[Oradlist] JAMA article

Tue May 4 09:45:49 PDT 2004

Hello all.

For what it's worth. I just spoke twice at the Iowa Dental 
Association. Now I spoke officially to about 400 dental assistants 
for their recertification requirements, but there were, as usual, a 
number of dentists who also took the 2 hour course. There was zero 
interest in the newspaper article. Iowa dentists don't get worked up 
about things. I did answer a question at the second 2 hour session 
which was actually at the Iowa Dental Assistants Association (about 
45 assistants), but that was because I almost asked to be asked. I do 
not sense a great deal of interest, at least not yet.

Rgds
Axel

>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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Axel Ruprecht D.D.S., M.Sc.D., F.R.C.D.(C)
Professor and Director of Oral and Maxillofacial Radiology
Professor of Radiology
Professor of Anatomy and Cell Biology

   (O) 319-335-7341
   (FAX) 319-335-7351

   e-mail:axel-ruprecht at uiowa.edu

   mail: University of Iowa - DSB
            Iowa City  IA 52242-1001

Web: http://ruprecht.radiology.uiowa.edu

The only man who ever got all his work
done by Friday was Robinson Crusoe.

"Education is what remains after one has forgotten what
one has learned in school."    -- Albert Einstein

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