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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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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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Third Molar Multidisciplinary Press Conference

Posted on 18. Oct, 2010 by wisdom.

Just a quick update to remind you that the Multidisciplinary Conference on Third Molars (Wisdom Teeth) will be occurring today October 19, 2010, at the Willard Intercontinental Hotel in Washington, D.C. at 11 A.M Eastern. To find out more details please refer to my previous blog post http://blog.teethremoval.com/multidisciplinary-conference-on-third-molars-wisdom-teeth/.

If you are unable to make the conference and would like to listen in online, a live audio stream will be provided. Simply visit http://www.visualwebcaster.com/event.asp?id=73177

This conference is being put on by American Association of Oral and Maxillofacial Surgeons (AAOMS) and Ira. D Cheifetz, the immediate past president of AAOMS, will be in attendance.

Update: I did get a chance to listen in on the conference which lasted just over an hour. The live stream also showed a PowerPoint presentation to accompany the speakers. The speakers who presented are seen in the above slide on the panel.  If you are interested in learning more about this panel who consisted of Dr. Ira D. Cheifetz, Dr. Louis K. Rafetto, Dr. James Q. Swift, Dr. Raymond P. White, Jr., Dr. Stephen Offenbacher, and Dr. M. Anthony Pogrel you can visit http://www.aaoms.org/docs/media/third_molars/press_conference_biographies.pdf. Each member of the panel did have their own slides which they presented although I don’t think  Dr. Ira D. Cheifetz explicitly had his own slides.

AAOMS has released some additional documents to accompany this Third Molar Multidisciplinary Conference which include a Press Release, an Executive Summary, and some Graphics. You can find these documents at http://www.aaoms.org/third_molar_news.php. I am not sure if any of the  PowerPoint Presentations will be made available in case you are interested in viewing but I did capture the majority of them while watching the conference online. Hence I will summarize below.

Dr. Louis K. Rafetto discussed briefly in his presentation about how pathology precedes symptoms so decision making should be based on the likely development of pathology and not on the presence of symptoms.

Dr. James Q. Swift discussed how diseases such as periodontal (gum) disease around wisdom teeth is often without symptoms and thus not noticed. He further addressed how wisdom teeth are difficult to reach and often have cavities or are affected with gum disease.

Dr. Raymond P. White, Jr. discussed some of the problems that can occur if someone keeps wisdom teeth such as periodontal inflammatory disease and the associated pathology. He discussed how microorganisms evade neutrophils and become colonized leading to migration by monocytes and lymphocytes which leads to an increase in inflammatory mediators which can then lead to enzymes that destroy collagen and bone.

Dr. Stephen Offenbacher  discussed the local and systemic implications of third molar retenion. A young pregnant female study was discussed which showed that the presence of wisdom teeth is associated with worse periodontal status, increases the risk of systemic exposure of oral bacteria, and is associated with systemic inflammation.

Discussion of the oral-systemic pathway was addressed:

1. Periodontal disease presents biofilm microbial and local inflammatory challenge.
2. Periodontal inflammation mediates pocketing and bone loss.
3. Oral bacteria invade into tissues to create inflammatory site of sepsis.
4. Cytokines, bacteria, and bacterial products disseminate into bloodstream. Systemic microbial and inflammatory challenge trigger hepatic acute phase response.
5. Liver releases APR proteins including fibrinogen, C-reactive protein and IL-6.
6. C-reactive protein and IL-6 promote atherogensis and oxidized LDL accumulation.
7. Increased atheroma increases plaque instability increasing risk for myocardial infarction and stroke.

Thus, this particular presentation by Dr. Offenbacher suggested that wisdom teeth represent a potential systemic source of infectious dissemination and systemic inflammation. Certain biochemical markers such as serum IL-6 and CRP  have increased levels with third molar pocketing and that this can cause more severe chronic systemic diseases which include atherosclerosis, cardiovascular disease, and poor glycemic control. Hence the argument is made that removing wisdom teeth decreases the risk of developing periodontal pocketing which thus can subsequently disease the risk of developing chronic systemic diseases.

Dr. M. Anthony Pogrel had one slide which he presented and discussed how around 10% of people with wisdom teeth removal have a complication that occurs and stated that most complications are quite mild and eventually lead to recovery. He discussed how complications that last a long time are rare and that the recovery from complications is slower and not as effective as one ages and gets older. Dr. Pogrel also addressed how most people who have their wisdom teeth out are back to school or work within a few days and that the incidence of complications occurring starts to increase after 25 years of age.

