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Legal Standpoint of Oral Surgery Complications

Posted on 30. Jul, 2010 by .

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As I have written on my website, I disagree with wisdom teeth removal from a legal standpoint (in addition to scientific). Essentially what I argue is that if you have your wisdom teeth extracted and suffer a complication that is not one of the better known you may not recover any money and be left with the pain, suffering, and loss of earnings for the rest of your life.

A recent oral surgeon lawsuit after wisdom teeth removal helps reaffirm my previous remarks.  The article states that Cynthia Thompson sued Dr Princell because he did not disclose all the risks of surgery and she suffered a neurological syndrome (specifically a damaged inferior alveolar nerve) as a result of the wisdom teeth removal.

“During the trial, 3 oral surgeons told the court that they knew little about the causes of the neuropathic pain syndrome and its association with extraction of wisdom teeth, according to court documents.”

This case occurred in the state of Georgia. Hence due to the complication of nerve damage occurring to Cynthia and the fact that the only risks that need to be disclosed before oral surgery are the most common ones (of which I have previously discussed with a lawyer), Cynthia is left with permanent nerve damage as a result of elective wisdom teeth removal and receives no compensation for her suffering, pain, and loss of earnings.

I personally have a problem with this case though as inferior alveolar nerve damage is a much more well known complication of wisdom teeth removal than some of the others. I argue that it is very important for oral surgeons to take data on what complications occur by their patients and release this data to other oral surgeons so that it can be compiled. I also argue that the legal system should be change to stop rewarding American doctors for malpractice.  The norm in America is to remove healthy wisdom teeth that are impacted but this is not the norm in other countries such as Britain.

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Dental Needle Could be Replaced

Posted on 20. Jul, 2010 by .

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I find this study to be quite interesting as I have had anesthesia delivered directly in my nose before in an attempt to prevent my constant 24/7 headache.

New evidence has emerged that a common local anesthetic, when administered to the nose as nose drops or a nasal spray, travels through the main nerve in the face and collects in high concentrations in the jaw, teeth, and structures of the mouth.

William H. Frey II and colleagues found that drugs administered to the nose travel along nerves and go directly to the brain, although I really don’t think this finding is novel. One of those nerves is the trigeminal nerve, which brings feelings to the face, nose and mouth. Until now scientists never paid much attention to intranasal drugs passing the nerve in the nose and how it might reach the teeth, gums and other areas of the face and mouth to reduce pain sensations in the face and mouth.

Researchers in this study found that lidocaine or Xylocaine, sprayed into the noses of laboratory rats, quickly traveled down the trigeminal nerve and collected in their teeth, jaws, and mouths at levels 20 times higher than in the blood or brain. This method thus has implications for providing a targeted method for treating  trigeminal neuralgia, migraine, dental pain, and nerve damage.

The researches say an improved future location to administer anesthetic is the maxillary sinus. I question if this is truly a good idea as injecting lidocaine or Xylocaine can cause many symptoms and complications. I feel like this may cause some localized inflammation which would lead to dryness and bleeding in the maxillary sinus. The maxillary sinus would thus be implicated more than it needs to in dental procedures. I would be interested in hearing the opinion of an Ear Nose and Throat Doctor on this issue.

I touch on some of the details of the nerves in the head on my website at http://www.teethremoval.com/nerve_damage_in_depth.html.  I also show the location of the maxillary sinus which is clearly visible in a dental x-ray at http://www.teethremoval.com/complications.html. I also discuss how I had maxillary sinus surgery on my website as after I had my wisdom teeth removed and developed a severe 24/7 headache I had an MRI done. The only abnormality was found in the maxillary sinus. The details of this are explained more on my homepage.

Source: Neil J. Johnson, Leah R. Hanson, William H. Frey. Trigeminal Pathways Deliver a Low Molecular Weight Drug from the Nose to the Brain and Orofacial Structures. Molecular Pharmaceutics, 2010: 100510131956016

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Metlife Dental and Dentist Cleaning

Posted on 16. Jul, 2010 by .

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So recently I have stated in a previous post on this blog, I have finished up graduate school and now moved to a new area with a new job. My employer offers dental insurance. The dental plan turned out to be Metlife. On their website they allow you to select your type of plan either PPO or HMO (I have PPO) and you also enter in your zip code. Now I found a dentist listed as one of their preferred providers and one of my friends in the area recently went to him so I decided to give it a shot.

Unfortunately I didn’t find out the specifics of how much the new dentist would charge for a cleaning and exam which turned out to be $286.00. Metlife sent me a statement in the mail saying they would cover $97 of the $286 which leaves me responsible for $189. This is somewhat unreasonable as they are only picking up 34% of the visit. You would think that having dental insurance would offer a little more benefit and incentive to go twice a year for a cleaning/exam. I had no x-rays during my visit for clarification.

