TeethRemoval.com

Wisdom of Having that Tooth Removed: AAOMS Response

Posted on 13. Nov, 2011 by wisdom.

Recently I indicated in a post over here http://blog.teethremoval.com/wisdom-teeth-advice-and-new-dental-schools/ that a New York Times article was run on September 5, 2011, by Roni Caryn Rabin which was titled “Wisdom of Having That Tooth Removed.” This article is located here http://www.nytimes.com/2011/09/06/health/06consumer.html

Recently a Letter to the Editor of the New York Times was written by the President of the American Association of Oral and Maxillofacial Surgeons, Arthur C. Jee, discussing this article located at http://www.aaoms.org/docs/media/LetterNYTimes-09-21-11.pdf

In the article he states

The AAOMS does not advocate for the “prophylactic extraction of wisdom teeth”

If this is in fact the case then I think the AAOMS should make this clear on their website.

The website on wisdom teeth http://www.aaoms.org/wisdom_teeth.php continues to say

“As you can see, it isn’t wise to wait until your wisdom teeth start to hurt you before you have them removed. “

Even so the wisdom teeth page on AAOMS has been updated a bit since the last time I looked.  It does mention at the bottom that you may keep your wisdom teeth after previously discussing many of the problems that wisdom teeth can cause if you keep them.

Further in the letter Dr Jee says

 ”an absence of symptoms does not equal the absence of disease; retained wisdom teeth frequently and unpredictably change position, eruption and periodontal status; over time even retained, asymptomatic wisdom teeth are more likely to exhibit progressive periodontal disease; and retained wisdom teeth with periodontal pocketing increases the risk for several broader conditions that are associated with increased systemic inflammation, including preterm birth and cardiovascular disease.”

In the letter to the editor Dr. Jee says that

“Oral and maxillofacial surgeons provide their patients the best advice based on a careful oral examination, appropriate imaging and tests, and frank discussions with the patient and caregivers”

As indicated numerous times on my website that is not representative of the kind of care I received.

In a recent article a college professor describes the experience of his 21 year old daughter who has impacted wisdom teeth when his daughter and him visited an oral surgeon in California http://blog.teethremoval.com/the-truthiness-of-extracting-wisdom-teeth-james-r-carey/.  The issues addressed and raised in that article do not appear to be frank discussions at all.

In addition, the informed consent forms I have reviewed http://www.teethremoval.com/consent_form.html, leave out numerous potential harmful risks of having wisdom teeth removed which I feel many should be mentioned for an elective procedure when there is ample time to prepare such as a chronic 24/7 headache and a scar on the check as indicated over at http://www.teethremoval.com/complications.html

Further, I think a frank discussion should mention the fact that healthy wisdom teeth are not extracted in the U.K. and explain the reasons why which is for the potential minor and major harmful risks of surgical intervention along with cost effectiveness as mentioned at http://www.teethremoval.com/controversy.html

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Wisdom Teeth Advice and New Dental Schools

Posted on 29. Oct, 2011 by wisdom.

A new article in the New York Times titled “Wisdom of Having that Tooth Removed” written by Roni Caryn Rabin published September 5, 2011, is an interesting articles for those considering whether or not to have healthy wisdom teeth extracted. The article is located at http://www.nytimes.com/2011/09/06/health/06consumer.html

The article explores some of the issues regarding whether or not you should or not have have healthy wisdom teeth extracted.

The article discusses how the American Association of Oral and Maxillofacial Surgeons (AAOMS) held a press conference back in October of 2010, http://www.aaoms.org/docs/media/third_molars/key_findings.pdf, in which one of the key findings was

“Retained, asymptomatic wisdom teeth are eventually extracted between 25% and almost 70% of the time.”

The author of the New York Times article questioned AAOMS on this statement which appeared on their website. The response from AAOMS was

“Yet when asked, the association was not able to produce the evidence for these figures.”

The author concludes

“As for my daughter Emma, we have opted for watchful waiting. She went off to college last month, wisdom teeth and all.”

An interesting article by the American Dental Association (ADA) titled “Special Report: An in-depth look at new dental schools” by Karen Fox published September 5, 2011, located at http://www.ada.org/news/6173.aspx explores new dental schools which are now opening in the U.S. This is partly driven due to new academic health centers which believe dental school is essential to their mission.

The ADA is concerned about the opening of these new dental schools as additional dentists can potentially bring down the overall average salaries of dentists.

The ADA is concerned with the extremely high costs of dental education as those who graduate from dental school from public schools paid an average of $124,397 for their education while those in private schools paid $223,788. These high costs can affect how a dentist practices. The ADA is also concerned with the research that may not be conducted by these new dental schools. The ADA is further concerned that many of these new dentists will work in more affluent areas and not serve those most in need of dental care in undeserved areas. The ADA maintains that it can not control the supply and demand of dentists, although I do not entirely agree.

