Infection Control Lapse in Hawaii at VA Dental Clinic

The U.S. department of Veteran Affairs (VA) has said that 20 patients treated on May 23 and May 27 in Hawaii may have been exposed to viruses due to instruments that were not sterilized. The dental instruments used were believed to be clean, but the VA monitors said they were not sterilized. Only a single load of dental equipment, which was typically sent from one medical center with a dental clinic to a different medical center for sterilization was not performed. It is believed that the risk of contracting anything like HIV or hepatitis is low but patients at risk are recommend to be tested for viruses. The source of the story is over at khon2 titled Veterans Affairs apologizes to dental patients for unsterilized instruments written by Nestor Garcia on June 27, 2014, and located over at  http://khon2.com/2014/06/27/veterans-affairs-apologizes-to-dental-patients-for-unsterilized-instruments/. Staff at khon2 observed the sterilization procedure followed at the VA. They said in their article “First, they scrubbed the instruments, then placed them into an ultrasonic machine to rid the instruments of debris. Next, the instruments were blown dry, placed in a bag and put into an autoclave. The machine steamed them clean for 45 minutes at a temperature of […]

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AAOMS Issues New Position Paper on Medication-related Osteonecrosis of the Jaw

Earlier in 2014, the American Association of Oral and Maxillofacial Surgeons issued a new position paper on Medication related Osteonecrosis of the Jaw (MRONJ) see http://www.aaoms.org/docs/position_papers/mronj_position_paper.pdf?pdf=MRONJ-Position-Paper. The condition in the past has been called Bisphosphonate-related Osteonecrosis of the Jaw but both antiresorptive and antiangiogenic therapies are associated with it so the name has been updated. MRONJ appears as non-healing exposed bone in the mouth and may affect patients undergoing intravenous cancer-related therapy or those treated with oral or IV bisphosphonates for osteoporosis. The paper states that patients may be considered to have MRONJ if the following characteristics are present: Current or previous treatment with antiresorptive or antiangiogenic agents; Exposed bone or bone that can be probed through an intraoral or extraoral fistula(e) in the maxillofacial region that has persisted for more than eight weeks; No history of radiation therapy to the jaws or obvious metastatic disease to the jaws. Most patients on antiresorptive or antiangiogenic agents who develop MRONJ do so after a dental procedure, such as a tooth extraction. The position paper cites several studies which has shown that between 52% to 61% of patients report tooth extraction as the precipitating event who develop MRONJ. It is estimated that […]

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Considerations For the Cost of Wisdom Teeth

In a recent post, I discussed the cost of wisdom teeth management based on an article that appeared earlier this year in the Journal of Oral and Maxillofacial Surgery (see http://blog.teethremoval.com/the-costs-of-third-molar-wisdom-teeth-management/) Another article discussing wisdom teeth costs also appeared in the Journal of Oral and Maxillofacial Surgery in 2012 (see http://blog.teethremoval.com/the-costs-associated-with-third-molars-wisdom-teeth/). In both articles the authors conclude the costs of non-operative management of asymptomatic, disease-free, wisdom teeth exceeds the cost of operative management. I take issue with their conclusions as I believe they make too many simplifications in their analysis. I argue that the authors are ignoring the real risks of having wisdom teeth extracted that are not going to likely occur with non-operative management. Removing wisdom teeth has complications that can result. Some of these can be serious, permanent, and lasting, and cause considerable cost to both the patient and society. For example over at http://www.teethremoval.com/dental_malpractice.html a case from the 1980’s is discussed of a 36 year woman who was given an overdose of anesthesia while having her wisdom teeth removed that left her with permanent brain damage and unable to care for herself. Due to a damage cap in the state of Indiana she only received $500,000 from a […]

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The Costs of Third Molar (Wisdom Teeth) Management

I have previously commented on the costs associated with wisdom teeth in a 2013 blog post that was based on a 2012 article appearing in the Journal of Oral and Maxillofacial Surgery (see http://blog.teethremoval.com/the-costs-associated-with-third-molars-wisdom-teeth/). More recently, another article discussing the costs of wisdom teeth has appeared in the 2014 Journal of Oral and Maxillofacial Surgery titled “The Cost of Third Molar Management” written by Gino Inverso, Ronald Heard, and Bonnie L. Padwa (issue 72, pp. 1038-1039). This article takes the position that most previous studies focused on discussing wisdom teeth costs when taking the position from the cost of billing to private insurance companies. Their article attempts to use the true cost which they feel should help promote discussion of the topic of retaining or removing healthy disease free wisdom teeth and possibly increase access to care. In their analysis they determine the approximate time spent with an oral surgeon and their staff for a patient for a consultation, an operative visit, and a post-operative visit. They then determine the estimate annual cost associated with an oral surgeon, a surgery assistant, and a receptionist in a private oral and maxillofacial surgeon office in 2013. This total cost for all 3 comes in at […]

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New Legislation In California Proposed to Increase Medical Malpractice Damage Caps: Why It is Important if you Are Having Wisdom Teeth Extracted

A recent piece over on DrBicuspid.com titled “Dentists fight Calif. malpractice insurance ballot measure” draws attention to new proposed legislation in California (California Proposition 46) see http://www.drbicuspid.com/index.aspx?sec=log&URL=http%3a%2f%2fwww.drbicuspid.com%2findex.aspx%3fsec%3dsup%26sub%3dbai%26pag%3ddis%26ItemID%3d316366. The article discusses the previous medical malpractice legislation in California called the Medical Injury Compensation Reform Act (MICRA) which placed a $250,000 cap on noneconomic damage awards. The act did allow for unlimited economic damages and out of pocket costs. The article then discusses Proposition 46 in California written as “The Troy and Alana Pack Patient Safety Act,” to quadruple MICRA’s cap on noneconomic damages to $1.1 million. This actually simply changes the original $250,000 non-economic damage cap established in 1975 to what it would be today if it was indexed for inflation. I have previously discussed this over at http://www.teethremoval.com/legal_standpoint.html. The article goes on to get commentary from a past California Dental Association president and why dentists should vote no on Prop. 46 come November. The dentist is quoted as saying “Proposition 46 was written by trial lawyers who stand to profit from medical lawsuits. They have thrown in other provisions under the guise of so-called patient safety, but this is really about lawsuit profits.” The dentist encourages people to visit the noon46.com […]

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