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Third Molars (aka Wisdom Teeth): Kandasamy vs White and Proffit
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
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
The Evidence Base for Third Molar (Wisdom Teeth) Decisions
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
Tips to Prevent Medical Errors – AHRQ
The largely ineffective Agency for Healthcare Research and Quality (AHRQ) has a list of 20 Tips to Help Prevent Medical Errors http://www.ahrq.gov/consumer/20tips.htm Number 20 on the list is “Learn about your condition and treatments by asking your doctor and nurse and by using other reliable sources.” It then suggests to ask your doctor if the treatment is based on the latest evidence. The way this is presented it seems to say that doctors and nurses often do not always present treatment options based on the latest evidence. As argued by Shannon Brownlee, http://www.washingtonmonthly.com/features/2007/0710.brownlee.html the U.S. is clearly in need of an “… independant agency that would fund systematic reviews of the medical literature, as well as clinical trials to test the comparative effectiveness of everything from drugs to treatments” Unfortunately the current AHRQ is not performing this service as it … Read more