Dental Turf War Sounds Familiar

HOT TOPIC

Percutaneous Injections of Triamcinolone Improve TED, Study Finds

In a recent retrospective case series of 24 patients with thyroid eye disease (TED), researchers found that those who received percutaneous injections of triamcinolone had improved margin reflex distance 1 (MRD1) and upper eyelid retraction (UER) by a clinically significant amount.

The analysis, conducted at three sites in Brisbane, Australia, between September 2014 and October 2022, found that the mean duration of symptoms of eye disease was 12.9 months before the injection. The average patient received a mean of 2.1 injections. Before treatment, the mean MRD1 was 6.2 mm, and the mean UER was 3 mm. The primary outcome of the injections was normalization of the MRD1 (< 4 mm) or improvement (at least a 0.5-mm decrease).

The final results of the case series showed that during a mean follow-up of 17.5 months, mean MRD1 improved by 2.2 mm, and mean UER decreased by 2.42 mm (P < .001 for both). Quite notably, the quality-of-life scores improved from 4.13 to 8.02 post-treatment (P < .001), while mean serum levels of thyroid-stimulating hormone receptor antibodies decreased from 8.53 IU/L to 1.63 IU/L (P = .002). No patient reported clinically significant IOP elevations.

According to the researchers, "Percutaneous triamcinolone injection is an effective and safe treatment option for TED-related UER.” (Read more.)

My Two Cents

Patients are often more concerned about their appearance than about many of the most sinister ocular conditions lurking beneath the surface. This particular treatment is notable because, not only will it alleviate some of the cosmetic issues associated with TED-related upper eyelid retraction, but it was also discovered to lower the mean serum levels of TSH receptor antibodies. A win-win!

OUTSIDE THE LANE

A Lesson Gleaned From Christie Brinkley’s Skin Cancer Story

Two months after her skin cancer diagnosis, Christie Brinkley, shares the details. The 70-year-old model had accompanied her daughter during an annual dermatology visit for a skin check. “At the very end [of her daughter’s exam], as he was putting away his little thing, I said, ‘Before you put that away, do you think you could just look at this?’” Ms. Brinkley recounts. After observing the small spot on her head, the dermatologist immediately recommended a biopsy.

The biopsy confirmed the presence of basal cell carcinoma, and Ms. Brinkley quickly underwent surgery to remove it. “They took care of it, and luckily, my hair grows in that direction, but the scar is barely noticeable,” she said.

@christiebrinkley

Basal cell carcinomas typically develop in areas of the skin continually exposed to sunlight, notably the face. It grows slowly and rarely spreads to other parts of the body.

My Two Cents

Every day, I have patients accompanied by a friend or family member who either interrupts the exam or blurts out a question about their own ocular health status at the end of the exam when I ask the patient if they have any questions. This story is a good reminder that these questions from “the peanut gallery” can lead to any number of outcomes, including the detection of a potentially severe health issue. Don’t take these inquiries lightly; rather, use them to your advantage, as you may be able to create a new patient for life!

CAN YOU RELATE

Most of us can relate to a turf war between professions dealing with the same area of the body, right? Well, while listening to my usual round of podcasts, I found the May 28th episode of NPR’s The Indicator, “Can Dental Therapists Fill the Gap in Oral Care?” especially interesting.

There is a growing segment within the dental profession called “dental therapists” who have been practicing in other parts of the world for decades, although they are rare in the United States. These professionals are licensed and certified providers who work under the supervision of a dentist. They receive intensive training in a select set of the most needed routine dental procedures. Dental therapists act similarly to physician assistants as mid-level providers. They provide preventive and routine dental care, including examinations, filling bare cavities, educating patients about oral health, performing regular cleanings, placing temporary crowns, and performing essential extractions.

Many feel that these dental therapists could be the solution to providing underserved rural communities with better oral care. According to the podcast, many affluent areas have no shortage of dentists—in fact, if anything, they have an excess supply. However, the lower-income communities are having difficulty attracting dentists to set up shop.

Not surprisingly, the American Dental Association seems to be opposing this potentially growing and needed profession. Sounds familiar.