Thomas B. Dodson

American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update.

Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ) were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007 and 2009. The position papers were developed by a special committee appointed by the board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ has expanded, necessitating modifications and refinements to the previous position paper. This special committee met in September 2013 to appraise the current literature and revise the guidelines as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis, staging, and management strategies and highlights current research status. The AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.

The Frequency of Medication-related Osteonecrosis of the Jaw and its Associated Risk Factors

This article provides the best current frequency estimate of medication-related osteonecrosis of the jaws (MRONJ), and identifies factors associated with the risk of developing osteonecrosis of the jaw (ONJ) among patients exposed to relevant medications (ie, antiresorptive or antiangiogenic agents). MRONJ is a rare but serious complication of cancer treatment or osteoporosis management. This review confirms that antiresorptive medications such as oral or intravenous bisphosphonates and denosumab are the most common risk factors for developing ONJ. The risk of MRONJ is greater in patients with cancer than in those receiving antiresorptive treatments for osteoporosis by a factor of 10.

What is the Risk of Future Extraction of Asymptomatic Third Molars? A Systematic Review

PURPOSEnThe purpose of our report was to determine clinically whether young adults who elect to retain their asymptomatic third molars (M3s) have a risk of undergoing 1 or more M3 extractions in the future.nnnMATERIALS AND METHODSnTo address our clinical question, we designed and implemented a systematic review. The studies included in the present review were prospective, had a sample size of 50 subjects or more with at least 1 asymptomatic M3, and had at least 12 months of follow-up data available. The primary study variables were the follow-up duration (in years) and the number of M3s extracted by the end of the follow-up period or the number of subjects who required at least one M3 extraction. The annual and cumulative incidence rates of M3 removal were estimated.nnnRESULTSnSeven studies met the inclusion criteria. The samples sizes ranged from 70 to 821 subjects, and the follow-up period ranged from 1 to 18 years. The mean incidence rate for M3 extraction of previously asymptomatic M3s was 3.0% annually (range 1 to 9%). The cumulative incidence rate for M3 removal ranged from 5% at 1 year to 64% at 18 years. The reasons for extraction were caries, periodontal disease, and other inflammatory conditions.nnnCONCLUSIONSnThe cumulative risk of M3 extraction for young adults with asymptomatic M3s is sufficiently high to warrant its consideration when reviewing the risks and benefits of M3 retention as a management strategy.

For treatment of odontogenic keratocysts, is enucleation, when compared to decompression, a less complex management protocol?

PURPOSEnTo determine whether the clinical management of odontogenic keratocysts (OKCs) is more complex in patients who undergo enucleation with or without adjuvant therapy than in patients who undergo decompression with or without residual cystectomy.nnnMATERIALS AND METHODSnThe authors implemented a retrospective cohort study and enrolled a sample composed of patients presenting for the evaluation and management of OKCs. The predictor variable was treatment group, classified as decompression with or without residual cystectomy versus enucleation with or without adjuvant therapy (Carnoy solution, cryotherapy, or peripheral ostectomy). The outcome variables were measurements of complexity of management, including total number of procedures, venue of procedure (operating room vs office), type of anesthesia, hospital admissions, and total number of follow-up visits. Data analyses were performed using univariate and bivariate statistics and a multiple linear regression model.nnnRESULTSnThe study sample was composed of 45 patients (66 OKC lesions) with a mean age of 43.3 years. Of the 66 OKCs treated, 34 (51.5%) were treated with decompression with or without residual cystectomy and 32 (48.5%) were treated with enucleation with or without adjunctive therapy. Larger lesions and lesions with radiographic evidence of cortical perforation were treated more often with decompression with or without residual cystectomy. Based on the multiple linear regression model, patients who underwent enucleation with or without adjuvant therapy compared with those who underwent decompression with or without residual cystectomy had on average 1) 1.1 fewer total procedures (P < .01), 2) 0.8 fewer total office procedures (P < .01), 3) 0.6 fewer local anesthesia procedures (P < .01), and 4) 4.8 fewer postoperative visits (P < .01). There was no difference in the number of general anesthesia procedures, office sedation procedures, or hospital admissions.nnnCONCLUSIONnGiven comparable recurrence rates, the increased complexity of managing OKCs with decompression with or without residual cystectomy might not be warranted. Enucleation with or without adjunctive therapy could be the more efficient treatment option.

Does Self-Citation Influence Quantitative Measures of Research Productivity Among Academic Oral and Maxillofacial Surgeons?

