Comparing Complications from Anesthesia with Wisdom Teeth Extractions

An article titled “Anesthesia Complications of Diazepam Use for Adolescents Receiving Extraction of Third Molars,” appears in the 2016 Journal of Oral and Maxilofacial Surgery by Gino Inverso and et. al, vol. 74, pp. 1140-1144. The article seeks to evaluate the safety of midazolam and diazepam for adolescents during wisdom teeth extraction and whether any differences in complications exist when using the 2 benzodiazepines alone or in combination. Compared with diazepam, midazolam has a faster onset of action, greater incidence of amnesia, and shorter recovery time. The authors hypothesized that diazepam, when used as an intravenous sedative agent for third molar extraction, would be associated with a higher rate of anesthetic complication than midazolam. The study included patients enrolled in the OMSOS from January 2001 through December 2010. To be included, patients had to be adolescents (<21 yr old) who underwent at least 1 third molar extraction by an oral and maxillofacial surgeon in the ambulatory setting. The study cohort was divided into 3 groups: patients who received diazepam as the only parenteral benzodiazepine, patients who received midazolam as the only parenteral benzodiazepine, and patients who received a combination of diazepam and midazolam. The primary outcome was perioperative anesthetic complications. Complications […]

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Quality Measures Need Measures of Quality

An article titled “Quality Measures Need Measures of Quality” appears in the 2016 Journal of Oral and Maxillofacial Surgery, issue 74, pp. 1101-1102, and written by Thomas Dodson. The article discusses how nowadays doctors have a lot more access to information thanks to the information technology revolution. He discusses HIPAA and electronic medical records (EMRs). The author states “EMRs were introduced—we were promised—to make patient information portable and to improve communication between providers, thus improving patient safety and quality of care. In truth, these were secondary intentions, the first and overriding being Medicare’s (now CMS’) need to provide comparable data across institutions in order to control costs and monitor utilization.” In the article he talks about compliance with data capture and automation and how with quality measures oral surgeons are not much farther now than in 1984. Measures of quality, outcome, and value (outcomes relative to costs) have been difficult to identify. He talks about how AAOMS, sponsored a practice-based research collaboration in 2012 to collect OMS-specific data in order to establish ‘‘benchmarks’’ that could be used by the membership to measure ‘‘quality. It is stated that with all the regulations, process measures, investments in technology, and hours of commitment […]

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Effect of Eruption Status of the Mandibular Wisdom Teeth on Distal Caries in the Adjacent Second Molar

An article titled “Effect of Eruption Status of the Mandibular Third Molar on Distal Caries in the Adjacent Second Molar,” written by Feiwu Kang and et. al. appears in  the 2016 issue of J Oral Maxillofac Surg. The article explores the eruption of mandibular wisdom teeth and their effect on adjacent second molars. A total of 500 cone beam computed tomography (CBCT) images of mandibular third molar (MTMs) from 469 patients were evaluated. The authors assessed the presence of distal caries in mandibular second molars (MSMs), impaction depths and angulations of MTMs, cementoenamel junction (CEJ) distances between distal MSMs and mesial MTMs, presence of pericoronitis in MTMs, and patient characteristics (age and gender). The authors state that previous studies show the prevalence of distal caries in MSMs has ranged from 13.4 to 30.1%. The authors found that the overall prevalence of distal caries in the mandibular second molars was 52.0%. According to the classification of Pell and Gregory, position A was the impaction depth at which most distal caries in MSMs were present (P= .036). For angulation of the mandibular third molars, when mesial angulations were 43 to 73%, MSMs developed more distal caries (P < .0001). Previous studies have reported that […]

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Prevalence of Visible Third Molars in the United States Population

An interesting article titled “Prevalence of Visible Third Molars in the United States Population: How Many Individuals Have Third Molars?” appears in the 2016 Journal of Oral and Maxilofacial Surgery 74, pp. 13-17, 2016, by Caitlin B. L. Magraw et al. In the article, the National Health and Nutrition Examination Survey (NHANES) is examined to look at the prevalence of wisdom teeth (third molars) in the U.S. population. Cross-sectional analyses of third molar data were conducted by the authors from the NHANES databases of 2001 through 2002, 2009 through 2010, and 2011 through 2012 to compare data for similarity of outcomes on wisdom teeth prevalence in the US population. The authors found the number of visible third molars in the NHANES databases of 2011 through 2012 decreased progressively from a mean of 1.48 in the 20 to 29 year old cohort to 0.81 in the 60 to 69 year old cohort. The authors found that in each NHANES from 2001 through 2012, the number of third molars decreased with each successive age cohort. Even though participants in each successive age cohort differed, there were no reasons for the decrease in numbers of third molars in older cohorts. It is likely […]

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Shared decision making in cases of conflicted evidence

An interesting article titled “When clinical evidence is conflicted, who decides how to proceed? An opportunity for shared decision making,” appears in the October 2015 issue of JADA (vol. 146 issue 10, pp. 713-714) and written by Arthur H. Friedlander and et al. The article discusses the concept of shared decision making “…particularly necessary in dentistry at this juncture, given recommendations but inconclusive data available to support abandoning the provision of prophylactic antibiotics to patients with total joint prostheses.” I have previously talked about shared medical decision making in the blog post The Well Informed Patient http://blog.teethremoval.com/the-well-informed-patient/. The article talks about how historically patients were expected to consent to the recommendations of their doctors without much discussion. However, since this is not enough to be legally and ethically correct shared decision making can be used which is a “…collaborative process encouraging patients and their providers to make health care decisions together, taking into account the best scientific evidence available as well as the patient’s values and preferences.” The authors go on to state “This bioethical, patient-centered, informed consent process demonstrates respect for the patient’s autonomy and supports their empowerment at a time when illness renders them dependent and vulnerable. Furthermore, it enhances […]

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