There was also a question and answer section at the end of where the presenters answered questions from both the live audience and also online questions from people listening in.

The above simply serves as a summary of what occurred at the Third Molar Multidisciplinary Conference but does not cover or articulate everything addressed.

Although I am not sure if this was really the intent, but it seemed that the message from the conference was that wisdom teeth should be actively managed and watched and even if someone has no symptoms a disease could still be present. This does not necessary mean all wisdom teeth need to be removed but oral surgeons are less likely to want to remove wisdom teeth for a patient who is in older age.

There is agreement that additional studies on wisdom teeth and analysis of data already available should be undertaken to better understand if asymptomatic wisdom teeth should or should not be routinely removed. There is consensus agreement that wisdom teeth causing problems should be removed. I make the argument in addition to other arguments highlighted on my website, that since it is not clear whether or not to extract symptom free wisdom teeth but it is clear that life altering complications can and do occur from their removal, that at this time the routine removal of asymptomatic wisdom teeth should be discontinued and stopped. In addition the conference did not go into many details on the complications that can occur after wisdom teeth removal and stated that around 10% of people have some complication.  Furthermore, this conference was put on by oral surgeons who make  a large portion of their living by removing wisdom teeth so it is of course skewed in regard to scientific fact.

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Anesthesia in the Oral and Maxillofacial Surgeons Office

Posted on 12. Oct, 2010 by wisdom.

The American Association of Oral and Maxillofacial Surgeons (AAOMS) is continuing to attempt to increase their ability to attract young adults to elect to have their wisdom teeth removed.

Back in May 2010 they released a video called “Anesthesia: Safety and Comfort in the OMS Office.” The video is over nine minutes long and takes viewers into actual Oral and Maxillofacial surgeon’s offices with interviews by Dr. M. Anthony Pogrel who is Professor and Chair of the Department of Oral and Maxillofacial Surgery at the University of California, San Fransisco, Dr. Andrew Herlich who is Chief of Anesthesiology at the University of Pittsburgh Medical Center, Dr. Michael Miloro who is director for the Postgraduate Residency Training Program at the University of Illinois at Chicago College of Dentistry, Dr. Michael Ding who is Chief Resident of Oral and Maxillofacial Surgery at the Baylor College of Dentistry, Roni Lockhart who is an Oral and Maxillofacial Surgery Anesthesia Assistant, Dr. Anthony M. Spina who is an Oral and Maxillofacial Surgeon, Dr. Kathy A. Banks who is an Oral and Maxillofacial Surgeon, and Dr. Richard D. Leathers who is an Oral and Maxillofacial Surgeon.

There is even a brief interview of a patient who recently received anesthesia and a brief history lesson of anesthesia by the narrator of the video.

I particularly enjoy the inclusion of Dr. M. Anthony Pogrel who completed general surgery training in Great Britain and has a clear British accent. I almost feel like his prominence in the video is an attempt to buy some credibility.

As stated numerous times before, I disagree with AAOMS and their stance on wisdom teeth removal. If you have not already done so please visit http://www.teethremoval.com/ to learn about why you should think twice before wisdom teeth removal.

If you look carefully on my website I do question whether or not oral surgeons should be administering anesthesia in their office.

There are certainly some concerns about sexual assault occurring while under anesthesia for wisdom teeth removal at the oral and maxillofacial surgeon’s office.

There are also concerns about oral and maxillofacial surgeon’s having faulty medical gas systems installed and seriously injuring patients while having their wisdom teeth extracted.

Of course there could also be something that might go wrong while under anesthesia and require a patient to be rushed to the emergency room to avoid death from wisdom teeth removal. Therefore, if the patient undergoing wisdom teeth surgery is already at the hospital to have the procedure done this could be the difference between life and death.

Certainly my concerns raised above are somewhat rare and not very likely to occur but they are worth mentioning and being aware of. Of course there could also be problems that occur if surgery is done in a hospital setting such as the anesthesiologist and the oral surgeon not properly communicating.

If you have any thoughts about this video feel free to let me know in the comments section below.

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Multidisciplinary Conference on Third Molars (Wisdom Teeth)

Posted on 12. Sep, 2010 by wisdom.

I wanted to let everyone know that on October 19, 2010, at the Willard Intercontinental Hotel in Washington, D.C. there will be a so called “Multidisciplinary Conference on Third Molars.”

