• Dentistry,  Oral Surgery

    Oral Surgery and Endocarditis

    A new study validates American Heart Association guidelines concerning oral surgery and the prevention of bacterial endocarditis.

    The strongest evidence yet to support clinical guidelines that recommend that people at high risk of endocarditis, such as those who’ve had previous episode the disease or who have a prosthetic cardiac valve, should take antibiotics before they have a tooth pulled or other types of oral surgery, comes from a new study that used two methodologies.

    But it also pointed out that two-thirds of the time they aren’t getting that type of antibiotic coverage.

    The researchers conducted a cohort study of almost 8 million retirees with employer-paid Medicare supplemental prescription benefits and dental benefits, then conducted a case-crossover study of 3,774 people from the cohort who’d been hospitalized with infectious endocarditis (IE) and who had invasive dental procedures. The bottom line is that the study supports the clinical guidelines from the American Heart Association and the European Society of Cardiology that recommend antibiotic prophylaxis (AP) before dental procedures for patients at high-risk of IE.

    Noncompliance is very worrisome. Dentists and patients alike should be vigilant in preventing this potentially deadly infection.

  • Dentistry,  Oral Surgery

    Oral Surgeon Loses License for Unsanitary Dental Practices

    Holy Cow!

    An oral surgeon lost his medical license for five years after 15 of his patients at his Budd Lake office were sickened and one died of a bacterial heart infection, according to authorities.

    Dr. John Vecchione, who operated North Jersey Oral Maxillofacial Reconstructive Surgery LLC on Route 46 in the Budd Lake section of Mount Olive, was ordered to pay $293,000 in penalties and costs after he failed to follow infection control protocols, which caused his patients to be exposed to bacterial endocarditis between 2012 and 2014, according to a statement by the Office of the Attorney General. Of those infected, 12 patients — who ranged in age from 24 to 80 — required heart surgery and a 54-year-old later died due to complications.

    Vecchione, who agreed in 2016 to have his license temporarily suspended as the allegations against him were pending, has been fighting his case in court. Shortly before he was expected to take the stand in his own defense in January, he agreed to settle the case under the terms contained in a Final Consent Order.

    “Dr. Vecchione spent years denying any responsibility for the infections contracted by patients in his care

    ,” said Howard Pine, the acting director of the Division of Consumer Affairs.

    In a complaint filed against Vecchione in August 2016, it was alleged that he engaged in professional misconduct and gross negligence following a series of inspections of his Budd Lake office. Specifically, investigators found Vecchione failed to use sterile water or sterile saline during surgical procedures; improperly handled and improperly stored single dose medication vials; failed to sterilize medical instruments; used expired vials of medication; and failed to properly dispose of needles and syringes.

    This dentist should just retire and quit practice. Clearly, he has either medical/mental cognitive problems.

    His manner of practice is way outside the standard of practice of dentistry.

  • Dentistry,  Oral Surgery

    Practical Joker Dr. Robert Woo Wins in the Washington Supreme Court

    Well, Dr. Robert Woo won yesterday in the Washington Supreme Court and he won BIG.

    An oral surgeon who temporarily implanted fake boar tusks in his assistant’s mouth as a practical joke and got sued for it has ended up with the last laugh.

    Dr. Robert Woo of Auburn had put the phony tusks in while the woman was under anesthesia for a different procedure. He took them out before she awoke, but first he shot photos that eventually made it around the office.

    The employee, Tina Alberts, felt so humiliated when she saw the pictures that she quit and sued her boss.

    Woo’s insurance company, Fireman’s Fund, refused to cover the claim, saying the practical joke was intentional and not a normal business activity his insurance policy covered, so Woo settled out of court. He agreed to pay Alberts $250,000, then sued his insurers.

    A King County Superior Court jury sided with Woo, ordering Fireman’s Fund to pay him $750,000, plus the out-of-court settlement. The insurance company won the next round, with the state Court of Appeals saying the prank had nothing to do with Woo’s practice of dentistry. On Thursday, the state Supreme Court restored Woo’s award.

    In a sprightly 5-4 decision, Supreme Court Justice Mary Fairhurst wrote that Woo’s practical joke was an integral, if odd, part of the assistant’s dental surgery and “conceivably” should trigger the professional liability coverage of his policy.

    And, Flap is so glad his daughters have gone into the law.

