Long Term Consequences of Traumatic Brain Injury (TBI)

An interesting article appears in the journal PLOS ONE looking at the consequences of traumatic brain injury (TBI) using rate models. The researchers used rat models and found that overtime TBI results in progressive brain deterioration characterized by elevated inflammation and suppressed cell regeneration. Long-term neurological deficits from TBI related to inflammation may cause more severe secondary injuries and even predispose people to neurodegenerative diseases later in life. Traumatic brain injuries are important to study since troops in the U.S. military have increasingly suffered TBI from improvised explosive devices. One of the coauthors from the journal article (Dr. Paul R. Sanberg) says “Progressive injury to hippocampal, cortical and thalamic regions contributes to long-term cognitive damage post-TBI. Both military and civilian patients have shown functional and cognitive deficits resulting from TBI.” In the study researchers looked at different parts of the brain in the rat such as the hippocampus, corpus callosum white matter, thalamus, and dorsal striatum. The researchers found that neuroinflammation after TBI causes cell death that hinders the brain’s ability to regenerate. After looking at the rats brains eight weeks after trauma the researchers found “a significant up-regulation of activated microglia cells, not only in the area of direct […]

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Potential Risks of Surgery for Wisdom Teeth (Third Molars)

M. Anthony Pogrel in his article “What Are the Risks of Operative Intervention?” in the Journal of Oral and Maxilofacial Surgery vol. 70, pp. 33-36, 2012, suppl. 1, goes into complications associated with removing impacted wisdom teeth (third molars). I have previously explored this topic in detail over at http://www.teethremoval.com/complications.html. Although I did a poor job of distinguishing actual complications from negligence. In the article, Pogrel describes how studies have indicated that around 10% (1 in 10) of people undergoing removal of third molars may suffer from a complication. However, most of these complications are mild and will completely resolve in time. Pogrel states “Complications from M3 removal can be divided into 2 groups: those that are short-lived and self limiting, including bleeding, inflammatory complications such as surgical site infection and alveolar osteitis, or “dry socket,” drug reactions, displaced crowns from adjacent teeth, and short-term anesthetic complications; and those with potential long-term or permanent complications.” Pogrel attempted to find high level evidence and searched PubMed, Scopus, and the Cochrane Database but no randomized controlled trials were found. He attempted to look at case studies used at least 100 patients and did not look at individual case reports and anecdotal reports. […]

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Senate Report Calls for Removing Deceptive Corporate Dentistry Entities From Medicaid

Previously I have written an article titled Fraud and Abuse in Medicaid Clinics where a discussion was made that currently dentists have large amounts of debt when they graduate from school. This leads to them having to face potentially hard and difficult choices to pay their bills as they essentially become indentured servants. Recently Senators Charles Grassley (R-IA) and Max Baucus (D-MT) published a 1517 page report in June 2013, titled “JOINT STAFF REPORT ON THE CORPORATE PRACTICE OF DENTISTRY IN THE MEDICAID PROGRAM.” This report is a very large PDF file (143 MB) and is available for download over at http://www.finance.senate.gov/library/prints/.  Don’t be intimidated by the size of the report though as it really is a bit over 30 pages with the rest of the 1400+ pages serving as an appendix. Hence, it is very readable. The report talks about dental management companies that in some cases own dental clinics and have complete control over operation which includes clinical care provided by dentists. Some states have specific requirements which only allow a licensed dentist to own a clinic. However, the report discusses how some dental management companies have deceptive ownership structures which may hide from state authorities that the […]

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Melatonin may be more effective than Amitriptyline for Migraine Prevention

Melatonin is an over the counter supplement and it has shown to be more effective than placebo for migraine prevention. In addition, it has a more favorable adverse effect profile than the tricyclic antidepressant amitriptyline. A study from a multicenter, randomized, double-blind, placebo-controlled trial showed that 3 mg of melatonin was more effective than placebo and had similar efficacy as 25 mg of amitriptyline. In addition, melatonin is better tolerated then amitriptyline without as much daytime sleepiness and no side effects of weight gain. Melatonin is a hormone that helps to regulate the sleep and wake cycle. It is often used to aid with sleep and help with jet lag. I have used melatonin (3mg or more most nights) to aid with falling asleep when it was suggested by a physician due to trouble falling asleep ever since having a 24/7 headache since 2 days after having 4 wisdom teeth extracted. Difficulty falling asleep has been noted in new daily persistent headache patients (see http://www.teethremoval.com/ndph.html) A disruption of melatonin has been linked to sleep disorders such as insomnia and delayed sleep phase syndrome which are also linked to headache. Headache is also know to disrupt sleep and lead to insomnia […]

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Association Between Partially Erupted Mandibular Third Molar and Caries in Distal Second Molar

An interesting article titled “Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars,” appears in the International Journal of Oral and Maxilofacial Surgery by S. G. M. Falci and et. al. (October 2012, pp. 1270-1274). The article mentions how previous studies have shown that caries on the mandibular second molar due to the presence of partially erupted third molars has varied between 7% and 32%. The article criticizes prior work where studies based their prevalence data on panoramic radiographs which is not as good as periapical radiographs when diagnosing caries. The authors state “The lack of sample characterization, the absence of sample calculation, the deficient or inadequate statistical analysis and the absence of a description of the eligibility criteria, discredits the scientific evidence of these previous studies.” The authors performed an aprior sample size calculation and determined they needed 246 radiographs for adequate statistical type I and type II errors I presume. Some key findings are found in the results section of the paper. The authors state “The univariate logistical regression analysis showed that male patients, and patients aged 23–57 years, are the most likely to […]

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