This meeting will consist on an invitation-only audience. This event is being organized by the American Association of  Oral and Maxillofacial Surgeons (AAOMS). Those who will be in attendance include dental, medical, governmental, and third party organizations. I wonder if I will be receiving an invitation however I doubt it due to the nature of the meeting and its intent to promote the removal of healthy impacted wisdom teeth due to so called “accurate and true evidence based research.”

Since I now reside near the D.C area I may try to attend the conference to see what is being discussed and to make sure that accurate results are being presented and discussed.

The program of the conference includes the following (bullets below) as stated in Ira D. Cheifetz’s In My View Section on page 2 of the AAOMS Today Volume 8, Issue 5, September/October 2010 issue.

• “Quantifies the issue of third molars in terms of the number of patients who have retained asymptomatic third molars, and the costs associated with managing those patients.”
• “Considers the nature of third molars: are they different than other teeth; how predictable is their behavior over time; and is there pathology associated with asymptomatic third molars?”
• “Discusses the risks accompanying the removal of asymptomatic third molars. Does timing, for example, affect the incidence and severity of complications, or the patient’s recovery?”
• “Examines the long-term consequences of third molar removal.”

After the Multidisciplinary Conference on Third Molars a press conference will take place. The intent of the press conference is to provide media with a chance to write articles and perhaps discuss on a TV news segment the potential problems with leaving healthy impacted wisdom teeth in hence why they should be removed.

The intent of this Conference is clearly to urge parents and teenagers/young adults who are considering oral surgery to have those wisdom teeth removed that are impacted.

The reason for AAOMS having this Conference stems from the fact that in 2008 the American Public Health Association (APHA) released an article titled “Opposition to Prophylactic Removal of Third Molars.” This article is viewable for your convenience on my website http://www.teethremoval.com/Opposition_to_Prophylactic_Removal_of_Third_Molars_wisdom_teeth.html.

Dr. Thomas B. Dodson states  in a June 2009 letter to the editor in the Journal of Oral and Maxillofacial Surgery http://www.joms.org/article/S0278-2391%2809%2900068-8/abstract that the American Public Health Association “cherry picked published fact and ignored the context and intent of many authors cited.” Hence AAOMS agrees with Dr. Dodson’s assessment and feels the policy statement by the APHA is flawed.

I feel my website does a good job presenting other information besides just the “Opposition to Prophylactic Removal of Third Molars” article and APHA policy statement. For example as clearly stated on http://www.teethremoval.com/ the British National Institute for Clinical Excellence states “The practice of prophylactic removal of pathology-free impacted third molars should be discontinued. . . . There is no reliable evidence to support a health benefit to patients from the prophylactic (preventative) removal of pathology free impacted teeth.” In addition, I clearly address the serious complication of a constant 24/7 headache I have had since 2 days after having all four of my healthy impacted wisdom teeth removed over 4 years ago. My website addresses other serious complications such as brain damage, stroke, and even death that has occurred in young adults upon having their wisdom teeth removed.

I also encourage you to review a letter I previously sent to AAOMS members back in January http://blog.teethremoval.com/american-association-of-oral-and-maxillofacial-surgeons-aaoms-contact-information-and-request/.In the letter I urge AAOMS to make proper recommendations regarding third molar removal in the United States based on evidence based medicine.

I have not seen AAOMS address the reasons for the British National Institute for Clinical Excellence recommendation and why AAOMS’s recommendation is completely opposite.

In addition, AAOMS is not providing any real evidence based research to suggest that removing healthy impacted wisdom teeth in your younger years is more beneficial than not removing them and keeping a watchful eye on them and then removing the wisdom tooth or teeth that are causing problems down the road. They lead you to believe that their Third Molar White Paper does a good job showing the evidence based research http://www.aaoms.org/docs/third_molar_white_paper.pdf but it is severely lacking in numerous areas and proper scientific studies and assessments.

The first aim and last aim of the Multidisciplinary Conference can really be summed up by the following. As a teenager / early 20′s year old person wouldn’t you rather have the younger years of your life healthy compared to the possibility that instead if you elect to have your wisdom teeth extracted you could suffer a complication perhaps a serious one and be left with that for the rest of your life. Where as instead, if you have suffer a complication later in your life when in fact your wisdom teeth are causing problems and need to be removed than you would have lived with that complication  for a shorter duration of your life.

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