What to Do about the Fourth Molar: Similar Management Strategies as the Third Molar aka Wisdom Tooth?

So wisdom teeth are also known as third molars but did you know that there are also fourth molars in a small subset of patients? A recent study was performed by the United States at an Air Base in Japan which is currently in press to appear in the Journal of Oral and Maxillofacial Surgery titeld Prevalence and Management of Fourth Molars: A Retrospective Study and Literature Review by Khurram M. Shahzad and Lawrence E. Roth, 2011. In the study conducted 409 patients were referred for a third molar (wisdom teeth) consultation. Two of 227 white patients (0.9%) had a fourth molar and 6 of 94 black patients (6.4%) had a fourth molar. One of the other 84 patients (1.2%) also had a fourth molar. Of these patients with a fourth molar 5 out of 9 (55%) had only 1 fourth molar and 4 out of 9 (45%) had 2 fourth molars. In 7 of the 9 (78%) of the patients the fourth molars were in the maxilla (upper) and in 2 of the 9 patients (22%) the fourth molars were in the mandible (lower). No patients had fourth molars in both the maxilla and mandible. All of the mandibular […]

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Research During Residency for Oral Surgeons?

Earlier this year over the summer an article appeared in the Journal of Oral and Maxillofacial Surgery discussing the attitudes of program directors and residents toward performing research during residency. I commented on this article here http://blog.teethremoval.com/the-lack-of-importance-of-research-in-oral-and-maxillofacial-surgery-residency-programs/ A new article has appeared in the Journal of Oral and Maxillofacial Surgery written by Dr. James R. Hupp titled Research During Residency – Should it be Mandated? (vol. 69, pages 2685-2687, 2011). In the article is a discussion of research and whether or not it should be performed by oral surgeons in residency. Dr. Hupp discuses his own experience with research work and then questions if the current accreditation standards require all Oral and Maxillofacial Surgery residents to do research. He says: “Now the question becomes, should our standards require all residents to have the opportunity to conduct research and, in my mind, also to learn how to communicate the findings of their research. This is indisputably important for residents planning an academic career. However, how does conducting research during training benefit a resident planning to enter private or institutional clinical practice? Perhaps many more residents should be exposed to research which, ultimately, might lead them to pursue an academic career.” Dr. Hupp […]

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The Cyberchondriac: Managing the Difficult Patient

There is an interesting series over at QuantiaMD on Managing the Difficult Patient. Presentations are available for viewing as long as you sign up for with your email. One such presentation was originally called The Patient Who Knows too much but has been changed to The Cyberchondriac. http://quantiamd.com/player/wywzswwh?courseid=31844 Mary Modahl  who is QuantiaMD Chief Communications Officer said after the original title was added  “‘The Patient Who Knows Too Much’ is a very poor title. Certainly a patient can never know too much. In every way, we’re supportive of doctors meeting their patients’ need for care.” Dr. Joseph Scherger, vice president for primary care at Eisenhower Medical Center in Rancho Mirage, California, defines a Cyberchondriac in the presentation: “This is a patient who is on the internet…indiscriminate with the material they are reading…they consider themselves an expert yet often their true medical knowledge is limited…they are pushing you to do things based on their information.” Dr. Scherger takes a jab at Cyberchondriacs and says “…sometimes these patients are very overweight, they are on the internet all the time…” He also says that if a patient is going to bring in a stack of materials from the internet they should send it in […]

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Do I Really Need to Remove My Wisdom Teeth?

A few days ago an article titled “Do I Really Need to Remove My Wisdom Teeth? appeared in Community Magazine by Jacques Doueck located at http://www.communitym.com/article.asp?article_id=101936  The article opens with “I was prompted to write this article because of two adult patients who suffered severe damage, infection, and swelling because they delayed taking out wisdom teeth. One of them actually broke his jaw because of a wisdom tooth that should have been removed long ago. The patient, 48 years old, lost both teeth and the fractured jaw forced him to eat baby food for six months. The other patient was 65 years old and had to have the wisdom tooth and the adjacent molar removed.” This opening in this article kind of cracks me up because both of these patients are quite old, especially the 65 year old. Of course we could go back and forth all day with between cases like the above and cases of young healthy individuals such as myself who had there wisdom teeth removed at a young age and then had lasting pain and problems for life. Numerous reports of complications from wisdom teeth extractions are indicated at the wisdom teeth stories page and complications page. […]

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Fraud and Abuse in Medicaid Clinics

I have previously discussed on this blog how students graduating from medical school have an average debt of around $158,000 and the average debt of those graduating from undergraduate college is around $27,000 in the U.S.  In fact, the video called College Conspiracy http://blog.teethremoval.com/college-conspiracy-and-united-states-hyperinflation/ profiles a dentist who is stuck with with high loans from school  (around the 11 minute mark). One quote appearing in this video is “…as soon as you get out of school you are indentured for life.” This figure below showing the inflation cost of college tuition (in blue), medical care (in red), and general inflation (in black) from http://www.leftbusinessobserver.com/College.html pretty much tells more of the story. In fact I would argue that college tuition costs and medical costs are correlated with each other and you should be able to calculate some sort of correlation coefficient. An interesting article titled “Our Junior Colleagues and Interstate Medicaid Clinics” written by Michael W. Davis DDS appears in the New Mexico Dental Journal, Fall 2011, vol. 62, no. 4, pages 24-28, helps further show the major problems with increasing college tuition and how this directly impacts and increases medical care costs. The article is available over at http://dentistthemenace.com/documents/M%20Davis%20NMDA%20Fall%202011.pdf The article discusses how often dentists are stuck with […]

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