“But it’s up to the governing board of an institution of higher education to decide to open or close a dental school. “The ADA has no role in the creation of new dental schools. A professional organization cannot control supply and demand,” said Dr. Brain T. Kennedy … chair of the ADA Council on Dental Education and Licensure.”

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The War on Healthcare: Patients Who Hate Doctors

Posted on 19. Sep, 2011 by wisdom.

Dr. Maurice Bernstein on his Bioethics Discussion Blog has an interesting discussion going on about people who hate doctors and their reasons. Reading through the large number of responses located at http://bioethicsdiscussion.blogspot.com/2005/06/i-hate-doctors.html , a common theme emerges: those who are well educated and particularly those with a PhD really hate those with an MD degree.

This is no surprise to me as the current American healthcare system pits patients vs. doctors in a battle.

Here a few snippets from the comments:

1 of the comments:

“I hate arrogant, sadistic, amoral, money-grubbing scumbags, and unfortunately, it seems far too many of these types have weaseled their way into the medical profession. I am one of the millions of people with chronic pain in this country who is at the “mercy” of the American medical profession, and thus cannot get my pain treated.”

Another comment snippet:

“Yes it is true, WAKE UP AMERICA…!! THERE ARE MORE DEATHS IN THE US EVERY YEAR, DUE TO “MEDICINE” & DOCTORS…THAN IN ANY WAR GOING ON!!

THAT is why people “hate” “Dr.s”…becuase they are Killing people!!! They & the AMA are also arrogant, narrow minded & dumb. To think that drugs & only drugs are going to heal somebody & to block out ALL other modes of healing from the practice ie: alternative modes such as Herbs, Accupuncture, Supplements etc…is Assinine, & totally insane!”

Another snippet

“It’s clear that medicine is only about money, about making a buck, about making as much profit as possible for the least amount of risk.”

Yet another snippet

“Lying to prevent malpractice when a heartfelt, humble apology would do? Then it goes too far. Exactly how does an apology protect, legally, against a suit? That’s utter nonsense and yet another backwards step in the entire health care crisis. We are fast approaching a time IMO when the general public will go to war against the health care system.”

As eloquently put by someone who suffered a chronic headache after having wisdom teeth removed just like myself

“In our society, protection from liability is primary, profit is secondary, preserving the posterity and ego of the medical profession is tertiary, and treating the patient is somewhere further down priority chain.”

Hence it is absolutely no surprise that when you go on to American Association of Oral and Maxillofacial Surgeons (AAOMS) Grassroots Action Center http://capwiz.com/aaoms/home/ the first thing you see is Urge Congress to Reform the Medical Malpractice System.

Well that sounds like a good idea especially if you review my site and can clearly see how too little is being provided to patients who have been injured by a doctor in terms of a non-economic damage award and only around 2% to 3% of patients who suffer from negligent care even file a lawsuit http://www.teethremoval.com/legal_system_medical_malpractice

In my case I had my wisdom teeth extracted after I just turned 20 and was extremely healthy and was never told that scientific evidence does not support the removal of healthy wisdom teeth. Nor was I told sufficient information to make an informed choice. Even so due to the the U.S. legal system that rewards doctors for malpractice I never received any compensation for my injuries.

In fact AAOMS and also the American Medical Association are trying to support something called HEALTH Act (S. 218/H.R. 5). See also http://www.teethremoval.com/legal_standpoint.html and http://www.gpo.gov/fdsys/pkg/BILLS-112hr5ih/pdf/BILLS-112hr5ih.pdf for further description.

The quick important details is from  http://www.citizenvox.org/2011/05/11/hr5-medical-malpractice-gop-patient-rights/

“H.R. 5, which would give virtual liability immunity to the medical industry for reckless conduct. Included in its repertoire is a national $250,000 cap on non-economic damages, restrictions on punitive damages against pharmaceutical and medical device companies that engage in reckless conduct, limits on the time period for a patient to file a lawsuit to seek compensation for injuries and other obstacles that would deter meritorious cases from going forward.“

I encourage you to review the complications that can happen from wisdom teeth removal and you will come to the same conclusions as I have that a $250,000 pain and suffering damage award for particularly young patients in some instances is extremely unfair, unjust, and downright ridiculous.

Numerous physician groups such as as the AMA and AAOMS in the U.S. have clearly demonstrated that they DO NOT care about their patients.

I urge you my fellow Americans to contact Congress and tell them you WILL NOT TOLERATE H.R.5 AS IT TAKES AWAY YOUR RIGHTS PROTECTED BY THE CONSTITUTION.

