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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

Daily Preventative Therapies Can Reduce Migraine

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The American Academy of Neurology/American Headache Society Guidelines released earlier in April 2012, provide evidence-based and effective treatments that can prevent migraine attacks and lessen their severity. They state 38% of migraine sufferers require preventive therapy, but just 3%  to 13% currently use any preventatives. Some patients are taking preventatives that have never been shown to work. The guidelines show that prevention of migraines requires daily medication. Mark Green, MD, director of the Headache Center at Mount Sinai School of Medicine, in New York says “If these guidelines are used widely, we will be able to up the odds of reducing headaches by 50 percent…Evidence is building to suggest that if we allow migraines to progress, the frequency of attacks may increase, and they may also become harder to treat.” The guidelines panel found the following: • The anti-seizure medications … Read more

Industry Bias in Biomedical Science

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An interesting article written by Christopher T. Robertson titled “The Money Blind: How to Stop Industry Bias in Biomedical Science, Without Violating the First Amendment,” appears in the American Journal of Law and Medicine (vol. 37, pages 358-387, 2011). The article discuses how the medical industry spends billions of dollars to create innovative products but also spends nearly as much to change the behavior patterns of those interested to make sure the products are purchased. The author states “As a veteran of the industry writes, ‘ in the pharmaeeutieal industry, there are two ways to market an approved drug for a new use: the ‘indication’ route—performing studies necessary for regulatory approval—or the ‘publication’ strategy, whieh stimulates off-label prescribing by using research ‘to disseminate the information as widely as possible through the world’s medical literature.’ “ A mention is made of a candid document by Pfizer which states … Read more

Cluster Headache Features and Therapeutic Options

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A review article titled “Cluster Headache: Clinical Features and Therapeutic Options” written by Charly Gaul, Hans-Christoph Diener, and Oliver M. Muller published in Deutsches Ärzteblatt International (vol. 108, issue 33, pages 543-549, 2011) provides an interesting look on new options for those with a chronic refractory cluster headache. The article discusses how 120,000 people in Germany are affected by cluster headache. The attacks are in the periorbital area on one side and last 90 minutes on average. The attacks often posses a circadian and seasonal rhythm. The author lists the diagnostic criteria for cluster headache as from the International Classification of Headache Disorders (ICHD-II). First line drugs for treatment include verapamil and cortisione or lithium and topirmate. In addition, short term relief can be obtained by local anesthetics and steroids along the course of the greater occipital nerve. I have … Read more