Opportunistic and Reprehensible Academic Plight Propolis
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LETTERS Send your letters to the editor, British Dental Journal, 64 Wimpole Street, London W1G 8YS Email [email protected] Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space Opportunistic and hospital practice, as well as in the They witness the challenges we face and teaching of undergraduates and it is difficult to paint a rosy picture in reprehensible postgraduates, we find the balance of this today’s environment. The resolution of Sir, the article by Macluskey, Slevin, Curran paper suspect and are concerned that it manpower issues, resource funding, and Nesbitt (BDJ 2005; 199: 671-675) has been independently reviewed and realistic expectations and autonomy are raised more questions than it answered. accepted as a scientific analysis. The desperately needed in academia. I believe Having stated within the introductory suggestion that a practice such as this if these are sorted then perhaps we can paragraphs that the usual referral centre could be a more proper place to train save the plight of the academic in currently is the nearest ‘District General students is patently opportunistic and dentistry. Hospital’, the paper then went on to review professionally reprehensible. R. McAndrew the differences between a teaching hospital N. Ali, J. Carter, L. Cheng, K. Coghlan, P. By email in Scotland and a specialist surgical dental Hardee, S. Holmes, I. Hutchinson doi: 10.1038/sj.bdj.4813434 practice in Northern Ireland! London The first identified flaw is that there is doi: 10.1038/sj.bdj.4813433 Propolis: a background no evidence whatsoever that the pattern of Sir, Dr T. A. Parr reported a patient who referral of patients with third molar disease Academic plight developed oral ulceration as a was in any way comparable between the Sir, recruitment and retention has been an consequence of exposure to a fungicide, two centres. By definition, dental teaching issue in clinical academia for many years who was then treated with propolis (BDJ hospitals with oral and maxillofacial and while this has never been fully 2006; 200: 64). However, before clinicians surgery units tend to attract a referral of addressed, any article which highlights the consider using propolis, a little more complex cases whereas, by their own plight of clinical academics within dentistry background might be worth considering. admission, the surgical dental practice has to be applauded (BDJ 2006; 200: 73- Propolis (bee glue, or royal jelly) is a surveyed attracted over 30% of patients 74). Despite the rosy picture painted by natural substance based on the resin of for third molar surgery who required only O’Brien and Kay, the shortages remain and pines, collected by bees. The term ‘simple extractions’. Even if it is accepted we need to ask ourselves: why is it suitable ‘propolis’ derives from ‘pro’ (Greek = that the case mix was not too disparate, people are not queuing up to join us? before), and ‘polis’ (city) based on the fact the second question is the degree of To fly high in academia, which is what I that honeybees use propolis to narrow the discrimination being exercised in believe O’Brien and Kay are advocating, opening to their hives. submitting patients to surgery. The dental you need to be able to get airborne and Propolis is a complex entity, containing hospital consultation process resulted in you cannot do this if you are laden down, about 55% resinous compounds and balsam, more than a quarter of the 50 patients tied or restricted. Unfortunately this is the 30% beeswax, 10% ethereal and aromatic examined being advised that they did not stark reality of academia. There are oils, and 5% bee pollen. Contained chemicals require a surgical procedure. In contrast several issues not least of which are the include amino acids; flavanoids including the practice submitted every one of their competing agendas of research, teaching, flavones, flavonols and flavanones; terpenes; 250 patients to a surgical episode. training and service provision. vanillin; tetochrysin; isalpinin pinocembrin It also seems remarkable that a dental Research governance becomes ever chrysin galangin; ferulic acid; caffeic acid; hospital should choose to put 42% of their more burdensome and as GDPs are caffeic acid phenethyl ester; cinnamic acid patients through local anaesthetic required to undertake CPD we are and cinnamyl alcohol. treatments compared to only 30% in the increasingly called upon to provide Propolis has a degree of antimicrobial surgical dental practice, whereas 70% of Section 63 courses. Add to that chronic action against fungi such as C. albicans, and the surgical dental practice patients are understaffing, increases in student some bacteria1 including a range of oral subject to local anaesthetic with IV numbers and lack of administrative