Posted on 19. Jul, 2014 by wisdom.
An interesting article titled “New Daily Persistent Headache As A Presenting Symptom Of Hashimoto’s Encephalopathy,” is written by Daniel E. Jacome and located over at http://www.webmedcentral.com/wmcpdf/Article_WMC00960.pdf. The article discusses Hashimoto’s encephalopathy (HE) which is a rare autoimmune neurological disorder and how patients with this disorder may present with a headache characteristic of new daily persistent headache or atypical hemicranias continua.
Patients of HE are said to have elevated serum titers of thyroid microsomal and antithyroglobulin antibodies. A reference is made to a past case of a woman who had such elevated antibodies and also a left sided headache and aphasia. The current article describes a case of a 50 year old man who had such elevated antibodies and also a persistent daily left sided headache with aphasia. Note that his brain MRI and MRA was normal.
In the article it is mentioned that the man is put on a indomethacin 2 week test as commonly done for hemicranias continua. He doesn’t respond to this and they then try intravenous methyl prednisolone which works well in providing headache relief. He later was put on intravenous immunoglobulin. He doesn’t take steroids on a long term basis and now commonly takes ibuprofen for his headache.
In the article the authors suggest a possible explanation for HE and headache
“Overtime it became apparent that many patients with HE were euthyroid. Subsequently, it was proposed that antibodies primary directed against the thyroid gland, “leaked” across the blood-brain barrier into the brain parenchyma, inducing an autoimmune lymphocytic response based on shared antigens between brain and thyroid….It is possible to speculate than in HE, an associated inflammatory response (asymmetric in this example) affecting the trigemino-vascular brain innervations, may result in peri-vascular nocioceptor activation and hemicrania continua.”
For patients who have a new daily persistent headache they may want to explore Hashimoto’s Encephalopathy as a possible alternative for their condition and have their CSF antibodies looked at. The article does note that the intravenous immunoglobulin alleviated the 50 year old man’s aphasia and cognitive impairment.
Posted on 12. Jul, 2014 by wisdom.
Recently, a death has occurred in Cambridge, Ontario, Canada, in a dental office. Details of the case have not yet been released, but a boy died after getting anesthetic and had a previously undetected heart condition. It seemed to have occurred sometime around late April, 2014, but the date may be off a bit. It appears that in this case the boy was brought to a hospital after the dental office in an attempt to save his life.
An interesting article over in the Cambridge times published June 27, 2014, by Gordon Paul, titled “Pediatric dental surgery with anesthesia should be done in hospitals, dentist says,” provides some comments on this case. See http://www.cambridgetimes.ca/news-story/4605070-pediatric-dental-surgery-with-anesthesia-should-be-done-in-hospitals-dentist-says/. In this article comments by Dr. Hanover who is on the political action committee of the Ontario Dental Association are provided.
“I think every pediatric dentist is most comfortable in a hospital. You’ve got the anesthetist, you’ve got a whole team of nurses, you’ve got crash carts, you’ve got ICUs … and in a dental office, you’ve got the dental anesthetist and maybe an RN. That’s the big difference.”
Dr. Hanover, says that he has performed dental surgery on thousands of children under general anesthesia, but he does not administer it himself. He states
“You talk to any anesthetist, doing kids is the most difficult thing you can do… Anything that happens happens very quickly and you’ve got to react very quickly. If a kid desaturates (low blood oxygen concentration), you’ve got less than a minute to get them going well. In an adult, you’ve got four minutes.”
Dr. Hanover, further discusses how very few hospitals in Canada provide dental anesthesia. His opinion is that the dentist should not administer the anesthesia. He feels the dentist should focus on the dentistry and doing two things at once can be difficult.
In the past I have written posts about anesthesia in an office based setting performed by an oral and maxillofacial surgeon, see for example, http://blog.teethremoval.com/anesthesia-in-the-oral-and-maxillofacial-surgeons-office/ and http://blog.teethremoval.com/anesthesia-in-the-oral-and-maxillofacial-surgeons-office/.
Another post I have written before also touches more closely to the views discussed by Dr. Hanover as a result of the young boy’s death in Canada, see Politics of Dental Anesthesiology. In this post it talks about how dental anesthesiology is not an American Dental Association (ADA) approved specialty. Note that the American Medical Association (AMA) also opposes operator anesthesia such as what an oral and maxillofacial surgeon does, see the post http://blog.teethremoval.com/american-medical-association-versus-american-association-of-oral-and-maxillofacial-surgeons/.
Posted on 05. Jul, 2014 by wisdom.
