Trigeminal Nerve Surgery for Neuropathic Pain

An interesting article titled “Factors Determining Outcome After Trigeminal Nerve Surgery for Neuropathic Pain” appears in the July 2016 issue of Journal of Oral and Maxillofacial Surgery written by John R. Zuniga and David M. Yates. It is known that the inferior alveolar and lingual nerves which are part of the trigeminal nerves can be damaged after wisdom teeth surgery. Additional surgery can be performed to repair the trigeminal nerve but in some cases this injury remains and is only partially resolved. The others set out to better explore why neuropathic pain can persist after trigeminal nerve surgery. The study included 28 patients who underwent trigeminal nerve repair in Texas between 2006 and 2014. The patients were grouped into three different cohorts: 1) those who had no recurrence (NR) were any neuropathic pain went away, 2) those who had complete recurrence (CR) were the pain level of any neuropathic pain was the same postoperatively, and 3) those who had incomplete recurrence (ICR) were the pain intensity was below the pain intensity prior to surgery.  Seven patients were in the NR cohort (25%), ten were in the CR cohort (36%), and eleven were in the ICR cohort (39%). There were statistically significant differences found among groups at 3 months, […]

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Can you Use Low Level Laser Therapy After Wisdom Teeth Removal to Reduce Pain?

An interesting article titled “Is Low-Level Laser Therapy Effective in the Management of Pain and Swelling After Mandibular Third Molar Surgery?” appears in the July, 2016, issue of Journal of Oral and Maxillofacial Surgery and written by Majid Eshghpour, Farzaneh Ahrari, and Mohammad Takallu. The article seeks to explore if using low-level laser therapy after removing impacted wisdom teeth can reduce pain and swelling. In the study 40 patients included had lower impacted wisdom teeth on both sides. One side was subjected to lower level laser therapy and the other side just placebo. After removing wisdom teeth patients often experience pain, swelling, and tristmus for several days. Pain usually reaches a peak 3 to 5 hours after surgery while swelling peaks around 12 to 48 hours later. The trauma that occurs during surgery leads to inflammation which causes these other symptoms. Surgeons typically prescribe medications to help alleviate these concerns but these have side effects. Treatments like low level laser therapy are believed to be without side effects. The study took place in Iran and to be included the patients had to have lower wisdom teeth on each side similar in position and inclination. Patients with certain diseases were excluded from the study. It […]

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Target specific brain cells to help with neuropathic pain

Researchers from Rutgers University have explored treating chronic neuropathic pain which affects over 1 million Americans. Neuropathic pain results when nerve damage is caused due to injury, surgery or a some disease. Researchers showed that pain could be reduced in animals when microglia brain cells are targeted which are supposed to provide immunity. The researchers say that the microglia brain cells are supposed to be beneficial to the nervous system but in those with neuropathic pain these cells known as microglia have proliferated and instead become toxic. The researchers say that if they catch the injury within one to five days to inhibit microglia after nerve injury the development of chronic pain can be partially reversed. Neuropathic pain persists after the nerve has healed and is often resistant to normal pain medications. In lab mice the researchers used chemotherapy drugs to prohibit the microglia brain immune cells from proliferating. This chemotherapy drug reduced the amount of pain the mice experienced after the injury occurred. The researchers feel that minimizing microglial proliferation may be a novel approach for pain control. They hope that this could help lead to the development of more effective pain killers that can help control the pain. As one who suffers from chronic pain […]

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Is it okay for dentists to not tell a patient everything wrong?

An interesting article titled “Is it unethical to not present a patient’s treatment plan in its entirety?” is written by Emily Ishkanian and appears in the June 2016 issue of JADA. The article discusses that a dentist gets a new patient in for only an examination, cleaning, and radiographs. However after the exam, the dentist determined that the patient has extensive treatment needs. The dentist is concerned that if they tell the patient everything wrong then the patient will be scared to return to the office. The patient went to the dentist for just a standard visit. It is likely they thought there was nothing wrong with their oral health. The dentist is concerned that the patient will suspect overtreatment which could lead them to decline the treatment plan or seek another opinion. The ADA code says that dentists need to be truthful and straightforward with their patients. The article states “The dentist should inform the patient of his or her oral health status by disclosing a treatment plan that addresses the patient’s needs in addition to presenting alternative treatment or treatments…Although a patient may find an extensive plan to be daunting, the dentist has an obligation to educate the patient about how to […]

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What are the ethical issues of terminating a patient?

An interesting article titled “The ethical issues of saying good-bye to a patient” appears in the July 2016 issue of JADA and written by Gary Herman. The article addresses the ethical issues that result from terminating a relationship with a patient. There are certain reasons for terminating a patient. This includes discharging a patient who is difficult or noncompliant, a patient who notifies you that he or she is choosing to go elsewhere, and a patient who just seems to disappear. A dentist of course is always concerned with treating a patient well. If you terminate a patient the practice goes against this goal. An article on risk management lists failure to recognize problem patients and failure to dismiss those patients properly as some of the biggest mistakes dentists make. The article states “When patients make unreasonable demands, have impossible expectations, or prevent you from meeting the standard of care, it is important to maintain control of your practice and terminate relationships with those patients from your practice, both for their benefit and yours.” The article states that it is essential to let a patient know you are discontinuing care. Dentists should follow up with a written notification detailing the reason for the termination and providing […]

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