microorganisms2 and viruses, and may be as sedation – for which, in that setting, an support and the reasons behind a lack of effective as aciclovir against herpes simplex additional fee is payable. manpower become clear. Opportunities to virus.3 It also has immunomodulatory Finally, the surgical dental practice is to partake in the so called more attractive activity with augmentation of non-specific be commended upon the 0% complication pursuits are in reality accepted less and antitumour resistance.4 rate which was achieved. However it is less as to do so often places an unbearable Not surprisingly therefore, many claims, interesting that within the hospital setting burden on colleagues left behind to hold not always substantiated, have been made where all surgical practitioners are subject to the fort. The academic masters, like Oliver for the general beneficial effects of propolis. peer review and continuous peer scrutiny, Twist, want more. Additionally, it is a In dentistry, propolis has been used in the comparable morbidity was 13%. stark reality that no matter how hard we dentifrices,5 as a storage medium for teeth As a group of practitioners of oral and try in our jobs, our activity and indeed our after evulsion,6 in periodontal therapy7 and maxillofacial surgery, involved both in plights are always on show to the people in endodontics.8 Propolis ethanolic individual practice, National Health we want to attract: our students and our solutions are the most used propolis Service district general and teaching junior colleagues. products on the market for assisting the BRITISH DENTAL JOURNAL VOLUME 200 NO. 7 APR 8 2006 359 LETTERS treatment of ulcers in the mouth, thrush or doi: 10.1038/sj.bdj.4813436 are very hard to achieve and inevitably skin infections: there is little evidence base. there is a high rate of failure but if we do While I am a great supporter of holistic Courage for debate not try, then extractions and/or dentistry and complementary medicine, the Sir, I was sad to see that the letters orthognathic surgery become inevitable. fact is that as well as the fact that there is criticising my opinion article, Science Some children improve their oral posture little evidence base for efficacy, versus empiricism (BDJ 2005 199: 495-497) spontaneously and this, as Dr McIntyre phytomedicines such as propolis, though tended to be personal rather that scientific. reminds us, may be the group that grow natural, cannot necessarily always be Empiricism essentially means favourably regardless of treatment. Mr regarded as safe.9 Propolis is, for example, experiment, and if one thing does not Pearson recommends a double blind well recognised as causing hypersensitivity work, try something else (trial and error) clinical trial but how does one assess the and anaphylaxis,10 and as occasionally but it is valueless without scientific logic. It changes in oral posture? No one has yet causing untoward reactions such as allergic is empiricism which has led the specialty developed a means of measuring tongue cheilitis,11 and oral ulceration.12,13 around the houses on the extraction issue. posture, so it would prove nothing. C. Scully CBE Angle tried without and it did not work so I know of only one way. Select a number By email Tweed tried with it and that failed too. Now of good responses to each treatment and no one knows. My critics would do better if compare them. The most ‘effective’ method 1. Kosalec I, Pepeljnjak S et al. Flavonoid analysis and they analysed people with naturally will have a higher ratio of satisfactory antimicrobial activity of commercially available propolis products. Acta Pharm 2005; 55: 423-430. straight teeth and used scientific logic to results but if one method is more 2. Park Y K, Koo M H et al. Antimicrobial activity of propolis work out why, but they do not do this. ‘efficacious’ it is likely to have a higher on oral microorganisms. Curr Microbiol 1998; 36: 24- Dr Horobin agrees with me that our ratio of excellent results. I would be happy 28. 3. Vynograd N, Vynograd I et al. A comparative multi- modern lifestyle is the obvious cause of to present 10 of my good cases so that they centre study of the efficacy of propolis, acyclovir and malocclusion, but Dr Di Biase believes could be matched against those of any placebo in the treatment of genital herpes (HSV). that ‘the aetiology of malocclusion is other orthodontist in the UK. Because I Phytomedicine 2000; 7: 1-6. poorly understood’. Is it ethical to treat a have been in practice longer than most, it 4. Orsolic N, Saranovic A B, Basic I. Direct and indirect mechanism(s) of antitumour activity of propolis and its disease that you do not understand? might be fair to increase this to three other polyphenolic compounds. Planta Med 2006; 72: 20-27. Twenty-five years ago I first put forward orthodontists. My only condition would be 5.