Wisdom Teeth

Gum diease can lead to selective disarming of the immune system

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A new study has shown that bacteria responsible for many cases of periodontitis causes dysbiosis in a two prong manipulation of the immune system. The researchers say that periodontal bacterium porphyromonas gingivalis acts on two molecular pathways to block immune cells’ killing ability while preserving the cells’ ability to cause inflammation. This protects these bacteria from being removed by the immune system and leads to bone loss and inflammation which is characteristic of periodontitis. The researchers say when inflammation occurs breakdown products are produced which causes dysbiosis and creates a vicious cycle. P. gingivalis is known as a keystone pathogen. Their presence may be relatively few in the mouth but they can exert a large pull on the overall microbial ecosystem. P. gingivalis doesn’t actually cause periodontitis but is responsible for causing the process that leads to it. The researchers believe that … Read more

AAOMS Issues New Position Paper on Medication-related Osteonecrosis of the Jaw

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Earlier in 2014, the American Association of Oral and Maxillofacial Surgeons issued a new position paper on Medication related Osteonecrosis of the Jaw (MRONJ) see http://www.aaoms.org/docs/position_papers/mronj_position_paper.pdf?pdf=MRONJ-Position-Paper. The condition in the past has been called Bisphosphonate-related Osteonecrosis of the Jaw but both antiresorptive and antiangiogenic therapies are associated with it so the name has been updated. MRONJ appears as non-healing exposed bone in the mouth and may affect patients undergoing intravenous cancer-related therapy or those treated with oral or IV bisphosphonates for osteoporosis. The paper states that patients may be considered to have MRONJ if the following characteristics are present: Current or previous treatment with antiresorptive or antiangiogenic agents; Exposed bone or bone that can be probed through an intraoral or extraoral fistula(e) in the maxillofacial region that has persisted for more than eight weeks; No history of radiation therapy to … Read more

Considerations For the Cost of Wisdom Teeth

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In a recent post, I discussed the cost of wisdom teeth management based on an article that appeared earlier this year in the Journal of Oral and Maxillofacial Surgery (see https://blog.teethremoval.com/the-costs-of-third-molar-wisdom-teeth-management/) Another article discussing wisdom teeth costs also appeared in the Journal of Oral and Maxillofacial Surgery in 2012 (see https://blog.teethremoval.com/the-costs-associated-with-third-molars-wisdom-teeth/). In both articles the authors conclude the costs of non-operative management of asymptomatic, disease-free, wisdom teeth exceeds the cost of operative management. I take issue with their conclusions as I believe they make too many simplifications in their analysis. I argue that the authors are ignoring the real risks of having wisdom teeth extracted that are not going to likely occur with non-operative management. Removing wisdom teeth has complications that can result. Some of these can be serious, permanent, and lasting, and cause considerable cost to both the patient … Read more

The Costs of Third Molar (Wisdom Teeth) Management

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I have previously commented on the costs associated with wisdom teeth in a 2013 blog post that was based on a 2012 article appearing in the Journal of Oral and Maxillofacial Surgery (see https://blog.teethremoval.com/the-costs-associated-with-third-molars-wisdom-teeth/). More recently, another article discussing the costs of wisdom teeth has appeared in the 2014 Journal of Oral and Maxillofacial Surgery titled “The Cost of Third Molar Management” written by Gino Inverso, Ronald Heard, and Bonnie L. Padwa (issue 72, pp. 1038-1039). This article takes the position that most previous studies focused on discussing wisdom teeth costs when taking the position from the cost of billing to private insurance companies. Their article attempts to use the true cost which they feel should help promote discussion of the topic of retaining or removing healthy disease free wisdom teeth and possibly increase access to care. In their analysis they determine the … Read more

New Legislation In California Proposed to Increase Medical Malpractice Damage Caps: Why It is Important if you Are Having Wisdom Teeth Extracted

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A recent piece over on DrBicuspid.com titled “Dentists fight Calif. malpractice insurance ballot measure” draws attention to new proposed legislation in California (California Proposition 46) see http://www.drbicuspid.com/index.aspx?sec=log&URL=http%3a%2f%2fwww.drbicuspid.com%2findex.aspx%3fsec%3dsup%26sub%3dbai%26pag%3ddis%26ItemID%3d316366. The article discusses the previous medical malpractice legislation in California called the Medical Injury Compensation Reform Act (MICRA) which placed a $250,000 cap on noneconomic damage awards. The act did allow for unlimited economic damages and out of pocket costs. The article then discusses Proposition 46 in California written as “The Troy and Alana Pack Patient Safety Act,” to quadruple MICRA’s cap on noneconomic damages to $1.1 million. This actually simply changes the original $250,000 non-economic damage cap established in 1975 to what it would be today if it was indexed for inflation. I have previously discussed this over at http://www.teethremoval.com/legal_standpoint.html. The article goes on to get commentary from a past California Dental Association … Read more