Archive | October, 2015

Care Guidelines for Wisdom Teeth: 2014 Finnish Guidelines

An article titled Current Care Guidelines for Third Molar Teeth appears in the May 2015 issue of the Journal of Oral and Maxilofacial Surgery (vol. 73, issue 5), written by Irja Venta. The article describes the 2014 Finnish Care Guidelines on wisdom teeth removal. The guidelines were written in mind for the best possible care to the patient without weighing against the resources of the health system. The author states “The updated guidelines for the third molar are based on evidence, with an extensive review of 180 references…Because nerve injuries continue to be the most common reason for malpractice claims submitted to the Finnish Patient Insurance Center, this issue warrants attention. Another important issue is the controversy surrounding the preventive, prophylactic, early, or elective removal of third molars; 4 distinct groups are suggested as candidates for early removal.” The guidelines have an emphasis on avoiding nerve injuries. Cone-beam computed tomogram can be used to obtain information about the relation between the root end and the mandibular canal. When the risk of nerve injury is high, the guidelines recommend removing only the crown (coronectomy). When the risk of mandibular bone fracture and nerve injury is present, the crown can be exposed […]

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Does Not Treating Asymptomatic Wisdom Teeth Cause Harm?

An interesting article appears in the July 2015, British Dental Journal, titled “Revolution vs status quo? Non-intervention strategy of asymptomatic third molars causes harm” written by V. Toedtling and J. M. Yates (vol. 219, no. 1, pp. 11-12.) The article addresses how the Faculty of Dental Surgery of the Royal College of Surgeons of England has asked the National Institute for Health Care Excellence (NICE) to re-assess their guidance on wisdom teeth extractions. This is because the group and doctors feel that there is an increasing amount of distal-cervical caries (cavities) in lower second molar teeth (teeth right next to wisdom teeth) when associated with asymptomatic partially erupted mesial or horizontally impacted lower wisdom teeth (mandibular third molars). The authors say that NICE has been reluctant to re-appraise their 2000 guidance and guidelines on wisdom teeth removal. The authors point out that these guidelines were based partially off of a report which refers to research that is 3 decades old (at the time of the guidance). This report showed that there is a very low rate of distal cervical caries in lower second molars (1 to 4.5% incidence). The authors say because so many wisdom teeth were prophylactically extracted during […]

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An Australian perspective of removing or retaining wisdom teeth (third molars)

An article titled “Cost effectiveness modelling of a ‘watchful monitoring strategy’ for impacted third molars vs prophylactic removal under GA: an Australian perspective” appeared in the July 2015, British Dental Journal and written by A.A. Anjrini, E. Kruger, and M. Tennant (issue 219, pp. 19-23). The article discusses the direct and indirect costs associated with removing impacted wisdom teeth in Australia. A news article appearing on the Australian ABC Science ( titled “Wisdom teeth: are we removing them more often than needed?” by Anna Salleh and written on August 17, 2015, discusses some of the points made in the journal article. The authors were interested in determining if a watchful waiting monitoring strategy should be used for impacted wisdom teeth or if a prophylactic strategy should be used. They looked at hospitalization data for impacted wisdom teeth removal for 2008 and 2009. They then calculated cost estimates for a one year watchful waiting strategy and a 20 year watchful waiting strategy. The authors estimated an individual cost of watchful waiting as $1,077 for a 20 year period and of $53 for a 1 year period. The authors propose moving to a watchful waiting monitoring strategy approach to the removal of […]

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Measuring Lingual Position of Lower Wisdom Teeth

An interesting study titled “Measurement of the Lingual Position of the Lower Third Molar Roots Using Cone-Beam Computed Tomography,” appears in the January 2015 issue of the Journal of Oral and Maxilofacial Surgery (vol. 73, issue 1) and written by Yusuf Emes and et al. The authors set out to use Cone-beam computed tomography (CBCT) to evaluate the proximity of lower wisdom teeth roots to the lingual cortex, which can be used to determine the potential risk of root displacement during lower wisdom teeth removal. The study used CBCT images of 32 impacted lower wisdom teeth of 31 patients (5 men and 26 women). The images were collected for reasons not related to surgery including impacted teeth, dental implants, and cysts of the jaws. An evaluation was performed independently by 2 trained oral and maxillofacial surgeons who were experienced in the radiographic evaluation of maxillofacial anatomy. The teeth were grouped according to their positions on the orthopantomogram as vertical, mesioangular, horizontal, and distoangular. Two measurements were performed for each tooth. If 1 tooth had more than 1 root, the root in the most lingual position was considered: 1) the distance from the root apex of the tooth, which is in […]

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Influencing Government: Perspectives from U.S. Oral Surgeons

As has been discussed before on this site and blog, The Journal of Oral and Maxillofacial Surgery is published on behalf of the American Association of Oral and Maxillofacial Surgeons (AAOMS). They of course have their own interests and seek to help get candidates elected in government with positions favorable to theirs. This is described a bit in the article Influencing Your Government by James R. Hupp  appearing in the January 2015 issue of The Journal of Oral and Maxillofacial Surgery (vol. 73, issue 1). The article discusses how voting in an election is only part of the story and advocacy stronger than one’s vote at the ballot box. The author states “Advocacy can take many forms. The one that comes to mind for most people is campaigning for someone running for office. Similarly, one can donate to a candidate’s campaign. These can be meaningful contributions to help elect your preferred candidate. Also, depending on your degree of involvement and magnitude of financial support, you can open communication pathways to that elected official and that official’s staff that may not be as freely available to other constituents. “ A discussion is then made of the AAOMS political action committee (OMSPAC). […]

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