If one is good, two must be better. This axiom, offering a rationale for indulgence, may cause more harm than good. Visualize the adverse effects of pharmacological overdosing or the impact of binge eating on those predisposed to obesity. Similarly, apply the concept to business ventures; how many sequels to movies have been as good as or better than the original? "Godfather II" and ... ?

In March 1999, I wrote an editorial titled "Outrageous." The theme focused on the need for dentists to speak out against the cancerlike growth of commercial interests that appear to pervade every niche of the K-12 curricula. The editorial was well-received—prompting the usual number of letters to the editor. So, considering the history of sequels, why revisit the subject?

Simply, the topic is critical to the oral and systemic health of America’s schoolchildren. And while a growing number of dentists appear willing to take on leadership roles in addressing this issue, many more dental supporters are needed. Now!

Pouring rights—a term used to describe exclusive contracts between school districts and soft-drink manufacturers—is where dentistry becomes involved. The commercialism of schools by industry is the umbrella issue that allows and promotes such contracts.

School systems, seemingly underfunded to carry out all the activities demanded of them, seek nonpublic financial support for their programs. Industry, sensing an opportunity to establish brand loyalty, becomes a willing partner and a ready source of funds. Pizzas, hamburgers, athletic shoes, candy and soda pop—all have become excellent candidates for "exclusive" marketing deals with schools.

If these commercial deals cause no harm, so be it. However, if one of these "pouring" contracts can be shown to adversely affect the health of schoolchildren, dental health professionals have an ethical responsibility to intervene. The excessive promotion of soft drinks falls in that category.

Consider the following excerpt from that earlier editorial. A high-ranking official of a school district with a lucrative soft drink contract sent a letter to his school principals warning that if their schools didn’t "dramatically" increase sales, the district’s schools would lose significant revenue.

While indicating that this was not to pressure the teachers, he did suggest "allowing students virtually unlimited access to soft-drink machines." To facilitate this access, he suggested moving the soft-drink dispensers closer to the classrooms. The letter also urged teachers to "consider" encouraging students to consume their soft drinks in class.

Amazingly, the edict generated little concern among the teachers. No teachers contacted the local education association, and the local dental society appeared to be out of the loop.

Not any more. In Michigan, Wisconsin, Ohio, Pennsylvania and New York, local and state dental societies are saying "we care" and are taking action. Both Michigan and Wisconsin submitted to the 2000 ADA House of Delegates resolutions directed to contractual arrangements that "inappropriately influence consumption patterns of soft drinks by schoolchildren."

Their combined efforts, plus testimony from a group of impassioned dentists during Reference Committee hearings, led to a resolution that attracted almost unanimous support from the 2000 ADA House of Delegates.

The resolution (73RC) calls on the ADA to "gather scientific facts and supportive data concerning consumption of soft drinks in schools, develop educational material for the public and school districts on this subject, encourage cooperation with various medical and school constituencies to increase awareness of the nutritive issues, and specifically endorse a policy directed to the opposition of ‘pouring rights’ contracts."

Some positive actions already have occurred.

Pennsylvania’s Fifth District dental leaders reported in a letter to JADA that "dentists are contacting school nurses, boards of education and administration. Already soda machines are being eliminated, restricted to non-school hours or limited to natural fruit juices. ..."

In Michigan, a special education teacher acknowledging organized dentistry’s involvement on the soft-drink issue wrote in the local paper, "Thanks ... for taking a stand and speaking out in our schools. I have long anguished over the availability and consumption [of soft drinks] at the school in which I teach special education and am happy to see a community member taking action."

The Jackson, (Mich.) Citizen Patriot’s May 28 editorial on this issue, called "Liquid Candy," stated, "Bless the men and women of the Michigan Dental Association who have drawn a line in the sand on the surrender of one school district after another to easy money from soft drinks. ... Dentists might have a reason to applaud the increased consumption of soft drinks, for it generates more tooth decay and thus more business. But, of course, that isn’t the way dentists look at it. Their professional goal is to educate, inform, and attack the factors promoting tooth decay."

Well stated.

The Lansing (Mich.) State Journal also praised the Michigan Dental Association’s efforts to promote good nutrition in schoolchildren. Pointing to the "pouring" contracts, they lamented, "Is this the price our children must pay so adults can make their budgets work?"

Outrageous? You bet!

Dentists are noting an increase in the caries rate in their teenage and young adult populations. While evidence remains anecdotal, ongoing research looks to increases in refined sugar consumption as the culprit. Fluoride-protected teeth can resist only so much acid before succumbing to decay. With more schools entering into pouring rights contracts (150 at last count), the highspeed hand-piece and anesthetic syringe could again become symbols of a dental visit by America’s youth.

Isn’t this sufficient reason for all dentists to become involved?