PURPOSEnQuantitative measures of research productivity depend on the citation frequency of a publication. Citation-based metrics, such as the h-index (total number of publications h that have at least h citations), can be susceptible to self-citation, resulting in an inflated measure of research productivity. The purpose of the present study was to estimate the effect of self-citation on the h-index among academic oral and maxillofacial surgeons (OMSs).nnnMATERIALS AND METHODSnThe present study was a cross-sectional study of full-time academic OMSs in the United States. The predictor variable was the frequency of self-citation. The primary outcome of interest was the h-index. Other study variables included demographic factors and citation metrics. Descriptive, bivariate, and regression statistics were computed.nnnRESULTSnThe study sample consisted of 325 full-time academic OMSs. Most surgeons were men (88.3%); approximately 40% had medical degrees. The study subjects had an average of 23.5 ± 37.1 publications. The mean number of self-citations was 15 + 56. The samples mean h-index was 6.6 ± 7.6 and was associated with self-citation (rxa0= 0.71, P < .001). Approximately 9% of subjects had a change in their h-index after removing self-citations. After adjusting for PhD degree, total number of publications, and academic rank, an increasing self-citation rate influenced the h-index (rxa0= 0.006, P < .001). Surgeons with more than 14 self-citations were more likely to have their h-index influenced by self-citation.nnnCONCLUSIONnSelf-citation among full-time academic OMSs does not substantially affect the h-index. Surgeons in the top quartile of self-citation rates are more likely to influence their h-index.

Writing a Scientific Paper Is Not Rocket Science

I elected to update an article on how to write a scientific paper as my contribution to this supplement because Dr Leonard Kaban introduced me to the discipline of writing. Our first collaboration resulted in a paper accepted at its initial submission. The present submission is based, with permission, on an article published 8 years ago. Ours is a mentor-driven specialty. Like those before me, I learned by observing others. Continuing the tradition, I would like to share strategies and detail tactics I use to write a scientific paper. The best written patientoriented research articles do not make me, the reader, work hard to understand their meanings. It follows that writing a patient-oriented research paper should be a straightforward exercise that translates data into a clear, practical lesson for the clinician. It should not be a burden to write or read. This is not a definitive article on the topic of preparing a scientificpaper. Rather, it is anoverviewofmypersonal process for writing a paper. This process is dynamic and evolving and has been guided bymentors and associates too numerous to name. Along the way, I have collected 12 aphorisms guiding manuscript preparation: 1. ‘‘There is no such thing as a paper that is too short.’’ Hemingway wrote a story in 6 words: ‘‘For sale: baby shoes. Never worn.’’ 2. ‘‘Write short declarative sentences.’’ 3. ‘‘All studies, no matter how complicated, can be resolved into a 2 2 table.’’ 4. ‘‘Surgeons have the attention span of a flea. You have 30 seconds to get their attention.’’ 5. ‘‘Readers should not have to guess your study purpose.’’

Complications of Moderate Sedation Versus Deep Sedation/General Anesthesia for Adolescent Patients Undergoing Third Molar Extraction

PURPOSEnTo examine the complications resulting from moderate sedation versus deep sedation/general anesthesia for adolescent patients undergoing third molar extraction and determine whether any differences in complication risks exist between the 2 levels of sedation.nnnMATERIALS AND METHODSnWe performed a prospective study of the Oral and Maxillofacial Surgery Outcomes System from January 2001 to December 2010. The primary predictor variable was the level of sedation, divided into 2 groups: moderate sedation versus deep sedation/general anesthesia. The primary outcome was the incidence of adverse complications resulting from the sedation level. Differences in the cohort characteristics were analyzed using the independent samples t test, χ(2) test, and analysis of variance, as appropriate. Multivariable logistic regression was used to measure the effect the level of sedation had on the adverse complication rate.nnnRESULTSnPatients in the moderate sedation group had a complication rate of 0.5%, and patients in the deep sedation/general anesthesia group had a complication rate of 0.9%. Compared with moderate sedation, deep sedation/general anesthesia did not pose a significantly increased risk of adverse anesthesia complications (adjusted odds ratio 1.63, 95% confidence interval 0.95 to 2.81; P = .077).nnnCONCLUSIONSnThe results of our study have shown that the risk of adverse anesthesia complications is not increased when choosing between moderate and deep sedation/general anesthesia for adolescent patients undergoing third molar extraction.

