Letters

Editor’s note: I have very fond memories of Dr. Wilson and his wife. When I would call his home to ask for guidance or to ask a question, his wife, Eleanore, would get his attention and bring him to the phone by calling out with great enthusiasm, “Mister Speaker!” It brings a smile to me even today.

A Gentle Hero

That’s how former ADA Trustee Dr. Rod Feldman described Dr. Charles Wilson when we spoke recently. Charlie recently passed at age 96 after a long and distinguished career where he certainly contributed to our profession.

Charlie was in college when the Pearl Harbor attack happened and in 1942 joined the Navy. There were so many recruits that the Navy kept him in school until he was needed. The 812 program was developed to pay for dental and medical school so there would be enough dentists and physicians to care for the returning troops after the war. Although he wanted to be a physician, they sent him to dental school at the University of Missouri at Kansas City where he graduated in 1947. He and Eleanore moved to Fairfield, Calif., in 1950, and while setting up his practice, he was drafted for the Korean War. After two years of service, he returned to Fairfield.

During his career, he served as the last president of CDA before reunification (November 1971 to November 1972). He was an ADA delegate, ADA vice president, CDA speaker of the house (July 1978 to July 1989) and many other leadership positions at the state and in his local component, Napa-Solano. His great sense of humor and skill made him one of the most popular and respected speakers. Dr. Feldman remembers vividly that at Dr. Wilson’s last session of his last house as speaker he said, “I love CDA.” A sentiment that is felt by many, but not often heard.

He also served as president of the Fairfield Chamber of Commerce and was a longtime member of the Lions Club.

Dr. Wilson was a large presence in dentistry. All those he mentored will always remember him with gratitude, respect and fondness. Fortunately, there are some members of our profession who truly make it better with their dedication and energy; Charlie Wilson was certainly one who did. He will be remembered with love by those fortunate enough to have known him. I am one of those fortunate ones.

—Henrik Hansen, DDS Fairfield, Calif.

Need More Rigorous Presentation

The recent retrospective research report by Griffith [1] confirms the importance of case series design studies based in community practice and offers a good opportunity to examine research methodology. The findings appear to reinforce the results of previous studies of conservative management of dental caries lesions in adults; however, in order for readers to accurately understand its implications, it would benefit from a more rigorous presentation.

Helpful checklists are available to authors today that give international standards for this type of report. [2] There are three important issues that a clinician should consider in evaluating this paper. First, the report does not clearly state if the cases were consecutive. (There may be bias in whether the treatments were offered to all patients with teeth that met the inclusion criteria or whether all patients accepted the treatment. It was not clear whether all cases that were eligible were abstracted.) Second, how the cases were abstracted and reviewed is not clearly described. Was there a checklist or a review manual? How was the review calibrated and the reliability of the abstractor assessed? Were the radiographs reviewed in a standardized manner? What proportion of the radiographs were unreadable or missing? (These details help a fellow clinician feel confident generalizing from the reported findings.)

Finally, the analysis is descriptive. An appropriate statistical model, likely survival analysis for clustered data, should have been employed and quantitative results presented in order to strengthen the conclusion that the results are valid. Such analyses require statistical adjustment for multiple teeth contributed by the same individual and also for varying lengths of follow-up. In addition, were any cases lost to follow-up? What concomitant treatment might have impacted the primary outcome? Without knowing the answers to these questions, the clinical reader’s opportunity to profit from the experience of this thoughtful and capable clinician is diminished.

—Peter Milgrom, DDS, Seattle

REFERENCES

1. Griffith M. Treating deep caries in 277 adult teeth with silver fluoride. J Calif Dent Assoc 2021;49(1):13–17.

2. Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP. The PROCESS 2018 statement: Updating Consensus Preferred Reporting of Case Series in Surgery (PROCESS) guidelines. Int J Surg 2018 Dec;60:279–282. doi: 10.1016/j.ijsu.2018.10.031. Epub 2018 Oct 22.

The Author’s Response to Dr. Milgrom’s Comments

1) Were cases consecutive? I began offering treatment to an older population that presented with very difficult caries to manage, both expeditiously and economically. All patients who met the criteria for inclusion were reported in the report. Teeth and patients that did not meet the follow-up criteria were not included in the report. Most individual patients whom I inherited were from two dentists who retired locally, and I ended up treating all patients myself.

I treated patients who were within my original patient population.

Those patients with deep decay that needed treatment were treated with silver fluoride. They were treated as they came in for recall in my practice, and none were excluded or selected out specifically for treatment. None of the patients who were offered treatment declined treatment after the options were presented. Those treatment options included the silver fluoride offered as a possible means of avoiding root canal therapy. No patients with really deep decay opted for immediate root canal treatment.

2) The patients’ treatments were kept on an Excel spreadsheet, entered by me, the operator. This maximized reliability of recorded data. All patients had readable preop X-rays and those without postop images were dropped. All images were stored in the office computer as well as on my laptop. The analysis was retrospective and descriptive. There was no attempt to set up a double-blind study or to apply statistical methodology other than simple mathematical percentages and averages. This was not a clinical study but a well-maintained clinical report, and more rigorous statistical analysis was seen as not indicated by this report’s design. A clinical study with larger numbers and double-blind controls was suggested.

3) I agree that a rigorous, longer treatment employing double-blind controls would be more credible. Followup was ended when I had to retire, and the few patients I have encountered have done fine, but this does not constitute real follow-up. What kept this process going was the observation that treated teeth were remarkably asymptomatic after excavating very deep decay, with some individuals exhibiting decay up to the pulp.

—Michael Griffith, DDS, MS, MA, San Francisco

The Journal welcomes letters

We reserve the right to edit all communications. Letters should discuss an item published in the Journal within the last two months or matters of general interest to our readership. Letters must be no more than 500 words and cite no more than five references. No illustrations will be accepted. Letters should be submitted at editorialmanager. com/jcaldentassoc. By sending the letter, the author certifies that neither the letter nor one with substantially similar content under the writer’s authorship has been published or is being considered for publication elsewhere, and the author acknowledges and agrees that the letter and all rights with regard to the letter become the property of CDA.