- Email: [email protected]
RISK OF PARESTHESIA: Author's response
L E T T E R S
primary teeth upon their removal. Stem cells are found in the pulp and periodontal ligament tissues, but they are of marginal value compared to stem cells that can be harvested from the developing tooth bud. The developing tooth bud offers an excellent source of highquality stem cells at a much earlier stage of development. The stem cells that will eventually form enamel, dentin, pulpal tissue, periodontal ligament tissues, blood vessels and nerve tissue include at least 29 distinct types of nerve receptors found in the periodontal ligament. This tissue has already been shown in studies1-5 to be capable of growing liver cells. The minimally invasive surgical approach to removal of tooth buds and collection of stem cells from the bud and from the surrounding bone will only take about two to three minutes per site after infiltration anesthesia. Because the nerves are not yet connected to the central nervous system, there is only minimal need for anesthesia to the overlying mucosa. I currently have method and device patents on instruments to allow prophylactic, minimally invasive removal of the developing tooth bud and collection of stem cells from the developing tooth bud and surrounding tissue, eliminating future problems associated with mandibular third molars. Ira L. Shapira, DDS Gurnee, Ill. 1. Ishkitiev N, Nakahara T, Sato T, Mitev V, Yaegak K. Hepatic lineage differentiation of milk and third molar pulp cells (abstract 1784). J Dent Res 2009; 88(special issue A). “http://iadr.confex.com/iadr/2009miami/ webprogram/Paper121148.html”. Accessed June 7, 2010. 2. Ikeda E, Yagi K, Kojima M, et al. Multipotent cells from the human third molar: feasibility of cell-based therapy for liver disease. Differentiation 2008;76(5):
495-505. Epub 2007 Dec 17. 3. Yagi K, Kojima M, Oyagi S, et al. Application of mesenchymal stem cells to liver regenerative medicine [in Japanese]. Yakugaku Zasshi 2008;128(1):3-9. 4. Huang CY, Pelaez D, Dominguez-Bendala J, Garcia-Godoy F, Cheung HS. Plasticity of stem cells derived from adult periodontal ligament. Regen Med 2009;4(6):809-821. 5. Yalvac ME, Ramazanoglu M, Rizvanov AA. Isolation and characterization of stem cells derived from human third molar tooth germs of young adults: implications in neovascularization, osteo-, adipo- and neurogenesis. Pharmacogenomics J 2010;10(2):105-113. Epub 2009 Sept 1.
Author’s response: We thank Dr. Shapira for addressing root-nerve contact and postoperative paresthesia. And we agree with the idea of early prophylactic extraction of mandibular third molars to decrease the possibility of the nerve damage. But this approach should be based on the reasonable rationale already addressed by the NIH Consensus Development Conference,1 by Mercier and Precious2 in their 1992 discussion of risks and benefits, by the American Association of Oral and Maxillofacial Surgeons’3 1994 workshop on third molar teeth and by Knutsson and colleagues4 in their comparison of prophylactic removal. So the decision about the prophylactic removal of the mandibular third molar should be patient-oriented and should involve the goal of leaving normally functioning third molars undisturbed. In addition, we want to make it clear that it would not be proper for us to comment about the possibility or usefulness of the stem cells from the third molars, and that we did not use cone-beam computed tomography for our study, as described in our article. Sang-Hwy Lee, DDS, MSD, PhD Professor Department of Oral and Maxillofacial Surgery Applied Life Science
Oral Cancer Research Institute and Oral Science Research Center College of Dentistry Yonsei University Seoul, Korea 1. Removal of third molars. National Institutes of Health Consensus Development Conference Statement, November 28-30, 1979. “http://consensus.nih.gov/1979/1979Molars021 html.htm”. Accessed May 28, 2010. 2. Mercier P, Precious D. Risks and benefits of removal of impacted third molars: a critical review of the literature. Int J Oral Maxillofac Surg 1992;21(1):17-27. 3. American Association of Oral and Maxillofacial Surgeons. Report of a workshop on the management of patients with third molar teeth. J Oral Maxillofac Surg 1994; 52(1):1102-1112. 4. Knutsson K, Lysell L, Rohlin M, Brickley M, Shepherd JP. Comparison of decisions regarding prophylactic removal of mandibular third molars in Sweden and Wales. Br Dent J 2001;190(4):198-202.
SCREENING FOR MEDICAL CONDITIONS
I am writing regarding Dr. Barbara Greenberg and colleagues’ January JADA article, “Screening for Medical Conditions” (Greenberg BL, Glick M, Frantsve-Hawley J, Kantor ML. JADA 2010;141[1]: 52-62). I agree with the authors’ basic premise. However, I don’t think it is practical. In a physician’s office, the lab work is done by a nurse or a technician, or the patient is referred to a medical lab. In the dentist’s office, the patient is likely to object to blood work, especially if he or she has had it done recently. Patients do not like injections of any type. A finger stick is no different. Referrals to a physician will result in doing the blood work over again. It takes time to explain the need to the patient, take the tests and discuss the results. Patients could question why I am doing blood work for conditions I cannot treat. If you give it some more thought, it would make sense to include a complete blood count,
JADA, Vol. 141
http://jada.ada.org
Copyright © 2010 American Dental Association. All rights reserved. Reprinted by permission.
