Silly Season 3
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LETTERS The sterile water we use for the auto- usually mimic squamous cell carcinoma, cause, and signed her letter ‘one of your clave is provided in one litre plastic a diagnosis becomes more challenging.4 victims’. Throughout the time I have had bottles, of which we use four each day, Mechanical tears and trauma in the oral to live under the threat of her ‘going pub- draining 3.5 litres off at the end of the cavity are considered one of the aetio- lic’. I suppose it is the risk we take don- day. Following the above assumptions, a logical factors for inoculation of bacte- ning a white coat, and I was relieved that total of 40,250 litres would go down the ria in the oral tissue from sputum. But she had chosen something so extreme drain, and 46,000 bottles used each day. surprisingly, there are very few cases of to fantasise about. The local police were The cost in energy in production of the secondary tuberculosis in spite of a high quite supportive and wanted to prosecute sterile water: to extract water from the incidence of sputum positive cases. her for wasting police time, however, they ground, to distil it, and fi ll the bottles; The authors have found positive spu- are not allowed to unless she withdraws and the energy required to produce the tum in their case. Acid fast bacilli can her allegation, which she refuses to do. plastic, convert it into a bottle, transport be found in saliva in a case of primary There is no way I can prove nothing it, and sterilise its contents, are substan- tuberculosis of the oral cavity but not in happened or prevent someone else doing tial. Further the 46,000 bottles per day, sputum. Positive sputum points to TB of something similar. I could install a video will require collecting and recycling, or pulmonary origin although sometimes, recorder to tape every working session, will end up being transported and tak- TB of the bronchioles is not evident on but I would have hours of tape to cata- ing up space in a land fi ll site. radiographs. To rule out that possibility, logue and keep forever. Anonymity for Although my calculations may be well bronchoscopy or CT scan is mandatory. the accused is viewed as unnecessary by wide of the mark, hopefully they pro- We therefore believe that the presented our law makers because the rates of false vide further food for thought. However case is of secondary tuberculosis of the accusation for rape and sexual offences is it is undoubtedly true that HTM 01-05 oral cavity. no higher than for any other crime. The has greatly increased dentistry’s carbon S. Gandhi, N. Gandhi, S. Bither stress that such an accusation causes can- footprint in this country. By email not be described or the sense of how unjust C. Dugmore it is when we are denied a right of reply. 1. WHO. Global tuberculosis control - epidemiology, Leicester strategy, fi nancing. Geneva: WHO, 2009. Name and address supplied DOI: 10.1038/sj.bdj.2010.823 2. Wang W C, Chen J Y, Chen Y K, Lin L M. Tuberculo- DOI: 10.1038/sj.bdj.2010.825 sis of the head and neck: a review of 20 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; POSITIVE SPUTUM 107: 381-386. SILLY SEASON 3. Nohrstrom E, Kentala E, Kuusela P, Mattila P S. Sir, we read with interest the paper Tuberculosis of the head and neck in Finland. Acta Sir, well the ‘silly season’ must be upon us! Primary tuberculosis masquerading Otolaryngol 2007; 127: 770-774. So I gather the GDC is considering remov- 4. Meng C M. Tuberculosis of the mandible. J Bone as gingival enlargement (BDJ 2010; Joint Surg Am 1940; 22: 17-27. ing our right to use the courtesy title ‘Dr’. I 208: 343-345). DOI: 10.1038/sj.bdj.2010.824 think there are some very important com- Tuberculosis has a very high incidence ments to make on this issue. in developing countries. According to DENIED A REPLY First the GDC should not be wasting WHO estimates 9.27 million new cases Sir, I read with interest the letter Anonym- their time and resources over an issue of tuberculosis (TB) occurred in 2007 ity rights (BDJ 2010; 209: 105), recount- that was sorted out after decades of with around 55% of global cases arising ing a false allegation of molestation from debate 14 years ago. I gather that the in Asia (South East Asia and Western a female patient. I have been in general excuse for this ‘debate’ is that the cour- Pacifi c regions), which is attributed to practice since 1986 and I always work tesy title ‘Dr’ can confuse the public and poor