Editorial: So, How Was Your Day?

Editorial: So, How Was Your Day?

William E. Stein, D.D.S.*:
It sure has been a great and early spring. Cedar Lake set a record for changing from a solid to liquid state. The Cuyuna Country Club, characterized by radio guru Joe Soucheray as “The  Poor Man’s Interlachen”, had its earliest opening ever. I’m playing better golf than I have in years. My lifelong plan of trying to buy a game has fi nally worked out, as I have fi lled my bag  with a wonderful array of clubs bearing the name “Rocket Ballz”. “Rocket Ballz” — it sounds like an obscure urological malady affecting male astronauts, yet they work as advertised, adding  years to my golf game.
 
The birds are all back. We have a pair of Trumpeter Swans nesting on the lake down the road. Yesterday as I drove home from work they were near the shore. As I approached, they  tipped their heads into the water and mooned me. I realize they were just feeding, not giving me the “bird”. 
 
It has been so much fun to go to work or walk “Tilly, the World’s Cutest Puppy” and not have to worry about slipping on the ice and requiring a joint replacement. Things are going well at  the office. Before he got into dental school, my associate spent two “well-educating” years working as a lab technician, so in addition to his exemplary chairside manner, he turns out  posterior composite restorations, the anatomy of which would make even Fred Noble drool with envy. 
 
So things are looking up; life is good. Then it happened. As I was showering, shaving, and performing all the other ablutions needed to start the day, the morning television shows were all  in full cry trumpeting the new study extolling the danger of dental X-rays. Patients who have had dental X-rays in the past are now more than twice as likely to suffer a benign brain tumor  called a “meningioma”. 
 
Oh come on! The study is suspect from the get-go. Yet here is the network physician/spokesperson, evidently hired more for her telegenicity than her scientific  acumen, pontificating on the dangers of dental X-rays, yet never once explaining how the advent of digital X-rays has vastly reduced the already miniscule radiation exposure to virtually nil. 
 
I went to the ADA website and recovered the following: “Dr. Alan G. Lurie, a radiation biologist and head of radiology at the University of Connecticut School of Dental Medicine, has many concerns about the study’s design and outcomes. ‘I think it’s a very flawed study,’ said Dr. Lurie, who is also president of the American Academy of Oral and Maxillofacial Radiology. “He characterized at least one outcome of the study - reflected in a table that related meningioma risk to types of dental X-ray examination - as ‘biologically impossible’. “Said Dr. Lurie, ‘They  have a table, Table 2, in which they ask the question, ‘Ever had a bitewing,’ and the odds ratio risk from a bitewing ranges from 1.2 to 2.0, depending on the age group. Then they asked, ‘Ever had full mouth’ series, and the odds ratio risk from a full mouth series ranged from 1.0 to 1.2. 
 
“‘That’s biologically not possible because the full mouth series has two to four bitewings plus another 10 to 16 periapicals. A full mouth series, just to round things off, is 20 intraoral X-rays  of which two to four are bitewings. They are showing that one bitewing has 50 to 100 percent greater risk than a full mouth series that has multiple bitewings plus a bunch of other films.  That’s biologically not possible.’ 
 
“Explaining this gross internal discrepancy is difficult, as the epidemiologic and statistical methods are widely accepted, Dr. Lurie said. He attributes the perceived discrepancy in the data  to possible recall bias in the patients involved in the study. “‘Epidemiologists are very aware of this bias,’ Dr. Lurie said. ‘What happens is you’re asking people to remember what kind of  dental X-rays they had 10, 20, 30 or 40 years ago. It’s anecdotal, and the argument is that it’s just as anecdotal for the group without meningiomas as it is for the group with  meningiomas. That is not necessarily true.’
 
“‘Individuals who had meningiomas and had surgery for them in this study population may be more likely to remember having had X-rays than individuals who did not have meningiomas,’ Dr.  Lurie said.
 
“Dr. Lurie emphasized that his comments on the dental X-rays study are his own. ‘They’re not necessarily the views of the Academy,’ he said, noting that the AAOMR was preparing an official response to be released this week.” 
 
Thanks to the ADA and MDA for putting the facts out for all to read if they have access to the internet. 
 
I know we have many trained “Go to” speakers who could eloquently give our side  of the story. The big problem is, how can they be given the access that the sensationalists have? 
Meanwhile we are left to defend our sound and necessary requirements to provide our  patients the standard of care that lets us accurately diagnose the dental diseases that we could be sued for missing. 
 
“Catch 22”: now a way of life, rather than the title of a great Joseph Heller novel.
 
Good luck! If you need me, I’ll be measuring myself for a lead thyroid collar for my next set of bitewings.  Dr. Oz says I have to.
 
 
 
*Dr. Stein is Executive Editor of Northwest Dentistry. He is a general dentist in private practice in Aitkin, Minnesota, AitkinDent@AOL.com