July 2010
829
primary teeth upon their removal. Stem cells are found in the pulp and periodontal ligament tissues, but they are of marginal value compared to stem cells that can be harvested from the developing tooth bud. The developing tooth bud offers an excellent source of highquality stem cells at a much earlier stage of development. The stem cells that will eventually form enamel, dentin, pulpal tissue, periodontal ligament tissues, blood vessels and nerve tissue include at least 29 distinct types of nerve receptors found in the periodontal ligament. This tissue has already been shown in studies1-5 to be capable of growing liver cells. The minimally invasive surgical approach to removal of tooth buds and collection of stem cells from the bud and from the surrounding bone will only take about two to three minutes per site after infiltration anesthesia. Because the nerves are not yet connected to the central nervous system, there is only minimal need for anesthesia to the overlying mucosa. I currently have method and device patents on instruments to allow prophylactic, minimally invasive removal of the developing tooth bud and collection of stem cells from the developing tooth bud and surrounding tissue, eliminating future problems associated with mandibular third molars. Ira L. Shapira, DDS Gurnee, Ill. 1. Ishkitiev N, Nakahara T, Sato T, Mitev V, Yaegak K. Hepatic lineage differentiation of milk and third molar pulp cells (abstract 1784). J Dent Res 2009; 88(special issue A). “http://iadr.confex.com/iadr/2009miami/ webprogram/Paper121148.html”. Accessed June 7, 2010. 2. Ikeda E, Yagi K, Kojima M, et al. Multipotent cells from the human third molar: feasibility of cell-based therapy for liver disease. Differentiation 2008;76(5):
495-505. Epub 2007 Dec 17. 3. Yagi K, Kojima M, Oyagi S, et al. Application of mesenchymal stem cells to liver regenerative medicine [in Japanese]. Yakugaku Zasshi 2008;128(1):3-9. 4. Huang CY, Pelaez D, Dominguez-Bendala J, Garcia-Godoy F, Cheung HS. Plasticity of stem cells derived from adult periodontal ligament. Regen Med 2009;4(6):809-821. 5. Yalvac ME, Ramazanoglu M, Rizvanov AA. Isolation and characterization of stem cells derived from human third molar tooth germs of young adults: implications in neovascularization, osteo-, adipo- and neurogenesis. Pharmacogenomics J 2010;10(2):105-113. Epub 2009 Sept 1.
Author’s response: We thank Dr. Shapira for addressing root-nerve contact and postoperative paresthesia. And we agree with the idea of early prophylactic extraction of mandibular third molars to decrease the possibility of the nerve damage. But this approach should be based on the reasonable rationale already addressed by the NIH Consensus Development Conference,1 by Mercier and Precious2 in their 1992 discussion of risks and benefits, by the American Association of Oral and Maxillofacial Surgeons’3 1994 workshop on third molar teeth and by Knutsson and colleagues4 in their comparison of prophylactic removal. So the decision about the prophylactic removal of the mandibular third molar should be patient-oriented and should involve the goal of leaving normally functioning third molars undisturbed. In addition, we want to make it clear that it would not be proper for us to comment about the possibility or usefulness of the stem cells from the third molars, and that we did not use cone-beam computed tomography for our study, as described in our article. Sang-Hwy Lee, DDS, MSD, PhD Professor Department of Oral and Maxillofacial Surgery Applied Life Science
Oral Cancer Research Institute and Oral Science Research Center College of Dentistry Yonsei University Seoul, Korea 1. Removal of third molars. National Institutes of Health Consensus Development Conference Statement, November 28-30, 1979. “http://consensus.nih.gov/1979/1979Molars021 html.htm”. Accessed May 28, 2010. 2. Mercier P, Precious D. Risks and benefits of removal of impacted third molars: a critical review of the literature. Int J Oral Maxillofac Surg 1992;21(1):17-27. 3. American Association of Oral and Maxillofacial Surgeons. Report of a workshop on the management of patients with third molar teeth. J Oral Maxillofac Surg 1994; 52(1):1102-1112. 4. Knutsson K, Lysell L, Rohlin M, Brickley M, Shepherd JP. Comparison of decisions regarding prophylactic removal of mandibular third molars in Sweden and Wales. Br Dent J 2001;190(4):198-202.
SCREENING FOR MEDICAL CONDITIONS
I am writing regarding Dr. Barbara Greenberg and colleagues’ January JADA article, “Screening for Medical Conditions” (Greenberg BL, Glick M, Frantsve-Hawley J, Kantor ML. JADA 2010;141[1]: 52-62). I agree with the authors’ basic premise. However, I don’t think it is practical. In a physician’s office, the lab work is done by a nurse or a technician, or the patient is referred to a medical lab. In the dentist’s office, the patient is likely to object to blood work, especially if he or she has had it done recently. Patients do not like injections of any type. A finger stick is no different. Referrals to a physician will result in doing the blood work over again. It takes time to explain the need to the patient, take the tests and discuss the results. Patients could question why I am doing blood work for conditions I cannot treat. If you give it some more thought, it would make sense to include a complete blood count,
JADA, Vol. 141
http://jada.ada.org
Copyright © 2010 American Dental Association. All rights reserved. Reprinted by permission.
July 2010
829