hygiene conditions.1 with my door open and a nurse in the mislead them into believing dentists are The authors of the paper presented a surgery. Five years ago a female patient medically qualifi ed! case of primary tuberculosis of the gin- had a lengthy crown prep procedure dur- So, have there been any issues where a giva. Such a condition is considered a ing which the surgery door was open and member of the public has been misled by rare entity affecting approximately 0.05- my nurse was present. This lady waited this courtesy title in the last 14 years? NO. 5.00% of patients with TB2 as the oral for one month and then reported to the The courtesy ‘Dr’ title for dentists is cavity is considered to be immune due police that she had been raped whilst in used by the majority of countries in the to local immunity of the mucous mem- the chair. She took two days of their time world. The people in these countries do brane.3 However, an increasing incidence and her story was so garbled that they not seem to have any problems over of TB (due to Aids and emerging multi- refused to take the matter any further. this, and there do not appear to have drug resistant strains) means that we are My frustration was and still remains that been any issues of the international or likely to see many cases of tuberculosis I was advised that I must not contact her EU public being misled in any way. The in the oral cavity in future, so that TB at all costs and I had no right of reply. GDC is implying that the British public should be considered as a differential She did not, as far as I know, broadcast are stupid - or certainly not as discern- diagnosis. The most usual presentation her allegations more widely. She has now ing as the rest of the world! is as an ulcer on the tongue, gingival fi ve years later sent a letter threatening to The majority of countries in the EEC or buccal mucosa and as a radiolucency end my career as she has found a retired refer to their dentists as ‘Dr’. The den- when bone is affected. Since the ulcers journalist who is going to champion her tal qualifi cations of EU countries are 264 BRITISH DENTAL JOURNAL VOLUME 209 NO. 6 SEP 25 2010 © 2010 Macmillan Publishers Limited. All rights reserved accepted in this country as being on a I am grateful that you have shown par with the BDS qualifi cation (as are that Dentist 50533 and most other num- dental qualifi cations from most non-EU bers are still trying to protect patients, countries), and the courtesy title Dr is despite the toothlessness of the Council. granted with these EU qualifi cations, as Let us all stay worthy of trust. is the BDS at present. T. Rhodes It could be argued very strongly that Westbury the GDC is in breach of EU law if they DOI: 10.1038/sj.bdj.2010.827 withdraw the courtesy ‘Dr’ title from English/British dentists. THE DEFINITIVE PAPER EU dentists would still be entitled to Sir, I was delighted to see the technique be called ‘Dr’ even if British dentists of coronectomy being advocated for the were not allowed. This would be seen treatment of lower third molars where as ‘active professional discrimination’ there is the possibility of damage to the against British dentists, and it could also inferior alveolar nerve (BDJ 2010; 209: be argued that it would also be a breach 111-114). I am quoted in the article but the of UK dentists’ rights. reference given is to an abstract of a paper We should also remember that our I gave at the annual meeting of the Brit- medical colleagues’ ‘Dr’ title is also a ish Association of Oral and Maxillofacial courtesy title. The title ‘Dr’ can really Surgeons. The reference for the defi nitive only be used be those who achieve a paper is: O’Riordan B C. Coronectomy ‘Doctorate’ title, ie PhD. (Intentional Partial Odontectomy of lower The GDC are not above the law and third molars). Oral Surg Oral Med Oral should be reminded as such! Path Oral Radiol Endod 2004; 98: 274-280. Well I guess that’s qualifi ed me for This is a retrospective study of coronec- a place in the ‘Grumpy Old Men’ team; tomy over a ten-year period with follow- move over Rick Wakeman. Now what up of four cases over ten years, 15 patients other issue can I fi nd to rant on about? over 5-9 years and 33 patients over 2-4 R. Piper years. Any interested reader going to the By email abstract will be disappointed to fi nd that DOI: 10.1038/sj.bdj.2010.826 is just that, but will fi nd the illustration of radiographs, method, results and discus- COURTESY TITLES sion in the defi nitive paper.