Patch Blog: Risky Business?

Okay, by 6 a.m. last Monday I was already being served up questions about dental x-rays and brain tumors, right along with my de-caf/non-fat latté, aka the “Brown Water Special.”

So another dental x-ray scare perpetrated by researchers in search of more research bucks is getting really tiresome…especially when the news hits before I even see my first patient of the week.

A couple of years ago, TV-MD Doc OZ stirred the radiographic pot by outlining the thyroid cancer/dental x-ray risks that we face minus lead apron neck protection. Thanks Doc, but these days lead aprons actually come down the assembly line with neck protection built-in as part of the package.

Monday’s “study” linked bitewing x-rays with meningiomas, benign tumors of the brain lining. The tumors can be asymptomatic and are often watched rather than surgically removed (Bitewings are the check-up x-rays that have a tab that fits between upper and lower back teeth when the patient closes.)

Elizabeth Claus, MD, PhD of the Yale School of Medicine studied information from 1,433 patients between the ages of 20 and 79 years who were diagnosed with the disease between 2006 and 2011. The control group consisted of 1,350 individuals with similar characteristics who had not been diagnosed with the disease.

Claus found that patients diagnosed with a meningioma were twice as likely as controls to report having had a bitewing x-ray. Those reporting yearly x-rays were 1.4-1.9 as likely as controls to develop the tumor.

There are some major problems with the study.

Claus asked patients for a self-reported history of x-rays; the report wasn’t based on recorded data. If you’re 50 years-old, can you give me a total of how many bitewings you experienced when you were 9 years-old? Also, the control group didn’t know what the study was about and undoubtedly wasn’t as present to the requested bitewing info as were those already diagnosed with a brain tumor (this is a great example of research bias.) Wonder what the risk of meningioma diagnosis would be from a recollected history of Twinkies, baseball caps, or iPods following a similar research approach?

The researchers noted that today’s dental patients are exposed to far less radiation but cautioned against overuse of dental x-rays, especially for those who have no symptoms. And you wonder why U.S. healthcare is ranked #33 in the world? But I bet we’re close to the top about stating the obvious.

These days, even traditional dental x-rays pack a radiation wallop comparable to your walk to the car in the SoCal sun. Digital x-rays deliver even less exposure. Periodic x-rays are a must; we can’t diagnose oral disease without them; no one I know recommends x-rays without considering the exposure risk versus the oral disease risk that’s different for each patient.

Patients who wait to have obvious symptoms risk serious consequences that can have an impact on oral health, general health, quality of life, and even length of life. Again, all patients are not created equal with regard to oral health risks. Dentistry is a preventive discipline and the care is personalized; if only we could say the same for most traditional medicine.

When I was a dental student, a medical emergency prof shared ER patients diagnosed with a brain abscess were first asked, “When was your last cleaning?” Really?

Last week, I heard an orthopedic MD/talk-radio jock refer a caller reporting TMD symptoms to an ENT medical specialist (at least the ENT could rule out the “E” that stands for ear.)

The tragedy is a few clueless people in a position of authority or media access can undermine progress…and today, the known health consequences are far greater.

And I hope I’m not being paranoid but then I guess I’d be the last one to know. J

Way back in May, 2000, the Surgeon General released a report confirming the connection between oral health and general health. My friend, former USC dental school dean and former head of the NIDCR Dr. Harold Slavkin, was a significant contributor to the report; he was quoted as observing “…medicine needs to know more about dentistry and dentistry needs to know more about medicine.”

Medicine and dentistry have made great progress working together to advance the quality of lives. Seems a shame that a few random acts of poor judgment and/or irresponsibility can garner so much media attention and generate so much fear (especially when only 50% of the U.S. population sees a dentist on a regular basis.)

I guess my question for the likes of Docs Oz and Claus and the media is, “Are you with us or against us?”