Gum diease can lead to selective disarming of the immune system

A new study has shown that bacteria responsible for many cases of periodontitis causes dysbiosis in a two prong manipulation of the immune system. The researchers say that periodontal bacterium porphyromonas gingivalis acts on two molecular pathways to block immune cells’ killing ability while preserving the cells’ ability to cause inflammation. This protects these bacteria from being removed by the immune system and leads to bone loss and inflammation which is characteristic of periodontitis. The researchers say when inflammation occurs breakdown products are produced which causes dysbiosis and creates a vicious cycle. P. gingivalis is known as a keystone pathogen. Their presence may be relatively few in the mouth but they can exert a large pull on the overall microbial ecosystem. P. gingivalis doesn’t actually cause periodontitis but is responsible for causing the process that leads to it. The researchers believe that keystone pathogens like P. gingivalis play a role in other inflammatory disease but this still needs to be researched. In the study the researchers looked at neutrophils, which carry the bulk of responsibility of responding to periodontal problems. They investigated the role of two protein receptors C5aR and Toll-like receptor-2, or TLR2. It was found that mice without either receptors and mice treated […]

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Infection Control Lapse in Hawaii at VA Dental Clinic

The U.S. department of Veteran Affairs (VA) has said that 20 patients treated on May 23 and May 27 in Hawaii may have been exposed to viruses due to instruments that were not sterilized. The dental instruments used were believed to be clean, but the VA monitors said they were not sterilized. Only a single load of dental equipment, which was typically sent from one medical center with a dental clinic to a different medical center for sterilization was not performed. It is believed that the risk of contracting anything like HIV or hepatitis is low but patients at risk are recommend to be tested for viruses. The source of the story is over at khon2 titled Veterans Affairs apologizes to dental patients for unsterilized instruments written by Nestor Garcia on June 27, 2014, and located over at  http://khon2.com/2014/06/27/veterans-affairs-apologizes-to-dental-patients-for-unsterilized-instruments/. Staff at khon2 observed the sterilization procedure followed at the VA. They said in their article “First, they scrubbed the instruments, then placed them into an ultrasonic machine to rid the instruments of debris. Next, the instruments were blown dry, placed in a bag and put into an autoclave. The machine steamed them clean for 45 minutes at a temperature of […]

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AAOMS Issues New Position Paper on Medication-related Osteonecrosis of the Jaw

Earlier in 2014, the American Association of Oral and Maxillofacial Surgeons issued a new position paper on Medication related Osteonecrosis of the Jaw (MRONJ) see http://www.aaoms.org/docs/position_papers/mronj_position_paper.pdf?pdf=MRONJ-Position-Paper. The condition in the past has been called Bisphosphonate-related Osteonecrosis of the Jaw but both antiresorptive and antiangiogenic therapies are associated with it so the name has been updated. MRONJ appears as non-healing exposed bone in the mouth and may affect patients undergoing intravenous cancer-related therapy or those treated with oral or IV bisphosphonates for osteoporosis. The paper states that patients may be considered to have MRONJ if the following characteristics are present: Current or previous treatment with antiresorptive or antiangiogenic agents; Exposed bone or bone that can be probed through an intraoral or extraoral fistula(e) in the maxillofacial region that has persisted for more than eight weeks; No history of radiation therapy to the jaws or obvious metastatic disease to the jaws. Most patients on antiresorptive or antiangiogenic agents who develop MRONJ do so after a dental procedure, such as a tooth extraction. The position paper cites several studies which has shown that between 52% to 61% of patients report tooth extraction as the precipitating event who develop MRONJ. It is estimated that […]

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Considerations For the Cost of Wisdom Teeth

In a recent post, I discussed the cost of wisdom teeth management based on an article that appeared earlier this year in the Journal of Oral and Maxillofacial Surgery (see http://blog.teethremoval.com/the-costs-of-third-molar-wisdom-teeth-management/) Another article discussing wisdom teeth costs also appeared in the Journal of Oral and Maxillofacial Surgery in 2012 (see http://blog.teethremoval.com/the-costs-associated-with-third-molars-wisdom-teeth/). In both articles the authors conclude the costs of non-operative management of asymptomatic, disease-free, wisdom teeth exceeds the cost of operative management. I take issue with their conclusions as I believe they make too many simplifications in their analysis. I argue that the authors are ignoring the real risks of having wisdom teeth extracted that are not going to likely occur with non-operative management. Removing wisdom teeth has complications that can result. Some of these can be serious, permanent, and lasting, and cause considerable cost to both the patient and society. For example over at http://www.teethremoval.com/dental_malpractice.html a case from the 1980’s is discussed of a 36 year woman who was given an overdose of anesthesia while having her wisdom teeth removed that left her with permanent brain damage and unable to care for herself. Due to a damage cap in the state of Indiana she only received $500,000 from a […]

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The Costs of Third Molar (Wisdom Teeth) Management

I have previously commented on the costs associated with wisdom teeth in a 2013 blog post that was based on a 2012 article appearing in the Journal of Oral and Maxillofacial Surgery (see http://blog.teethremoval.com/the-costs-associated-with-third-molars-wisdom-teeth/). More recently, another article discussing the costs of wisdom teeth has appeared in the 2014 Journal of Oral and Maxillofacial Surgery titled “The Cost of Third Molar Management” written by Gino Inverso, Ronald Heard, and Bonnie L. Padwa (issue 72, pp. 1038-1039). This article takes the position that most previous studies focused on discussing wisdom teeth costs when taking the position from the cost of billing to private insurance companies. Their article attempts to use the true cost which they feel should help promote discussion of the topic of retaining or removing healthy disease free wisdom teeth and possibly increase access to care. In their analysis they determine the approximate time spent with an oral surgeon and their staff for a patient for a consultation, an operative visit, and a post-operative visit. They then determine the estimate annual cost associated with an oral surgeon, a surgery assistant, and a receptionist in a private oral and maxillofacial surgeon office in 2013. This total cost for all 3 comes in at […]

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