Evidence Base for Oral and Maxillofacial Surgery Journals

An interesting articled titled “The evidence base for oral and maxillofacial surgery: 10-year analysis of two journals,” appeared in the January 2012 edition of the British Journal of Oral and Maxillofacial Surgery (vol. 50, issue 1, pages 45-48) wirrten by Amandip Sandhu. The author opens by discussing an editorial in the Lancet in 1996 which discussed how there is a lack of scientific rigor in surgical research. The author states “There is a well established hierarchy of levels of evidence, and the medical community considers that meta-analyses and randomised controlled trials (RCTs) are the most scientifically stringent means of investigating the efficacy of one intervention against another. Other grades of evidence (in increasing weakness of level of evidence) are case controlled studies, comparative studies, case series, correlation studies and expert committee reports, and the clinical experiences of respected authorities.” The author evaluated articles published in both the British Journal of Oral and Maxillofacial Surgery and the International Journal of Oral and Maxillofacial Surgery between January 1999 and December 2009. The author looked at the abstract of every article and looked at the article in full if the abstract was not sufficient for analysis. The author looked at 3294 articles and […]

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Why Bother With Research

An intriguing article recently appeared in the International Journal of Oral and Maxillofacial Surgery titled “Research – why bother?” (vol. 40, issue 12, page 1346, December 2011) written by G. Dimitroulis. The article discusses of oral and maxillofacial surgery needs research to make itself known as a professional body and not as just a technical trade. A brief mention is made that dual degree programs place time pressures on trainees at the expense of research. The author mentions how head and neck surgical oncology is shared by a number of surgical specialties with mutual interest. The author states “We cannot rely rely on the research experience of other surgical specialties if we are to secure the respect and trust of our medical and surgical colleagues from other disciplines who also have a mutual interest in head and neck oncology.” The author goes on to say “It is only through our diligent efforts to record and analyse our surgical experiences, and making these known to the world through journal publications, that we are able to consolidate our interests in various specialized areas of surgery such as cleft surgery, trauma, surgical oncology and implants and so on.” The author says that all […]

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Getting published in peer-reviewed journals

An interesting article appears in the December 2011 issue of the International Journal of Oral and Maxillofacial Surgery (vol. 40, issue 12, pages 1342-1345) titled “Getting published in peer-reviewed journals,” by G. Dimitroulis. The author opens by saying “Writing a paper for publication in a peer-reviewed journal is a rewarding experience. Even though there are no direct financial incentives for publishing in peer-reviewed journals, thousands of manuscripts are produced each year which compete for the limited journal space available worldwide. In other words, there is a sense of pride and achievement behind every published journal article that has its own rewards for which money plays no role.” Journal articles can be published to help comment or criticize the work of others, to synthesize and build a consensus about what is presently known, to announce new work, to serve as training for those postgraduate students, to further one’s career, to help attract funding, and even just by the desire to have one’s name appear in print. The author mentions that most oral and maxillofacial surgery literature that is evidence based is that of retrospective case series with a comprehensive review. The author points out that it can be hard to convince […]

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Using Computed Tomograph (CT) To Lower the Incidence of Wisdom Teeth Removal Nerve Injuries

A question that everyone who has wisdom teeth wants to know these days is the following: “If you use Computed Tomography (CT) can it lower the risk of developing a nerve injury from having wisdom teeth removed?” Three authors from Spain (Sanmarti-Garcia, Valmaseda0-Castellon, Gay-Escoda) recently conducted a study asking this question titled “Does Computed Tomography Prevent Inferior Alveolar Nerve Injuries Caused by Lower Third Molar Removal?” appearing in the Journal of Oral and Maxillofacial Surgery (vol 70, pages 5-11, 2012). The issue is as stated by the authors is that “panoramic radiography alone cannot identify the buccolingual position of the mandibular canal and the 3M roots.” Computed tomography (CT) is able to show this information. Even so an estimated 40% of cases show superposition of the roots and the mandibular canal. Hence many of the potential CTs performed may potentially add additional costs and exposes patients to additional radiation without in some cases adding any clinically useful information to the pre-surgical picture. The authors state “the utility of CT in the extraction of a 3M is questionable because in most cases it does not modify the surgical technique, it seems to have a low positive predictive value for IAN injury […]

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Potential Alternatives to the Current Medico-Legal System in the United States

On my site I discuss numerous issues with the current legal system and how this relates to the medical system with a focus on third molar (wisdom teeth) removal. See http://www.teethremoval.com/legal_system_medical_malpractice, http://www.teethremoval.com/legal_standpoint.html, and http://www.teethremoval.com/dental_malpractice.html. One issue is that there are a host of different damage caps (non-economic ‘pain and suffering’ awards) in different states throughout the United States. This can sometimes limit the amount a patient can receive even if there was gross negligence by the dentist or oral surgeon. Hence this can prevent fair compensation from being awarded. Another issue with the legal system is that sometimes when patients suffer complications and problems due to negligence they will not be able to sue due to the case not being able to get a very large settlement amount. In addition, these legal cases can drag on for years and years and take a toll on the health of the patient and the doctor. Unlike in the airline industry for pilots, doctors don’t have their own skin in the game so to speak. If a pilot crashes a plane then the pilot may be seriously injured or even die along with the passengers. When a doctor performs a poor surgery that […]

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