Archive | October, 2013

Controversy Over Spinal Fusion

Debate over spinal fusion surgery continues to occur. A recent article tiled “Spinal fusions serve as a case study for debate over when certain surgeries are necessary,” appears in the Washington Post written by Peter Whoriskey and Dan Keating and published on October 27, 2013. (Note I have previously mentioned some of the controversy over spinal fusion in the post Tips to Prevent Medical Errors – AHRQ) The article mentions that spinal fusions being performed in the U.S. has risen over the years and that around half of the surgeries they reviewed don’t meet expert consensus on when the surgery should be performed. This article discusses a surgeon at a Florida hospital who was earning well over a million a year performing spinal fusions on patients. Auditors at the hospital began to wonder if all the cases were necessary and paid for an independent review which showed that 9 out of 10 cases was not medically necessary. A lawsuit emerged which provided several details on the financial arrangements between the doctor and the hospital. For example, the surgeon earned additional money beyond his base salary for each procedure after a certain threshold. The surgeons at the hospital were charging patients […]

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Active Surveillance For Managing Retained Wisdom Teeth

An interesting expert opinion by Thomas B. Dodson appears in the Journal of Oral and Maxillofacial Surgery vol. 70, issue 9, supplement 1, pages 20-24, 2012, titled ” Surveillance as a Management Strategy for Retained Third Molars: Is It Desirable?”  The author opens by describing in the third paragraph that the treatment of symptomatic disease-free wisdom teeth can be challenging. The author states in the third paragraph “Absent good evidence, management decisions should incorporate the clinician’s experience and expertise, and after a careful, balanced review of the risks and benefits of both treatment options, weigh heavily the patient’s wishes and desires regarding extraction versus retention. The opinions in this chapter reflect the author’s personal decision-making process based on a careful literature review and clinical experience/expertise.” The author opens by describing his clinical classification of wisdom teeth rationale. He states that the clinician needs to determine if the wisdom teeth are causing symptoms or not. Patients can complain of pain near wisdom teeth but this may not mean the wisdom teeth are the source of the pain as other things could be going on such as normal teething pain. From this, the clinician can determine if the patient is symptomatic or […]

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Looking at the Timing of Removal of Wisdom Teeth and It’s Effect on Complications

An interesting study by M. Anthony Pogrel titled “What Is the Effect of Timing of Removal on the Incidence and Severity of Complications?” appears in the Journal of Oral and Maxillofacial Surgery, vol. 70, issue 9, supplement 1, pages S37-S40, 2012. The author sets out to explore if younger patients (less than 25 years) have a decreased risk for postoperative complications than older patients.  The author begins by describing three studies in the literature that have shown that complications associated with wisdom teeth removal increase after 25 years of age. I have also mentioned several of these studies over at http://www.teethremoval.com/wisdomteeth.html. The author then goes on to discuss that recovery for patients of wisdom teeth surgery older than 21 may be delayed after extraction (by two studies). The author then discusses that mandibular fracture and tuberosity fracture may occur after wisdom teeth removal and the incidence (based on 6 cases) may increase with age. The author then discusses 4 studies which demonstrate that infections can occur more frequently in older patients after wisdom teeth removal. An additional study suggests that infections can occur more often when surgical time increases. The author later discusses periodontal complications after wisdom teeth removal and […]

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When Abstinence is Evidence-Based

I came across a 2012 talk Jay W. Friedman gave titled “When Abstinence is Evidence-Based: The Case Against Prophylactic Third Molar Extractions,” at the 2012 National Oral Health Conference. The PowerPoint for the talk is located over at http://www.nationaloralhealthconference.com/docs/presentations/2012/05-02/Jay%20Friedman.pdf (I have mirrored it over at http://www.teethremoval.com/When_abstinence_is_evidenced_based.pdf). For those not aware of Jay W. Friedman you can start by reading the post American Journal of Public Health Author Jay W. Friedman is 2009 Author of the Year and Looking at the Concept of Prevention in Dentistry. Some interesting graphics appear in the talk, a few which I have included in this post. The talk is very concise and to the point and very informative for anyone considering whether or not to extract wisdom teeth (third molars). I will now provide a brief overview of the talk, but encourage you to look at the full talk yourself. Like usual (see http://www.teethremoval.com/controversy.html) several jabs are taken at AAOMS (the American Association of Oral and Maxillofacial Surgeons). For instance, he mentions how AAOMS placed a 4 page ad in USA Today in 2007 and didn’t mention any potential complications from extraction. He says that even though AAOMS has changed the language on their website […]

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Removing Wisdom Teeth May Improve The Periodontal Health of Remaining Teeth

An interesting article titled “Removal of Symptomatic Third Molars May Improve Periodontal Status of Remaining Dentition,” by Carolyn Dicus-Brookes and et al. appears in the Journal of Oral and Maxillofacial Surgery (vol. 71, pp. 1639-1646, 2013). The article seeks to explore the impact of removing wisdom teeth on the periodontal status of adjacent second molars and other teeth located in the mouth specifically for patients who have mild symptoms of pericoronitis. As discussed recently over at Upcoming Changes to JOMS and AAOMS in 2014, select articles in JOMS will have press releases written by AAOMS staff to accompany them. This is one of those articles so that feature appears to have already been rolled out. To get an idea of what the press release entails I will briefly describe it. It is very short (less than 10 sentences) and fits on 1 page. It was released on October 1, 2013. The press release states 69 patients were followed with mild symptoms of pericoronitis. All patients had wisdom teeth prior to the study start and had an average age of 21. The main conclusion of the study as stated in the press release, is that at the beginning of the study […]

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