One of the overriding themes of the Science Based Medicine blog is to use rigorous science when evaluating any health claim – be it medical, dental, dietary, fitness, or any other assertion put forth with the intention of improving one’s health. Once the scientific evidence is evaluated as to efficacy, there are other criteria which must be taken into consideration, such as ease of administration, costs, possible adverse effects, and so on. Benefits have to be carefully weighed against risks to properly determine any appropriate course of action. For example, if a new pill is developed which is significantly better at , say, managing hypertension than existing medications, but it kills 10% of patients taking it, it obviously would not be the drug of choice. Conversely, if a proposed treatment, say homeopathy, is touted as being 100% safe with no side effects, but has absolutely zero benefits, it too would not be a recommended treatment. It’s a complicated and often ambiguous algorithm, and is imperfect due to the impossibility of attempting to quantify non-quantifiable values and qualities. (more…)
Archive for Dentistry
I get a lot of e-mails from publicists offering suggestions for articles and interviews with their clients. I quickly delete most of them, but one recently caught my eye. It said that patients travel from as far as Europe and Africa to have California “holistic dentist” Dr. David Villarreal remove the old silver fillings that are damaging their health. He has removed 20,000 of them in his 30-year career; removing fillings accounts for 75% of his practice. It said your dental fillings could be killing you – and not just the mercury in your “silver” fillings. Dr. Villarreal says that filling materials that are not compatible with your particular body chemistry can suppress immune responses, leading to a host of illnesses from frequent colds to autoimmune diseases to far worse conditions. He performs a blood compatibility evaluation to pick the right material for your body. He picks the right composite to maintain optimum health and help heal the immune system. (more…)
We dentists are an evil group of sociopaths. When we’re not trying to kill you or give you chronic diseases such as multiple sclerosis with our toxic mercury saturated fillings, we are advocating for the placement of rat poison/industrial waste (i.e. fluoride) in your water supply by our governmental overlords. What is up with us?
The problem is, we’re failing miserably. Even after more than 150 years of placing silver amalgam restorations in our patients, thereby saving untold numbers of teeth, reducing pain and suffering, and improving chewing ability for millions upon millions of people, there is still no evidence worth a damn that shows any correlation or causative effects for any known disease or condition. And with fluoride, after adjusting fluoride levels in municipal water supplies throughout the U.S. and in many places world wide for over sixty years, after adding fluoride to toothpastes and mouthwashes, and giving fluoride treatments to patients in our offices, the only nefarious result we have obtained is the significant reduction of dental decay with its concomitant savings of billions of health care dollars and untold pain and suffering for our patients. Man, we can’t do anything right.
Now, with the help of the American Academy of Pediatrics (AAP), there’s a new strategy.
[Editor’s Note: I’m pleased to announce that Grant Ritchey has agreed to join SBM as a regular. He’ll be writing about dental science and pseudoscience every four weeks on Sunday. (I swear, we’ll get up to seven day a week publishing if it kills me—or the other bloggers.) Grant will be starting with science, but I’m sure he’ll soon be discussing all the sorts of claims about dentistry and dental disease that are—how shall I put it?—less than science-based soon enough.]
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which the airway is partially or completely blocked during sleep. Although little or no air is flowing, the person continues to attempt to breathe. Typically, cessations in breathing last longer than 10 seconds per episode, but can last over a minute and usually occur multiple times during sleep. This can lead to poor sleep quality and precipitous drops in blood oxygenation levels over an extended period of time. This potentially life-threatening condition is frighteningly prevalent, especially in adults over 40, and it is estimated that 80-90% of OSA goes undiagnosed, further compounding the problem.
When a person experiences multiple apneic episodes during the night, the brain responds by alerting the body, resulting in increased efforts to breathe, gasping, and arousal from sleep. These frequent waking events, combined with lowered oxygen levels, can lead to the signs, symptoms, and sequelae of obstructive sleep apnea. Typically, OSA sufferers snore loudly, then are silent for 10-30 seconds as the airway is blocked. This is followed by choking, snorting, or gasping sounds when their airway reopens.
