Differing Views in Medicine and Dentistry Applied to Wisdom Teeth

An interesting article appears in the 2014 version of the Journal of Oral and Maxillofacial Surgery titled “Asymptomatic Third Molars Under Nominalist and Essentialist Lenses,” written by V. Wallace McCarlie and Daniel L. Orr II, pp. 658-659.  The authors define two differente views: 1) essentialism and 2) nominalism and then try to apply them to the management of wisdom teeth. The authors state “Essentialism is the notion that underlying every properly defined disease is an unchanging reality causing illness. Conversely, nominalism is not concerned with underlying causes, but rather with signs and symptoms of illness.” In the article the authors mention a study which says that dentists detect rather than diagnose. The authors later say that detection implies nominalism and diagnosis implies essentialism. The authors give some downsides to both points of view. For example, they say essentialism is less focused on the patient and treatment. They say nominalism does not focus on causes which may be important for prevention. The authors state “An example of the importance of not focusing solely on symptoms (nominalism) is the case of asymptomatic impacted third molars. Life-threatening head and neck pathology, such as space infections, necrotizing fasciitis, osteomyelitis, and cysts or tumors, may […]

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Should the NICE Guidelines for Management of Wisdom Teeth (Third Molars) be Reevaulated?

An article titled “Changes in Demographics of Patients Undergoing Third Molar Surgery in a Hospital Setting Between 1994 and 2012 and the Influence of the National Institute for Health and Care Excellence Guidelines,” written by Vahe Petrosyan and Phillip Ameerally appears in the February 2014 issue of the Journal of Oral and Maxillofacial Surgery, pp. 254-258. The article discusses how National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) were published around 2000 recommending against prophylactic removal of wisdom teeth. This led to a reduction in surgeries performed. In the article the authors question whether or not the NICE guidelines on wisdom teeth should be updated. They mentioned a 2009 study which said 27% of previously symptom free wisdom teeth can become symptomatic after 1 year, especially those that are distoangularly impacted. In the article the authors looked at data from Northampton General Hospital in England which services around 0.7% of the population over the time period from 1994 to 2012. A total of 10,447 patients older than 16 years were treated during the study period. The mean patient age increased from 29 years in 1994 to 36 years in 2012, with the median […]

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Periodontal Disease and Cardiovascular Risk

In a post many years ago I discussed Patients With Moderate To Severe Periodontitis Need to Be Evaluated For Cardiovascular Problems. In a new study, periodontal disease has again been looked at as a risk factor for cardiovascular disease. In the study conducted, more than 15,000 patients with chronic coronary heart disease gave information on their dental health with results showing periodontal disease indicators were common. The study included self reported dental health information from the STABILITY trial, a clinical trial with 15,828 participants from 39 countries all with chronic coronary heart disease and a risk of cardiovascular disease.  All study participants had a physical exam and blood work up, and completed a lifestyle questionnaire. They reported their remaining number of teeth and frequency of gum bleeding. The results indicated a high prevalence of tooth loss with 16% reporting having no teeth and 41% reporting having less than 15 teeth. Around one-quarter of the patients reported gum bleeding when using a toothbrush. Almost 70% of study participants were current or former smokers. It was shown by statistical analysis that increasing prevalence of tooth loss was significantly associated with higher waist circumference, systolic blood pressure, LDL cholesterol levels, and fasting glucose levels. […]

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Periodontal Therapy Impact on General Health

An interesting article titled “Impact of Periodontal Therapy on General Health,” appears in the American Journal of Preventive Medicine (published online June 18, 2014) and written by Marjorie Jeffcoat and et. al. The authors attempt to estimate the effects of periodontal therapy on medical costs and hospitalizations among those with type 2 diabetes, coronary artery disease, cerebral vascular disease, rheumatoid arthritis, and pregnancy. The goal was to see if periodontal disease therapy might prevent or mitigate some of the adverse effects associated with the 5 studied conditions. The authors found significant reductions in healthcare costs and hospital admissions for pregnant women and patients with type 2 diabetes, coronary artery disease, and cerebral vascular disease. The authors found that the medical costs for pregnant women were 74% lower than for those with untreated periodontal disease. Patients with both type 2 diabetes and cerebral vascular disease had medical costs that were roughly 40% lower than for those with untreated periodontal disease. In addition those with coronary artery disease had medical costs that were roughly 11% lower than those with untreated periodontal disease. Periodontal disease can be treated by cleaning the tooth above and below the gum line with scaling and root planning. […]

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Moving Towards a Clearer Diagnosis of Myalgic Encephalomyelitis

A group of researchers have recently used functional PET imaging to show that levels of neuroinflammation is higher in patients with myalgic encephalomyelitis also commonly referred to as chronic fatigue syndrome than in healthy patients. Myalgic encephalomyelitis or chronic fatigue syndrome is a debilitating condition which is mostly characterized by chronic and disabling fatigue. Some patients feel that chronic fatigue syndrome trivializes the condition and prefer a name change. In a study in the Journal of Nuclear Medicine researchers found that levels of neuroinflammation markers are elevated in myalgic encephalomyelitis patients when compared to healthy patients. It had been suspected that neuroinflammation is the cause of the condition. In the study the researchers performed PET scans on nine people diagnosed with myalgic encephalomyelitis and ten people who were healthy. The patients were all asked to describe their pain, depression, cognitive impairment, and level of fatigue. They used a protein expressed by microglia and astrocyte cells known to be active in neuroinflammation. The researchers found that inflammation in certain areas of the brain such as the hippocampus, amygdala, thalamus, midbrain, cingulate cortex, and pons were all elevated in a way that correlated with the symptoms. For example, patients who reported problems with […]

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