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