American Association of Oral and Maxillofacial Surgeons' Anesthesia and Third Molar Extraction Benchmark Study: Rationale, Methods, and Initial Findings

PURPOSEnBenchmark statistics are used in quality assurance/quality improvement processes. The purposes of the present report are to 1) review the rationale for a new specialty-specific benchmark study, 2) summarize the methods to create a practice-based research collaborative (P-BRC) designed for collecting data to create benchmarks, and 3) describe the characteristics of the P-BRC surgeon participants.nnnMATERIALS AND METHODSnThe study was designed as a prospective cohort study. We created a P-BRC composed of randomly selected American Association of Oral and Maxillofacial Surgeons (AAOMS) members in private practice in the United States, who agreed to enroll patients scheduled to receive anesthesia of any type in the office-based ambulatory setting. The study variables included clinician demographics and their P-BRC status, grouped as 1) invited, active participants, 2) invited, inactive participants, and 3) uninvited AAOMS members. The P-BRC participants collected data for dozens of variables from their patients related to anesthesia. If the procedure was third molar (M3) surgery, additional M3 procedure-specific data were collected. Data analyses were composed of computing descriptive and bivariate statistics. Preliminary sample size estimates suggested that the P-BRC should include 300 surgeons to produce estimates with a ±5% error.nnnRESULTSnDuring the 1-year study interval, 642 surgeons (11.8%) were invited to join the P-BRC from a population of 5,455 eligible AAOMS members. The 124 active participants in the P-BRC contributed 6,344 subjects to the anesthesia data set and 2,978 subjects who had had 9,207 M3s removed to the M3 data set. The active participants in the P-BRC were younger and more likely to be board-certified than were the inactive participants (P < .05). Details of the anesthesia and M3 variables will follow in future reports.nnnCONCLUSIONSnDespite vigorous efforts, we did not achieve our stated goal of creating a P-BRC composed of a random sample of 300 AAOMS members. With the current P-BRC sample, variables with very high (>93%) or very low (<7%) frequency estimates will produce estimates with the desired range of ±5% error. The P-BRC includes a sample of self-selected, not random, participants and is well-characterized in terms of age, gender, board-certification status, academic degrees, and geographic distribution.

Which Factors Affect Citation Rates in the Oral and Maxillofacial Surgery Literature

PURPOSEnCitation rate is one of several tools to measure academic productivity. The purposes of this study were to estimate and identify factors associated with citation rates in the oral and maxillofacial surgery (OMS) literature.nnnMATERIALS AND METHODSnThis was a retrospective longitudinal study of publications in the Journal of Oral and Maxillofacial Surgery (JOMS), International Journal of Oral and Maxillofacial Surgery (IJOMS), and Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology (OOOO) from January through December 2012. The predictor variables were author- and article-specific factors. The outcome variable was the citation rate, defined as the total number of citations for each article over a 4-year period. Descriptive, bivariate, and multiple regression statistics were computed.nnnRESULTSnThe authors identified 993 articles published during 2012. The mean number of citations at 4xa0years after publication was 5.6xa0±xa05.3 (median, 4). In bivariate analyses, several author- and article-specific factors were associated with citation rates. In a multiple regression model adjusting for potential confounders and effect modifiers, first author H-index, number of authors, journal, OMS focus area, and Oxford level of evidence were significantly associated with citation rate (Pxa0≤xa0.002).nnnCONCLUSIONnThe authors identified 5 factors associated with citation rates in the OMS literature. These factors should be considered in context when evaluating citation-based metrics for OMS. Studies that focus on core OMS procedures (eg, dentoalveolar surgery, dental implant surgery), are published in specialty-specific journals (eg, JOMS or IJOMS), and have higher levels of evidence are more likely to be cited.

Pseudomyogenic Hemangioendothelioma: A Vascular Tumor Previously Undescribed in the Oral Cavity

The pseudomyogenic hemangioendothelioma (PMH) is a low-grade malignant vascular neoplasm of different tissue planes including skin and soft tissue. Primary tumors in the skeletal muscle and bone have also been diagnosed. The PMH was introduced into the WHO classification of tumors of soft tissue and bone in 2013. This is the first description of oral involvement. A 21-year-old female presented with a 2-month old swelling of her gingiva. The swelling appeared red in color and was soft in consistency. A clinical diagnosis of a pyogenic granuloma was made and an incisional biopsy was submitted for histopathological evaluation. The lesion consisted of a proliferation of spindle and epithelioid looking cells. Cells were arranged in loose fascicles and sheets. Rhabdomyoblast-like cells were also seen. No mitotic figures were present. Lesional cells were reactive to cytokeratin AE1/AE3 and CD31. Lesional cell reactivity to S100 protein, HMB 45, SMA, Desmin and CD34 was negative. Following the diagnosis, a wide excision for clear margins was performed. No recurrence has been reported 2xa0years since the removal. The PMH is a cutaneous tumor that behaves in an indolent fashion. This is the first report of oral involvement by this neoplasm. Recognition of its histopathological features and immunohistochemical reactivity will prevent misadventures in the diagnosis of oral lesions.