Saturday, 10 September 2016

The wisdom of wisdom tooth extraction

I have 4 kids, 3 of whom had their wisdom teeth removed on reaching adulthood on the advice of specialists. I had mine removed in my 30s for some reason and so did my wife. In the US and much of the world this is a billion dollar per year business, with millions of molars extracted every year in the US alone. With those numbers, even a small complication rate can add up to a lot of complications, and as a surgical procedure there are also significant costs. Yet it has been argued that the reasoning behind most of the extractions are flawed and that the procedure is often unnecessary.

Surely this is just another example of 4 billion years of evolution getting it wrong and modern medicine finding the solution? With the focus of modern medicine being on solutions, we are often diverted from the fact that there may not be a problem in the first place.

A paper published in 2007 (here) suggests that more pain comes from molar extraction than from leaving them alone and points out the fallacies behind routine extraction, such as:

1. Wisdom teeth have a high rate of associated pathology
Wrong, and even if they do, problems can often be treated without surgery.

2. Early removal is less traumatic
It is not necessarily less traumatic than late excision, and it is more traumatic than leaving them alone.

3. Wisdom teeth cause crowding of the front teeth
No evidence of causation.

4. The risk of problems increases with age
Not supported.

5. Low risk of harm by removing them
Depends on how you measure it, but there is arguably more pain, discomfort and adverse effects from removing them than leaving them alone if they are not causing symptoms.

The author of the article above is not alone. From looking at (more recent) evidence based guidelines (here, here and here) and even those that waver a little (here – where they say there is no supporting evidence for routine removal but the clinician should decide – based on what, I don’t know) there does not appear to be good evidence that third molars without symptoms should be excised – yet that’s what happened to me and my kids, and to millions of others.

The bottom line
Routine extraction of third molars is not supported by strong evidence and there is evidence that contradicts some of the reasons for removal. The benefits of this practice appear to be overestimated and the harms appear to be underestimated. 

I normally don't comment too much on finances, but given that this practice is driven by practitioners who gain financially from the procedure, it looks like a lot of people are wasting a lot of money, and a few people are gaining a lot of money.



NB: I thank MC, a reader of my book, for alerting me to this problem

2 comments:

  1. I was suggested to remove my wisdom teeth... but I didn't. I don't think they ever gave me a problem.

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  2. I totally agree I think that wisdom teeth should not be removed just because they might create problems later on. I have one on the left side of my mouth and got no problems with it after it has fully erupted. Well, I had trouble when it was starting to come out; I had an irritating itch in my gum which munching on ice cubes didn't resolve. (I discovered that gnawing my finger did the trick, despite all the drool. It was like regressing to a teething baby.) I had a dentist take a look at it just to be sure everything is alright, and she suggested to leave it alone. She did recommend to have one wisdom tooth removed, though, because it was growing into the adjacent tooth. Since I'm not a fan of having my teeth yanked out, I waited until the pain became unbearable before I had it taken out.

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