Oil pulling is a traditional Ayurveda method of oral care. It involves swishing sesame oil or a similar oil, perhaps mixed with other substances, in the mouth for 10-20 minutes as a means of preventing caries (cavities), reducing bacteria, and promoting healthy gums. In our internet-fueled age of misinformation, oil pulling has seen a surge in popularity as it makes the rounds on Facebook and other popular social media sites.
The proliferation of unscientific medical advice also essentially assured that oil pulling would be updated to incorporate the latest marketing memes in the alternative marketplace. It is therefore not surprising that this technique is being presented as a cure-all, treating all sorts of systemic diseases by allegedly pulling toxins from the mouth. The Wellness Mama (the first hit on Google) proclaims:
Oil pulling is an age-old remedy that uses natural substances to clean and detoxify teeth and gums. It has the added effect of whitening teeth naturally and evidence even shows that it is beneficial in improving gums and removing harmful bacteria!
Food Matters also gushes:
It is believed that these oils help the lymphatic system of the body as harmful bacteria are removed and beneficial microflora are given with [sic] a healthy environment to flourish. Because of this holistic perspective, oil pulling has been used as a preventative health measure for many other conditions.
This is followed by a long list of conditions from migraines to bronchitis. (more…)
The following post is a collaborative effort between myself and science-based dentist Grant Ritchey DDS. Dr. Ritchey is a co-host of the always excellent The Prism Podcast, most recently interviewing Dr. Robert Weyant and discussing how to teach critical thinking to dental and medical students. He can also be found on Twitter at @SkepticalDDS. Dr. Ritchey has written for SBM before on the topic of cranial osteopathy in dentistry.
As a pediatric hospitalist, I don’t deal with issues of dental health very frequently. Sure I see plenty of oral mucosal lesions, as occur during a primary herpes outbreak or a case of Kawasaki disease, but not many problems with the teeth themselves. I do admit a few dental abscesses here and there that need to be cooled down with IV antibiotics prior to definitive surgical drainage. And as a hospitalist that sees a fair amount of newborns, I also discover the occasional natal tooth. That’s when a baby is born with a tooth, usually a central mandibular incisor, having already erupted.
But as a pediatrician, I care deeply about the overall health of children and the network of caregivers that surround them. I guess you could say that I take a holistic approach, but I would prefer that you didn’t. Although we aren’t dentists, pediatricians recognize that oral health is integral to the well-being of a child and that many long-term dental maladies develop during the first two decades of life, often before the first tooth even appears. The most common, and one which non-dentist health care providers can have a major impact on, is the development of dental caries, or “cavities”. (more…)
Another venerable scientific journal has fallen prey to “alternative” medicine research. The Journal of the American Dental Association (JADA) has joined the New England Journal of Medicine and Annals of Internal Medicine, among others, with its publication of “A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder,” in the October, 2013, issue.
And what “chiropractic intervention” is this? The Activator Method Chiropractic Technique (AMCT) as taught by Activators Methods International (AMI), which also conveniently sells its own line of Activator Instruments. (Practice-building seminar DVDs sold separately.)
What is this Activator Method? In short, it is a method of detecting and correcting subluxations (the chiropractic version, not the medical one). Thus, the underlying premise of this study was that subluxations could cause myofascial temporomandibular disorder (TMD) pain and that finding and vanquishing these subluxations could bring about pain relief.
Now, as regular readers of this blog know, vertebral subluxations are a figment of the chiropractic imagination. They do not exist, as we have pointed out many, many, many times. And here is where alternative medicine has it all over conventional medicine and dentistry. In alternative medicine, once you invent a non-existent condition you can proceed to invent all sorts of diagnostic techniques and remedies to treat patients with this condition. The AMCT is a perfect example of this. Conventional medicine and dentistry, on the other hand, are saddled with the scientific method, biological plausibility, having to discard therapies when studies no longer support their use, and all sorts of other persnickety limitations.
I quite like Portlandia. I find it funny and it captures a part of Portland. I recognize large swaths of the city’s culture in the show. Other representations of the city I recognize less. Sunset publishes beautiful photographs of the NW, but when I look at the photos I think, that section of the city never looks that good. It is quite wonderful how Photoshop can improve on reality.
