dietary, hygienic, etc) are necessary, and premolar evidencing an MOD amalgam restoration sometimes sufficient, to successfully treat the (prosthesis) and a lingual cusp lost to fracture. The disease. If such therapies are not appropriately MOD amalgam pros­ administered, unwarranted blame for postoperative thesis is intact and caries lesions, including so-called recurrent carious has not separated lesions, is often misassigned to the patient or the from the tooth. To restorative effort. the contrary, part In short, our misuse of the term caries inappro­ of the tooth has priately de-emphasizes essential evaluation tech­ separated from it. niques and emphasizes surgical treatment at a time By our currently ac­ in our discipline's development when just the reverse cepted definitions of seems called for. Incipient (i e, noncavitated) caries a dental restoration lesions are now often being remineralized, not just (as stated above), passively monitored, and certainly not surgically there is absolutely removed. Slowly progressing caries lesions are now nothing wrong with often being actively monitored over long periods of this dental restora­ time, sometimes never requiring surgical interven­ tion. Clearly this is tion. Definitive restorative surgery is now often a ridiculous assertion to defend. But what is the postponed until the disease process can be brought error here? under control. Perhaps this question can best be addressed by way Spin-offs of such misuse of the term caries are of an analogy. Suppose we undertake to restore a such inaccurate terms, often found in our textbooks, wooden table top (a definable portion of a table) that as incipient caries, recurrent caries, cavitated caries, has a small dent in its surface. There are a number remineralized caries, arrested caries, class 1 caries, of techniques for accomplishing this restoration, but etc. These terms have in common an inaccuracy of no matter which is chosen, the final product will reference error and also evidence, individually, other involve filling the dented volume (or some larger vol­ inaccuracies too numerous to discuss here.
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