Now obviously I feel I am being charged a bit more than I should have been for the services rendered and Metlife did not nearly pick up the appropriate percentage they should have.

Looking around the internet, there appears to be a wide range of what people are paying for a dental cleaning and of course depends on where you live. Some people report paying as low as around $50 for a cleaning where as others have reported paying over $300.

So I am curious, if you remember/had your dentist clean your teeth recently, do you remember how much you were charged for the dental cleaning and how much the insurance paid (if you are lucky enough to have) ?

UPDATE: I never had to pay for the $189 dollars. It turns out Metlife (along with other insurance companies) have a contract rate of which it is agreed upon prior they will pay. So again although Metlife paid $97 of the total $286 that was billed, the dentist’s office I went to only ever received the $97 and never any more from myself.

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Brush Teeth Twice a Day to Help Prevent Heart Disease

Posted on 13. Jul, 2010 by .

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A new study lead by Professor Richard Watt from University College London has analyzed the Scottish Healthy Survey results of 11,000 adults. The study set out to  investigate whether the number of times individuals brush their teeth has any consequences on the risk of developing heart disease.

In the survey individuals were asked how often they visited the dentist (at least once every six months, every one to two years, or rarely/never) and how often they brushed their teeth (twice a day, once a day or less than once a day).

On a separate the respondents had  nurses collected information on medical history and family history of heart disease, blood pressure. In addition blood samples from those who consented were collected. The samples enabled the researchers to determine levels of inflammation that were present in the body.

The results demonstrate that oral health behaviours were generally good with 62% of those saying they visit the dentist every 6 months and 71% saying that they brush their teeth twice a day.

The data was then adjusted for established cardio risk factors such as obesity, smoking,  social class, and family history of heart disease.

This allowed the researchers to determine that participants who reported less frequent toothbrushing had a 70% extra risk of heart disease compared to individuals who brushed their teeth twice a day. In addition,  individuals with poor oral hygiene tested positive for inflammatory markers.

Clearly this study demonstrates that you should be brushing your teeth in the morning and in the evening. If you are not already doing so take proactive steps to remember by perhaps writing yourself notes or having someone else remind you.

Source: Cesar de Oliveira, Richard Watt,and Mark Hamer,. Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ, 2010;340:c2451

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Wisdom Teeth Survey

Posted on 05. Jul, 2010 by .

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I wanted to remind everyone that the Wisdom Teeth Removal Survey is still ongoing. If you are new to this site or a long time visitor and have not yet taken the survey I encourage you to do so.

Below is a response from someone who completed the survey. Remember the survey is anonymous and is not linked to you in any way.

I am 23 and currently suffering from the decision for prophylactic removal of my 3rd molars, a.k.a. wisdom teeth. Prior to the operation, I was perfectly healthy.

During surgery, the doctor almost ripped a nerve running through my jaw, as my wisdom teeth were particularly complicated to remove, and one of them had the roots wrapped around a nerve. I instructed him to stop pulling after I felt immense pain under 2 shots of anesthesia to that area. I was lucky that he was also educated on the matter and elected not to chance it. In fact, he himself was the one who informed me that it may be possible that the root tips might be wrapped around a nerve. Why that wasn’t investigated prior to extraction is beyond me, and I hope it’s not common in the industry.

After surgery, I have not been able to sleep without the aid of a pain killer. My throbbing swelling has persisted for one week (today), and, although it’s gradually getting better, the full recovery time for such an operation is 6 months, according to my dentist. I am also at risk for getting an infection, for which I refused prophylactic antibiotics. I don’t need to learn the same lesson twice. Prophylactic medicine seems like the work of soothsayers and apothecaries.

I like my dentist. They seem very caring, practiced, and informed about their industry, but the conventional wisdom of prophylactic removal is an unnecessary evil upon dentistry and its patrons.

The reasons I was given to remove the teeth were to prevent crowding of my other teeth, infection, and future extraction. Well, now I’m at the risk of infection anyway, which will endanger the other molar — anyway. This is not to mention what would have happened had my doctor removed the root tip that was wrapped around my nerve. All in all, I suppose I got lucky, but the $1300 I paid out of pocket (thanks U.S. insurance system I can’t afford) is certainly not worth the pain I’m going through now. And to read this data suggesting that my symptomless, infectionless, painless wisdom teeth had more of a chance of staying that way than not simply adds insult to injury, both physically and otherwise.

Love your wallet, love your mouth, love your body, keep your wisdom teeth until they have a problem. You’ll be going through the same pain anyway.

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