Recently, patients of a long time dentist in Pennsylvania have been warned of possible exposure to HIV and hepatitis B and C. The dental license of the 74 year old dentist has been suspended as state officials investigate. It is suspected that he was not properly sterilizing his instruments. No reports of disease or transmission have occurred.
The dentist is a long time dentist of a school district. In an interview with one of the school’s students who was examined by the dentist and her mother, it was stated the dentist didn’t have gloves on when treating patients and didn’t wash his hands between patients. The full interview can be seen over at http://www.nbcnews.com/watch/nbc-news-channel/dirty-dentist-has-town-clenching-its-teeth-282301507827 provided by NBC News.
In the past, other cases have occurred where dentists or oral surgeons have been suspected of not following proper procedures to avoid spreading disease. For example see the post Dental Patients Warned of Possible HIV and Hepatitis Exposure Due to Oral Surgeon’s Practices and the post Oral Surgeon Investigated for Reusing Needles and Syringes. In the first post an oral surgeon in Oklahoma potentially used rusty instruments and lax sterilization procedures potentially exposing around 7,000 patients to HIV and hepatitis. In the second post, an oral surgeon was found to re-use needles and syringes between patients to give intravenous medications.
Those patients who have seen a dentist or oral surgeon who potentially used lax sterilization procedures or failed to follow proper procedures to reduce potential disease transmission, should be tested and checked for HIV and hepatitis.
Source: Eric Scicchitano. License of Shamokin dentist suspended. June 14, 2014. http://newsitem.com/license-of-shamokin-dentist-suspended-1.1703391
Researchers are interested in studying fluoride and it’s possible benefits and risks due to it commonly being in water supplies of communities. This is because fluoride is known to help prevent cavities. Even so, some question if putting fluoride in everyone’s water is the right thing to do as some people could experience problems from the water.
For example, several studies have shown Large Amounts of Fluoride Consumed by Young Children Leads to Fluorosis. Hence, it is beneficial to minimize fluoride exposure to young children. Others have looked at the opposite end of the age spectrum: old people. Researchers in Sweden have investigated the possibility that fluoride in the water can lead to additional hip fractures.
The study consisted of a large amount of Swedish residents who were exposured to fluoride levels with the researchers testing a hypothesis that there is an association between fluoride level in drinking water and the risk of hip fracture. The study appeared in the Journal of Dental Research.
The researchers included all of those born in Sweden between January 1, 1900 and December 31, 1919, who were currently still alive and living in their municipality of birth. A total of 473,277 participants were used and their information was linked with several Swedish data sources on the population. Further it was possible to group drinking water fluoride exposure into 4 categories: very low < 0.3mg/L, low 0.3 – 0.69mg/L, medium 0.7 – 1.5 mg/L and high > 1.5mg/L.
The researchers found no association between chronic fluoride exposure and the possible risk of hip fracture in this Swedish study. Hence, it appears that chronic fluoride exposure from drinking water does not appear to cause additional hip fractures. The researchers feel other potential health risks of chronic fluoride exposure from drinking water should be studied and explored.
P. Näsman, J. Ekstrand, F. Granath, A. Ekbom, and C.M. Fored. Estimated Drinking Water Fluoride Exposure and Risk of Hip Fracture: A Cohort Study. Journal of Dental Research, October 2013.
Posted on 22. Jun, 2014 by wisdom.
Earlier this year (2014) in February, I posted about an Eighteen Year Old Music Student in Portland Dies After Wisdom Teeth Removal. This occurred in Maine. It has been since confirmed by a medical examiner, that the 18 year old man died after his wisdom teeth extraction by developing necrotizing fasciitis. This is a flesh eating bacteria which can ravage muscles and skin tissue.
A quote is provided (see source below) by the infection control expert from the American Dental Association who says he has never heard of necrotizing fasciitis after wisdom teeth extractions. I am not quite sure why he says this as cases have appeared of this in the literature and I have discussed this on the wisdom teeth complications page over at http://www.teethremoval.com/complications.html.
Another case of death occurring from necrotizing fasciitis after wisdom teeth extraction occurred to a 25 year old man in 2007, in Seattle, Washington. See Carol Smith. Seattle Post-Intelligencer. Enough Scrutiny in Dental Deaths? July 15, 2008. http://www.seattlepi.com/local/370740_dentists15.html. In this case it took 3 days after the wisdom teeth extraction until death. This was also the number of days before death in the case in Maine for the 18 year old male.
Source: Tomas Jivanda, June 22, 2014, The Independent, http://www.independent.co.uk/news/world/americas/flesheating-bacteria-kills-teen-following-routine-wisdom-teeth-extraction-9554772.html