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October 30, 2015

The Tyranny of Oral Surgeons

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I wanted to give kudos to Jim Du Molin. He is the founder of Internet Dental Alliance, which is a direct competitor to my company, Infinity Dental Web. But I’m on the same side as he is in this dental political issue of oral sedation, which I believe is slated to be voted on at the annual meeting of the American Dental Association, November 5-10, in Washington, DC.

He sent me an email early this morning about this issue. I had heard about this issue through other sources, but he put it rather directly and I liked his style of not pulling any punches. He titled it “The Tyranny of Oral Surgeons.” I’d like to quote it here:

The rivalry between oral surgeons and general dentists has never been fiercer.

And it looks as if the oral surgeons have seized the upper hand.

Right now, a tiny group of oral surgeons in positions of influence at the ADA who are pushing forward a proposal – Resolution #77 – that will make it much harder and much more expensive for general dentists to continue serving their fearful and anxious patients using moderate enteral sedation.

In fact, if their proposal, Resolution #77, is approved at next month’s ADA annual meeting, it could well spell the beginning of the end of oral sedation.

The BIG problem is this: Most of the ADA House of Delegates members who will be asked to vote on Resolution #77 have no clue what’s behind the proposal or what a dramatic impact it will have on dentistry and patients. The oral surgeons are counting on their ignorance – and their blind trust that if the ADA is proposing changes, they must be for the better.

We know that millions of patients have been treated safely and effectively – without incident – by general dentists who adhere to the existing guidelines and their states’ associated regulations.

Yet, under the ruse of concern for public safety – and it is nothing more than a ruse! – oral surgeons are poised to rewrite the ADA’s oral sedation guidelines to conform to their selfish interests.

I am joining with concerned leaders in the general dentistry community in urging you to contact your ADA House of Delegates representatives immediately (there is no time to waste) to let them know you strongly oppose Resolution #77.

Calling or writing them will only take a few minutes of your time, but it could make the difference for sedation dentistry and the millions of our patients who rely on it.

Thank You,

Jim Du Molin

On mynewsmile.com I reference this issue as it played out in Iowa. (See my page on Iowa Sedation Regulations.) In Iowa, the oral surgeons were able to use their influence with the Iowa Board of Dental Examiners to put in place highly restrictive rules on the use of oral sedation, effectively outlawing it in the state. Many patients were hurt by this policy. Until they did this, I was able to treat hundreds of patients using oral sedation without a single adverse incident. But being able to use oral sedation meant that I could compete with oral surgeons in offering wisdom tooth extractions and other services that they wanted to perform. I had a lower rate of complications, including zero dry sockets, over a period of many years, than our local oral surgeons.

The links below, provided by Jim Du Molin, courtesy of TEAM1500.org, include contact details for any member dentists who wish to contact their ADA House of Delegates representatives, plus additional details on Resolution #77.

Three Simple Steps to Help
http://www.team1500.org/cta2.html

Calls to (ADA) Action: Briefing
http://www.team1500.org/briefing.html

State-by-State Directory of ADA House of Delegates http://www.team1500.org/delegate_directory.html

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

December 16, 2011

Prophylactic wisdom tooth removal – my view

There is an article linked from this morning’s Drudge Report that I wanted to comment on. It’s titled, “Parents sue after teen dies during wisdom tooth surgery,” and it’s by ABC News. Jenny Olenick, a lovely 17-year-old young woman (I assume the photo is of her), died in April from complications following wisdom tooth removal. The cause of death was determined by the medical examiner to be hypoxia (oxygen deprivation). She was anesthetized, failed to breathe properly apparently as a result of the anesthesia, and was not able to be resuscitated. 

The author of the article, Katie Moisse, then takes off on the wisdom tooth removal procedure, and tries to turn the incident into an indictment of the oral surgery profession for doing this unnecessary procedure, and even goes so far as to say that the science supporting wisdom tooth removal as a preventive procedure (“prophylactic wisdom tooth removal”) is thin. It compares the surgery to prophylactic removal of the appendix because, it says, the potential complications of leaving impacted wisdom teeth alone carry the same degree of risk as leaving the appendix in. The article goes on to make a sweeping indictment of the oral surgery profession and oral surgeons.

However, there are two glaring flaws in the article.

The first is that the article entirely leaves out the main reason for removing wisdom teeth before they become a problem, and that is the dramatic increase in the surgical risk of the procedure with advancing age. There are two factors affecting this. The first is that, as you age, the bone in the jaw becomes much less pliable. This is the chief factor. From my experience, removing wisdom teeth on someone aged 17 to 20 is fairly easy, and the operation takes about five to ten minutes per tooth. And the risks of complications are very low. By age 25, the difficulty and the risks double. Add five more years, and the risks double again. As a result, when I had patients who were 40 or over, who had fully impacted wisdom teeth, I recommended that they not have them removed, because I feel that the risks of removal outweigh the risks of leaving them in. But below age 40, I believe the risks argue for taking them out.

The second factor is that, in teenagers, the roots of the wisdom teeth aren’t fully formed yet. This greatly simplifies the procedure.

The other glaring error in the article is that the patient didn’t die from complications of the surgery, but from complications of the anesthesia. Again, in a 17-year-old, the surgery is fairly simple, and can be done easily with moderate conscious sedation, which is extremely safe. Although this isn’t disclosed in the article, it appears that the patient was subjected to either general anesthesia or deep sedation.

I had my own wisdom teeth out prophylactically, as did all of my children. By the time you are in your late teens, it is fairly easy to predict if there will be enough room in your jaw for your wisdom teeth to erupt normally. If there isn’t enough room, I strongly recommend that you have them removed.

And interestingly, I had an e-mail from a patient come to me the following week that illustrates the wisdom of a prophylactic removal of wisdom teeth. Click the link to read the story.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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