[Oradlist] JAMA article

Mon May 3 11:17:15 PDT 2004

At this time AAOMR has not been asked to make a statement, however,
Julian Gibbs and Stuart White have agreed on Thursday AM 4-29-04, to
preapre a response for AAOMR.

Ken

-----Original Message-----
From: oradlist-bounces at lists.ucla.edu
[mailto:oradlist-bounces at lists.ucla.edu] On Behalf Of Keith Horner
Sent: Wednesday, April 28, 2004 3:26 AM
To: Oral Radiology Discussion Group
Subject: RE: [Oradlist] JAMA article

I was approached by the BBC online service on Tuesday to comment (having
seen just a brief summary). I evaded making a decisive response about
it, but I suggested broadly the same explanations as Douglas did. This
does look like it's going to cause a bit of a disturbance for all of us.
Keith

-----Original Message-----
From: oradlist-bounces at lists.ucla.edu
[mailto:oradlist-bounces at lists.ucla.edu]On Behalf Of Douglas Benn
Sent: 28 April 2004 01:23
To: oradlist at lists.ucla.edu; slbrooks at umich.edu
Subject: Re: [Oradlist] JAMA article

I was approached yesterday morning and asked to provide comment before 3
PM yesterday. I was given a copy of the JAMA paper. I spoke to Julian
Gibbs for about 30 minutes and then to Scott Tomar who is the Editor of
J Dent Publ Health.

You can see the questions from the news network and my replies. Ideally
this should have been a reply from AAOMR but as I only had 2 hours to
deal with it I felt a reply was needed. I hope my replies are
acceptable. I did not represent AAOMR or any other group. I did state I
was a past editor of Dentomaxillofacial Radiology.

Douglas

QUESTIONS-

What is your view of the significance of this story?  Are the study
methods sound? The story is significant in that it raises the issue of
whether dental radiographs are harmful to developing babies. The study
methods are sound with the following limitations:
a) the authors acknowledge that they do not know if the mothers had been
exposed to other sources of X-rays besides dental.
b) the study relies on self-reported information that is often
unreliable.
c) mothers who smoke are likely to receive more x-rays because they are
more likely to have gum disease and it is possible that the gum disease
could be associated with low birth weight. However, the study certainly
does show an association with x-rays but this should not be mistaken to
be a definite cause and effect situation.

  2. What new information does it give?
There has not been a similar study.

 3. What will be the clinical impact of this article?
It should remind dentists to be sure there is a good reason for taking a
radiograph and to avoid routine 6- or 12-month radiographs. In healthy
people without active decay or gum disease it is perfectly acceptable to
have 4 small bitewng x-rays only every 2 to 3 years. However, people
with active disease or at high risk can have more frequent x-rays.
However, since about 70% of regular attenders to dental offices are
healthy they only need bitewings every 2-3 years.

4. What do you currently recommend to pregnant mothers regarding x-rays,
dental or otherwise? Follow the same rules. In other words if there is a
good reason for taking an x-ray where the benefits outweigh the risks
then the x-ray should be taken at any stage of pregnancy. An example
would be a lady who is a new patient presenting on a Friday afternoon
complaining of dull pain for one week on one side of her face. If after
examining her visually the dentist cannot find a cause for the pain then
there are two possible scenarios. First the dentist could offer a
panoramic x-ray that rotates about the head and produces radiation
equivalent to one day of natural radiation i.e. what we all get each day
from natural sources. If the x-ray showed a buried wisdom tooth as the
source of the infection then the dentist could prescribe an antibiotic
to remove the acute infection and then a week later an oral surgeon
could take the tooth out to avoid a general anesthetic. The other option
would be to not take the x-ray, not make a diagnosis and tell the lady
to come back on Monday if it did not get better. The risk here is that
the lady could develop a severe infection over the weekend requiring an
ER visit, x-rays, a general anesthetic to drain pus, and then a further
visit to an oral surgeon for the tooth removal. In this latter scenario
the baby would have been exposed to a severe infection, general
anesthetic drugs, the risks of low oxygen, and hospital infections. All
because a very lose dose x-ray was not taken. Clearly the benefits
clearly outweigh the risks here. However, there would be no
justification taking films on a symptomless pregnant person  in the
absence of symptoms or risk factors. 5. Should this information be
reported to the public, or is it better suited to communiction within
the medical community only? Yes report to public.

Douglas Benn

Dr. Douglas K. Benn, BDS, MPhil, PhD, DDR (RCR UK)
Professor of Radiology & Director of Oral Diagnostic Systems, Dept. Oral
and Maxillofacial Surgery & Diagnostic Sciences, University of Florida
College of Dentistry, Box 100414, Gainesville, FL 32610-0414, USA.
Tel: (352) 392 5210.
Fax: (352) 392 2507
Email: benn at dental.ufl.edu

>>> slbrooks at umich.edu 04/27/04 18:43 PM >>>
This paper was originally presented at IADR abstract 3982. Did anyone
catch it there? I was not able to attend the meeting and didn't hear it.

The ADA was notified of this paper by JAMA a week or so ago. They
contacted Carol Anne Murdoch-Kinch, who is on the Council of Scientific
Affairs, and me (I am one of their consultants) and we provided some
commentary to a reporter of ADA News for a response that will be coming
out in the next day or two. His deadline was this morning so I suspect
the paper will be very soon. The ADA is also providing a full response
on their website. We were told that the Associated Press had also been
given an advance copy so it will hit the press probably hard and soon.

The premise behind the study was that exposure to the thyroid of the
mother caused the low birth weight (LBW) of the baby, not any direct
exposure to the fetus itself. They claim that this is one of the
theories being considered right now for LBW. They did not measure
thyroid function of the cases or controls but they did try to control
for (or adjust for) a huge number of confounding variables. The odds
ratios were not high (about 2) but were statistically significant.

That's what I know right now about this paper. I expect it will make a
big splash.

Sharon Brooks

>Is anyone responding to this article?
>
>http://jama.ama-assn.org/cgi/content/abstract/291/16/1987?etoc
>
>Elaine Orpe
>
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--
*******************************************************************
Sharon L. Brooks, DDS, MS (slbrooks at umich.edu)
Diplomate, American Board of Oral and Maxillofacial Radiology

University of Michigan, School of Dentistry, Ann Arbor, MI 48109-1078
Phone: 734-764-1595     FAX: 734-764-2469
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