BAD BREATH

Michelle G. Hutchinson
JADA 2013;144(3):246

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COMMENTARY

LETTERS

LETTERS

242 JADA 144(3)

http://jada.ada.org

KEY PERFORMANCE
INDICATORS

Dr. Roger Levin offers sound

advice in his November JADA
column on The Importance of
Key Performance Indicators
(JADA 2012;143[11]:12481249). In this complex world,
confusion awaits any who are
unclear about what matters
most. It is especially important
to focus on the leading indexes
and to do so consistently over

time in order to reveal trends.

As noted, we need systems that
allow professionals to maintain
a strong focus on excellent
clinical care for patients.
Dr. Levin suggests 10 key
performance indicators (KPIs),
such as collection percentage,
gross revenue and profit. These
are all lagging indicators that
reflect decisions made in the
past. They are not marketoriented in the sense of
showing what drives patient
care-seeking behavior. The suggested KPIs are, however, easy
measures to understand
because they do not require
looking into patients mouths,
and any staff member can be
trained to diagnose them.
The advice that dentists
should focus on what is critical is worth following, but it
must be paired with Dr. Levins
additional admonition that
office success should be tracked

March 2013

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ADA welcomes letters from

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appeared in The Journal. The
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COMMENTARY

LETTERS

on what each dentist considers

important.
David W. Chambers, EdM,
MBA,
PhD
Professor of Dental Education
School of Dentistry
University of the Pacific
San Francisco
and
Editor
American College of Dentists
Gaithersburg, Md.

BRUXISM AND MYOFASCIAL

TMDs

244 JADA 144(3)

http://jada.ada.org

opportunity to emphasize
points already highlighted in
our article. We clearly state
that cross-sectional data from
our study did not address the
possibility that SB [sleep
bruxism] could be involved in
the initial onset or triggering of
a myofascial TMD [temporomandibular disorder].
Nevertheless, we emphasize
that treatment aimed at reducing sleep bruxism among
those who already have a
chronic myofascial TMD is
clearly misguided, since
myofascial TMD patients do not
brux at excessive rates at night.
Karen G. Raphael, PhD

Bloomington, Ind.

Authors response: Dr.

Bishops letter provides us an

March 2013

Copyright 2013 American Dental Association. All rights reserved.

Professor
Department of Oral
and Maxillofacial Pathology
and Medicine
College of Dentistry
New York University
New York City

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Thank you for the November

JADA article by Dr. Karen
Raphael and colleagues, Sleep
Bruxism and Myofascial Temporomandibular Disorders: A
Laboratory-based Polysomnographic Investigation (Raphael
KG, Sirois DA, Janal MN, et al.
JADA 2012;143[11]:1223-1231).
I think the conclusion that

there is no relationship between the two may be

overreaching.
If we had a sore joint due to
overuse, such as tennis elbow,
our mothers told us to rest
until we were better. Indeed,
we were sore, and therefore
had to rest. Measuring our
activity after the fact might
show little activity and mislead
a researcher to make a broad
statement about the relationship between overuse and
soreness.
The etiology of temporomandibular disorders is a difficult
subject to study, but the temporomandibular joint is similar to
other joints in our bodies and
we need to keep this in mind.
Gary D. Bishop, DDS

COMMENTARY

LETTERS

BAD BREATH

are suspected as the point of

origin, dentists can refer
patients to an otolaryngologist
for further evaluation.1
We are pleased that Dr.
Hutchinson finds the For the
Dental Patient page helpful
and hope that all JADAs
readers will continue to use
this resource as a starting point
in patient education.
1. ADA Council on Scientific Affairs. Oral
malodor. JADA 2003;134(2):209-214.

CORRECTION

The March JADA article Is

Change in Probing Depth a
Reliable Predictor of Change in
Clinical Attachment Loss? by
Bryan S. Michalowicz, DDS,
MS, and colleagues (JADA
2013;144[2]:171-178) contained
errors in Tables 4 and 5. The
title of each of those tables, as
well as the right-hand column
in each, should be labeled r
value rather than r2 value.
JADA regrets the error.

Marietta, Ga.
1. ADA Council on Scientific Affairs. Oral
malodor. JADA 2003;134(2):209-214.

Response from the

American Dental Association Division of Science: We
appreciate Dr. Hutchinsons
feedback concerning the September For the Dental
Patient page and regret that
we neglected to mention the
tonsils as a potential source of
oral malodor.
Poor tonsillar health,
including formation of tonsilloliths, may play a role in bad
breath, which can be discussed
with the patient. When tonsils
246

JADA 144(3)

http://jada.ada.org

March 2013

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I have long appreciated JADAs

For the Dental Patient
column and admired the
writers abilities to translate
biodental information into language the general public can
understand. But I was disappointed that the September
column, Bad Breath: Causes
and Tips for Controlling It
(American Dental Association
Division of Science. JADA 2012;
143[9]:1053), didnt mention
tonsilloliths or, as the dental
patient might understand
them, tonsil stones.
Although tonsilloliths are
probably not the most likely
cause of halitosis, the ADA
Council on Scientific Affairs
has reported that odor from
the tonsils can be determined
by assessing the tonsils
enlargement and the presence
of tonsillar crypts in
concretion.1
I realize that space for the
For the Dental Patient
column is limited to one page,
but we as dentists have an obligation to inform dental consumers that tonsilloliths might
be a cause of bad breath, and
we owe it to our patients to let
them know how these concretions can be removed.
Michelle G. Hutchinson,
DMD, MPH, CPH