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Third Molars (aka Wisdom Teeth): Kandasamy vs White and Proffit

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Like usual there are often heated exchanges over the management of wisdom teeth (third molars). Back in November 2011, in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5)  there was an exchange regarding two previous articles that had appeared and consequent exchange (White RP Jr, Proffit WR. Evaluation and management of asymptomatic third molars: lack of symptoms does not equate to lack of pathology. Am J Orthod Dentofacial Orthop 2011;140:10-6; and Kandasamy S. Evaluation and management of asymptomatic third molars: watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 2011;140:11-7) The articles in question I am referring to here are “Third molars” by Raymond P. White, Jr, and William R. Proffit in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5, pages 600-601) and Author’s response by Sanjivan Kandasamy … Read more

Review of the Wisdom Behind Third Molar Extractions

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Back in 2009, an article titled  The wisdom behind third molar extractions” by “S Kandasamy and DJ Rinchuse appeared in the Australian Dental Journal (54. pages 284-292. 2009) I discussed some of the provocative comments in this article in the post Bringing About Healthcare Change. To reiterate he states “…in the 21st century, the routine removal of asymptomatic pathology- free third molars has become a dated practice that is rapidly running out of valid excuses, and it has no justification in contemporary dentistry and medicine.” Earlier this year an article titled “Patient Specific Variables are a Consideration in the Decision to Extract Asymptomatic Third Molars” by Katerine W. L. Vig appeared in the J Evid Base Dent Pract. (2012 12 pp. 92-94) The conclusion of this article is “The removal of third molars to avoid lower incisor crowding is not justified. … Read more

Death and Greed at the Dentist: Is Your Child at Risk?

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A new investigation came out recently by ABC News appearing on both “Nightline” and “World News With Diane Sawyer” looking at sedation deaths from dentistry. The story is located over on the ABC News website which appeared on July 12, 2012 and is titled “Death, Greet at the Dentist: American Children at Risk.” A synopsis of the investigation appeared on drbicuspid.com on July 13, 2012, titled “ABC News spotlights pediatric dental sedation risks.” The story over on ABC News opens up with “American children are being put at risk by inadequately trained dentists who often seek to enhance profits by sedating their young patients for even routine tooth cleaning and cavity treatments.” In the segment on “Nightline” Brian Ross says “…it is a scandal in many cases driven by dentists who are told they can increase their bottom line. Hundreds … Read more

The Evidence Base for Third Molar (Wisdom Teeth) Decisions

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An excellent editorial appears in the Journal of Oral and Maxillofacial Surgery in the August 2012 edition titled “Those Who Ignore the Evidence Are Doomed to Misuse It” by Dr. Thomas B. Dodson (70, pages 1765-1767). Dr. Dodson explains how the debate regarding whether or not to either 1) remove asymptomatic, disease-free third molars, or 2) retain asymptomatic, disease-free third molars has become highly controversial. He argues that there are an assortment of viewpoints that play a role here. A) Payer-based clinical decision making: “The payer is the invisible hand in the operatory, influencing the treatment plan with a bold line that determines whether a service is covered or not. With PBCD, there is little regard or sympathy for what the OMS perceives about the individual patients and their circumstances. Thus, PBCD risks moral hazard by pre-empting services that the … Read more

Migraines – Cause and Effect

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Roughly 30 million Americans suffer from migraine headaches and women are affected 3 times more often than men. Hormonal changes are part of the reason why females have such a higher incidence. Migraine headaches typically last between 4 and up to 72 hours with some experiencing them several times a month. Several risk factors have been identified that increase a person’s chance of having migraines: Family history: If one has 1 or more first-degree relatives with migraine headaches, the likelihood rises substantially. Age: Most people are between 15 and 55 who have migraine headaches. Gender: Women are much more likely to suffer from migraines than men. Certain medical conditions: epilepsy, anxiety, stroke, depression, and high blood pressure are all associated with migraines. Hormonal changes: Women with migraines often have them just before or shortly after menstruation. The exact cause of … Read more