    For this Friday, you readers, cannot ever say that Flap does not blog on dental issues.

    And, lastly, for Dr. Woo with a big hat tip to Anthony York:



    The You Tube author removed it from being embedded but you can watch it here.

    Oral Surgeon Moron: Pot Bellied Pig

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  • Dentistry,  Oral Surgery

    Dentistry Today: Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate disodium) Associated with Osteonecrosis of Jaw – REDUX

    Previously at the FullosseosuFlap’s Dental Blog, Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate dis odium) Associated with Osteonecrosis of Jaw

    An update from the Journal of Endodontics, Critical Information for Patients About Possible Side Effect of Bisphosphonates.

    An article titled, “Bisphosphonate-associated Osteonecrosis of the Jaws and Endodontic Treatment: Two Case Reports,” in the October issue of the Journal of Endodontics (JOE), a publication of the American Association of Endodontists (AAE), suggests patients using bisphosphonates as part of their cancer treatment and for debilitating bone diseases, such as osteoporosis and Paget’s disease, may be at risk of experiencing a painful, disfiguring condition known as osteonecrosis of the jaw, a disease that leads to the breakdown of the bone. The word osteonecrosis literally means “death of bone” (osteo = bone, necrosis = death).

    Initial symptoms include burning, tingling or localized pain in the jaw, and may lead to more serious complications, such as infections and jawbone degeneration. Patients who think they may be experiencing symptoms of osteonecrosis of the jaw should seek counsel from their general physicians and oncologists, and inform their dentists, endodontists and other dental professionals that they are undergoing treatment with bisphophonates.

    The latest generation of bisphosphonates includes: alendronate (Fosamax®); pamidronate (Aredia®); and zoledronate (Zometa®). Bisphosphonates help strengthen bone and prevent fractures in the hip, spine and other skeletal regions by inhibiting bone loss.

    The article indicates that at the same time bisphosphonates support the buildup of bone in areas weakened by disease or as a side effect of treatment, some patients taking bisphosphonates may experience the opposite effect in the lower and upper jawbones. “Considering the large number of patients around the world using bisphosphonates for prevention or treatment of osteoporosis, dentists may be dealing with a significant potential complication,” write the authors.

    Written by Aaron P. Sarathy, D.M.D., Sidney L. Bourgeois, Jr., D.D.S. and Gary G. Goodell, D.D.S., M.S., M.A., the article suggests that problems in some patients using bisphosphonates may be triggered by a dental procedure, such as a tooth extraction, or could occur spontaneously.

    To prevent complications, the article suggests that those who take bisphosphonates seek counsel from their medical and dental providers before any elective dental procedures, and that any non-elective dental work – especially extractions, which, the article notes appear to “precipitate the majority of this condition” – be done before starting bisphosphonate therapy. When dental work is required after starting bisphosphonate therapy, patients, physicians and general dentists should consult with appropriate dental specialists, including endodontists, because non-surgical root canal treatment may be a safer alternative to extraction.

    “Bisphosphonates are important drugs that help manage the side effects of cancer treatments, as well as bone loss in people who have osteoporosis,” says JOE Editor Kenneth M. Hargreaves, D.D.S., Ph.D.. “But, as this article indicates, both healthcare professionals and patients should be aware of the risks so together they can ensure optimal dental treatment.”

    Updates will be posted as they occur.

    H/T Baltimore Tales

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  • Dentistry,  Oral Surgery

    Wisdom Teeth Removal Often Unnecessary?

    WebMD poses this question: Are wisdom teeth removal often unnecessary? And answers this rhetorical question in the affirmative:

    Teens often have their wisdom teeth removed. But there’s no evidence this painful procedure prevents future trouble.

    That’s the conclusion of a careful review of dental studies by a research team including Dirk G. Mettes, DMD, of Radboud University Medical Center in, Nijmegen, Netherlands. Although Mettes and colleagues looked at 40 studies, they found only two controlled clinical trials of wisdom tooth removal.

    The bottom line: If impacted wisdom teeth are not causing trouble, there’s no evidence that removing them helps or hurts future health. But there is some evidence that removing teens’ impacted wisdom teeth “to reduce or prevent late incisor crowding cannot be justified,” the researchers conclude.

    Read the abstract of the Mettes’ study here.