Like most major cities, Portland has a monthly magazine, Portland Monthly. The city represented in that magazine is mostly alien to me. I look at the advertisement, the articles, the photographs, and wonder when did Portland become a city with an average 7 figure income? The Portland in which I grew up and currently live is rarely found in the pages of Portland Monthly. If you are extremely well to do, I suppose you are in the demographic Portland Monthly. But when I flip through the pages of the magazine, I see little I recognize, but I have never completely abandoned the hippie/grunge aesthetic of my younger days.
Every January they have the best Doctors issue* and this year, for the first time, they offer The Portland Alternative Medicine Guide. Well, less a guide and more an extended infomercial filled with ‘facts’ that deserve the quotes. (more…)
Fear sells, and the media loves it. If it’s scary, no matter how tenuous the link or inconclusive the study, you are going to see it on the news. How many times over the years have you heard that your cell phone might give you brain cancer, even though it never turns out to be true? Once such a claim is made, however, it becomes lodged into the public’s psyche and is accepted as true, even after refutations and retractions are published (see Wakefield, Andrew).
And so it is with x-rays. The latest scare du jour, a recent study out of Yale that claims to show a correlation between dental x-rays and intracranial meningioma — the most common brain tumor and usually benign — has been enjoying widespread attention in newspapers and on the evening news. We don’t know if it will be on Dr. Oz, because we can’t bring ourselves to watch that show, but we feel the chances are good. Other alt-medders will no doubt have collective woogasms over the story and will further incite fear and mistrust into the doctor-patient relationship. In fact, the Mercola website wasted no time in weighing in:
While this study does not necessarily establish causation between dental X-rays and tumors, previous research has also implicated dental X-rays in the development of thyroid cancer, and research clearly shows this type of radiation is not harmless…
Typical alarmist fear-mongering. When has any health care professional claimed that radiation is harmless? This is not cutting edge research; Wilhelm Röntgen, the discoverer of x-rays in 1895 and winner of the Nobel Prize in 1901 for his research in the field, advocated the use of lead aprons for protection from the ionizing radiation way back when. Further, trying to lump one study linking dental x-rays to meningioma to another study linking them to thyroid cancer is taking quite the kitchen sink approach. But if there are multiple alleged possible potential theoretical adverse effects from our dental death rays, it must be true, right?
Well, not so fast. We’re dentists, and unlike many knee-jerkers, we’ve actually read the study and would like to offer a little bit of insight into this before everyone panics. In fact, with respect to Letterman, we’d like to offer our Top Three Reasons Not To Panic:
Editor’s note: Having just submitted a major grant on Friday and then having had to turn around and head to an NIH study section meeting today in Bethesda, I just didn’t have the time to produce something up to the usual standards of SBM for today. (And, being managing editor, I should know what’s up to the usual standards of SBM; what I started to write wasn’t it. Trust me on this.) Fortunately, Dr. Grant Ritchey and Dr. Steve Hendry, two skeptical, science-based dentists, did submit something up to SBM’s usual standards. Even better, since we’ve been having a number of requests for posts involving dentistry, it seemed like a perfect time to publish their first contribution to SBM and see how our readers like it. Maybe next time around, I’ll have them update the “state of knowledge” regarding amalgams.
Form follows function, as the old saying goes. Nowhere in the human body is this adage more fitting than in the oral cavity. In less than two generations, the practice of dentistry has evolved from basic pain relief and function-based procedures (such as extractions and fillings), into today’s practices of complex cosmetic rehabilitation, orthopedic and orthodontic management of the teeth, jaws, and facial structures, replacing missing teeth with dental implants, and treatment of sleep apnea and temporomandibular joint (TMJ) disorders, to name but a few. With such rapid progress, it is to be expected that for every science based advance made in our field, there are just as many claims that are either dubious in their evidential support or outright pseudo-scientific or anti-scientific nonsense.
In this article, we’ll be taking a look at the roles that health care practitioners such as chiropractors, osteopathic physicians, and physical therapists, are attempting to play in the dental field. We will also see how well-meaning dentists have been trained in and apply their pseudo-scientific principles in their dental practices. In particular, we’ll be examining Cranial Osteopathy (also known as Craniosacral Therapy or Cranial Therapy) in the management of the dental patient, the purported benefits claimed by practitioners of cranial osteopathy, and the quality and quantity of evidence for this type of treatment in the scientific literature.