Re: Rumor has it...


Steven Bornfeld wrote:
> clintonz@xxxxxxxxxxx wrote:
> >
> > However, it presents quite a dilema if infection is present
> > but not discernable based on x-rays. Suppose a patient has
> > cancer but it cannot be seen on CT. Does that mean no surgeon
> > ever operates and the patient dies.
>
> If there is an infection there should be some clinical signs. I
assume
> the patient presents with some sort of symptom, and some clinical or
> radiologic sign points to infection. Same with cancer. There is
some
> reason to suspect cancer before treatment can commence.

Well, what is happening with some of these osteomyletic/osteonecrotic
infections is that some legions cannot
be seen. In my case a local OS found soft bone and there where
radilogic indications of erosion of the maxilla and borderline
radiolucent infection, but a lot of patients are finding, me
included that the extent of these infections is not clear at
all from regular CT or panorex.

In fact I know one person who recently had a jawbone graft for
osteonecrosis at a well known research university. They found
schlerotic bone, mush bone and what appeared to be a cavitation,
though none of it apparently was evident on x-ray before hand.


>
> >
pain, and that are not culturable in the blood.
>
>
> There should be some reason to suspect infection is present, right?
Or
> am I missing something?

The patient obviously knows in jaw osteomyletis but the symptoms
as in leg osteo are general so that the OS cannot rule jaw infection in
or out. Many of these legions (especially chronic OM) do not show up
well on radiograph or MRi because of the thinness
of the bones in the jaw. This was also found in some
of the studies done for the FDA on the cavitat, so in essence
these infections are silent.

>
>
> Also, surely a
> > patient should have the right to have a root canal removed even if
it
> > is not necesssarily infected, yet the boards appear to be
indirectly
> > forcing patients to keep these treatments.
>
>
> No, a patient has no absolute right to mandate treatment. An
informed
> patient has the right to refuse treatment, as does a doctor.

However in the case of a RC the dentist has altered the tooth
or introduced a foreign substance in the root so IMO the patient
has a right to have that removed, just like a patient could
probably demand a hip implant be removed. Also the patient could
have originally opted for an extraction so I do not think it
is ethical to later force them to keep the RC tooth

cz

.

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