    How controversial is it to remove wisdom teeth that aren’t currently causing problems? Two dentists who spoke with WebMD agree that there’s no reason to remove perfectly healthy wisdom teeth. Both agree that troublesome wisdom teeth should be removed. And both say that there has to be a medical reason to perform such a serious surgery.

    Eric K. Curtis, DDS, spokesman for the Academy of General Dentistry and a private-practice dentist in Safford, Ariz., says it comes down to what an individual dentist thinks is best for an individual patient.

    “In my practice, about 75% of the asymptomatic (without symptoms), impacted wisdom teeth I see I take out,” Curtis tells WebMD. “It is subjective. There is no decision tree to tell us, ‘If this happens, take the tooth out,’ or ‘If this happens, leave it in.’ It comes down to your own sense of what is right and wrong and to patients’ own preferences.”

    Mohamed Bassiouny, DMD, PhD, professor of dentistry at Temple University — the oldest dental school in the U.S. — in June will celebrate his 40th anniversary as a dentist.

    But isn’t it normal for teen’s to have their wisdom teeth removed? Not to Bassiouny.

    “It is a shame,” Bassiouny tells WebMD. “It should not be considered that way. God gave us a full set of teeth. We should live with it.”

    Wisdom tooth removal is so common, Curtis says, that patients have stopped thinking of it as a serious medical procedure.

    “In the public’s mind, dentistry is really routine,” he says. “You turn 18 and you think it is time for wisdom teeth to come out. It is almost ubiquitous, a rite of passage. But a dentist has to tell you maybe you should take out wisdom teeth for this, this, and this reason. But there is this, this, and this risk, too. You have to decide if it is worth it.”

    Wisdom teeth typically emerge around age 17 to 24 or later. Wisdom teeth can be a problem because the human jaw is shorter than it was early in our evolution. And these teeth are at the very end of the jaw, Curtis notes.

    “If the jawbone is straight, the tooth wants to come in straight,” Curtis tells WebMD. “But most people run out of bone. Your jawbone starts its curve upward, and the wisdom teeth on the lower jaw get caught in that curve and tip forward.”

    Impacted wisdom teeth may lie fully horizontal. If that’s the case, trouble almost certainly lies ahead. It’s a harder call when a wisdom tooth fully emerges but is only slightly tipped toward the molar next to it. Some worry that, over time, this will cause crowding of the front teeth. The Mettes review, however, suggests this is not the case.

    “If a wisdom tooth is completely horizontal, I almost universally recommend taking that out,” Curtis says. “The chances of bone disease are so high that I can predict with pretty good probability that 10 or 20 years down the road that person will have gum problems that will pose a risk to other teeth as well.”

    Also risky, Curtis says, is a wisdom tooth that emerges from the underlying bone but comes only part way through the skin. That leaves a person open to high risk of decay and infection.

    When a dentist deems wisdom tooth removal necessary, he or she should talk to the patient about possible risks of surgery.

    “It is surgery, so there is risk of infection, there is some risk of jaw fracture, and risk of numbness that lingers on because a nerve is damaged in pulling the tooth,” Curtis says. “And that is a really uncomfortable thing to have your lip numb for the rest of your life or even for a couple of years. You have to think of risks.”

    What Good Are Wisdom Teeth, Anyway?

    We get three sets of molars — and get them at different times of life — because the diet we ate as we evolved into humans was tough on the teeth. A third set of molars — the wisdom teeth — kept us chewing on as our first set of molars wore out.

    The modern diet isn’t so tough, so we aren’t as likely to wear out our first two sets of molars.

    “Wisdom teeth simply aren’t necessary. I don’t know anyone who can’t get along without them,” Curtis says. “And a wisdom tooth is very difficult to clean. Even when it comes in well, it is far back against the upward curve of the jawbone. Sometimes you can’t get a toothbrush behind it — sometimes not even to it. So if it takes a root canal or crown to fix a decayed wisdom tooth, that is not an unsubstantial cost. So is it worth it to do that?”

    Bassiouny says it’s still a good idea to have an extra set of molars.

    He points out that the wisdom teeth can take up the slack should other teeth fall out or need to be pulled — as commonly happens as we age. And when a person needs a dental bridge, Bassiouny says, wisdom teeth provide an important anchor.

    Check out the good illustrations of wisdom teeth classifications here.

    Bottom Line: A good educated discussion with your dentist and oral surgeon can best inform the patient as to the appropriate course of treatment.