Write to your Representative and make it known.

https://writerep.house.gov/writerep/welcome.shtml

Here is some AC / DC – War Machine to help set the tone.

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Astroturfing And How Your Thoughts Are Being Manipulated by Corporate Interests

Posted on 28. Jul, 2011 by wisdom.

Astroturfing is a form of advocacy typically to support an agenda with the appearance of a fake grassroots organization that is usually sponsored by corporations or those with a certain political interest. They work in such a way so that you are not aware that the corporate or political backing is present and you are led to believe that just an independent public organization is speaking out. There are a lot of ethical issues raised by doing this and evidence shows that astroturfing can be effective.

A recent article in the Journal of Business Ethics titled “Astroturfing Global Warming: It Isn’t Always Greener on the Other Side of the Fence,” by Charles H. Cho, Martin L. Martens, Hakkyun Kim, and Michelle Rodrigue (online July 3, 2011) explores the issue of those who visited astroturf websites and how it affects the perceptions of global warming.

Before explaining the study let’s make it clear global warming is unequivocal and there is at least a 90% likelihood it is caused by human activity.

In the study the researchers used a final sample of 278 students enrolled in accounting classes at a Canadian university. The true intent of the study was disguised from the students and they were told the website they would be viewing was a marketing experiment about effective website design for social issues including fair trade, homelessness, racism, and global warming. Eight versions of websites all on global warming were set up by the researchers designed to either be an astroturf or real grassroots website and each student was randomly assigned to view one website. Each website either didnt have a funding source listed or included‘ ‘Funded from donations by people like you,’’ ‘‘Funded by ExxonMobil,’’ or ‘‘Funded by grants from the Conservation Heritage Fund.”

As one would hope to have found those who browsed a website from an astroturf organization found the information as less credible and the organization as less trustworthy, compared to those who browsed a website from a grassroots organization. Even so as astroturf organizations had intended to instill confusion and uncertainty in the general public regarding the global warming issue they did accomplish that and those who visited an astroturf like website had their beliefs about global warming significantly altered and had more uncertainty about the cause of global warming.

Even more shocking is that those individuals in the study who were highly involved and knowledgeable about climate change had their views significantly influenced by the astroturf message. In addition, those who were not highly involved in the issues of global warming had their views affected even more.

The researchers note

“Our findings not only indicate that corporations are successful in fostering their own interests through astroturfing, but they also imply that this corporate political activity is likely to be detrimental to grassroots organizations. Astroturf organizations take the social movement approach to fulfill corporate agendas. Such fraudulent replication of grassroots organizations is likely to raise questions about the legitimacy of those organizations in the mind of the public…Once aware that they have been manipulated by a fake grassroots organization, members of the public are likely to be much more cautious and skeptical with all grassroots organizations, whether they are genuine or fake.”

There are clear ethical and societal concerns with not having full transparency for any astroturfing organization.

The researchers also say

“Astroturf organizations are (1) successful in creating uncertainty about the importance of global warming in the mind of the public and (2) utilized by corporations to attack the emerging logic of climate change and defend the carbon based energy logic which encompasses corporate interests.”

In addition these astroturf organizations go against the ethical considerations to protect the environment for future generations.

These findings have broad implications that certainly extend beyond global warming. As I have indicated on an earlier post http://blog.teethremoval.com/lets-give-our-kids-a-chance-to-succeed/ today’s youth has a very difficult time distinguishing fact from fiction on websites and information they view online. The results of this study described above just seek to add to support this and in fact demonstrate that their views can be manipulated even though the views they are ‘planted’ with may not be in their own personal best interests.

This even has implications in our own personal health and yes even the decision to extract or not extract healthy wisdom teeth as I discuss on this site. For example the American Association of Oral and Maxillofacial Surgeons (AAOMS) states on their website http://www.aaoms.org/wisdom_teeth.php

“It isn’t wise to wait until your wisdom teeth start to bother you.”

In fact as discussed, scientific evidence does not currently support or refute removing healthy wisdom teeth removal. By AAOMS failing to provide this information on their website which is publicly available they are helping to create additional uncertainty in the minds of those who are trying to seek the best decision for their personal health and well being.

It is imperative that our educators recognize that we need to teach our youth how to effectively read and analyze information on the internet and determine facts from fiction. What really makes this difficult is highlighted in the article discussed on astroturfing and global warming:

“…Western Fuels Association [delivers], for free, to public and university libraries across the United States hundreds of copies of their Greening of Planet Earth video, which shows that plants on earth are lacking carbon dioxide, and that an increase in atmospheric carbon will provide a more fertile world….the Heartland Institute [sends] thousands of brochures and DVDs to Canadian schools, pushing them to teach their students that scientists have been exaggerating the effects of human activity on global warming.”

Again to reiterate global warming is unequivocal and there is at least a 90% likelihood it is caused by human activity.

Who is looking out for our children and our youth? They have more to worry about like the extremely high cost of education which has ballooned out of control in the U.S. at both the undergraduate and further graduate and medical school levels.

Source: http://www.kevinmd.com/blog/2011/07/medical-education-cost-health-policy-imperative.html

Additional Source: http://arstechnica.com/science/news/2011/07/astroturfing-a-major-challenge-to-climate-change.ars

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The American Association of Oral and Maxillofacial Surgeons Fails to Use Basic Statistics in Research on Wisdom Teeth

Posted on 13. Dec, 2010 by wisdom.

I have previously reported how the American Association of Oral and Maxillofacial Surgeons (AAOMS) recently had a press conference on wisdom teeth in Washington, D.C. See http://blog.teethremoval.com/third-molar-multidisciplinary-press-conference/ for more information.

Shortly after the press conference they issued a press release available at http://www.aaoms.org/docs/media/third_molars/press_release.pdf which is titled “Conventional Wisdom about Wisdom teeth Confirmed: Evidence Shows Keeping Wisdom teeth May be More Harmful than Previously Thought.” One of the additional key findings listed in this press release  is

“Most patients (60 percent) with asymptomatic wisdom teeth prefer extraction to retention.”

This finding comes from a recent article in the Journal of Oral and Maxillofacial Surgery, titled “Most Patients With Asymptomatic, Disease-Free Third Molars Elect Extraction Over Retention as Their Their Preferred Treatment.”  The article is by Brian E. Kinard, BS and Thomas B. Dodson, DMD, MPH.  It appears in the December 2010 issue in volume 68, issue 12, on pages 2935-2942.

The article uses a study sample from patients presenting to the Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital between November 2008 and August 2009 for the evaluation and management of their third molars (wisdom teeth) by Thomas B. Dodson.  In the article on Table 8 it is presented that a total of 319 patients were seen during this time who had asymptomatic disease free wisdom teeth. 129 of these patients chose to keep their wisdom teeth and 190 of these patients chose to extract their wisdom teeth. A simple calculation was performed by the authors of 190/319 * 100 = 60%. (it actually equals 59.5611 % but they rounded up). This is how they arrived at their statement quoted above that most patients with asymptomatic wisdom teeth prefer extraction and how they arrived at the titled of the article most patients prefer extraction.

Thomas B. Dodson admits that their bias in this result as “…it is possible for clinicians to present treatment options in a manner, consciously or unconsciously, that directs patients toward the clinician’s preferred treatment.”  This is a valid concern. I also have a problem in that no statistical analysis was done beyond this point with this specific result.

During my undergraduate studies I took several courses on statistics. One popular program to use is MINITAB in addition to knowing how to do hand calculations.

Using this proportion data it is possible to do in MINITAB and by hand a 1 proportion test and determine a confidence interval. A 95% (two sided) confidence interval of this data is (0.539505, 0.649924).  This is calculated by calculating an estimator for the standard error. This estimator is the square root of [(p * (1-p)/n] where p is in this case 190/319 corresponding to the sample proportion which is an estimator of the population proportion and n is the sample size which in this case is 319. We then look up in a t table or use MINITAB to determine the test statistic, which in this case is 1.96745. The 95% confidence interval is then calculated as 190/319 +/- sqrt[(190/319 * (1-190/319)/319] *1.96745  . We then arrive at our 95% confidence interval of 53.9505% to 64.9924% which means we are 95% confident that the true population proportion of those who keep their asymptomatic wisdom teeth falls in this range.

The other important piece of information we need to asses is if we have enough samples in our data. A total of 319 patients were used in this study who had disease free wisdom teeth but it turns out we need more than 319 patients to make an accurate assessment before we can even calculate a 95% confidence interval.

If we look at the Statistics Department at Penn State University we can easily find an educated guess and  conservative method to determine the required sample size.  In this case our educated guess is calculated as [ (1.96)^2 *  0.595611 * (1 - 0.595611) ] / (0.05)^2 which equals 370.113 and our conservative method is calculated as [ (1.96)^2 *  0.5 * (1 - 0.5 ] / (0.05)^2 which equals 384.16. Thus we determine that it is necessary to have at least 371 patients in our study to be able to even come up with a statement as to whether or not we can be 95% confident that patients prefer either to extract or retain healthy impacted wisdom teeth.

The authors only used 319 patients in their study and thus the data does not allow them to make such as statement as they did which AAOMS subsequently reported in a press release.

I encourage Thomas B. Dodson and other oral surgeons to consider using some basic statistics in their research before releasing such information to the the public who should be receiving information that can allow them to make informed decisions about their health.

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