9 ms·

The wisdom teeth industry is probably a scam

73 points by thebent 11y ago

collyw 11y ago
In the UK my dentist said its up to me. They don't recommend it any more but are happy to do it if you want. Mine do catch a fair bit of food and get minor infections relatively frequently (maybe every three months they hurt for a few days). I want them out but don't want to go through the process.
- WalterBright 11y ago
  Mine do too, but what helps is to use one of those rubber tipped pointy sticks to work round it, and to use a plastic syringe to squirt it good with an anti-gingivitis mouthwash. Have your hygienist pay special attention to cleaning them thoroughly during your regular cleanings.
horsecaptin 11y ago
Get em' removed when if (when) they become a problem. I still have mine. My Dad got his removed when he was 50-something. He says that it's a lost easier to clean behind the teeth, and that he used to have gum growth over the wisdom teeth before along with bleeding as a result, which is no longer a problem.
jbssm 11y ago
My thoughts exactly. I'm in my 30's, I've never had dental problems and every time I go to a dentist and he suggests to remove my wisdom teeth, I change to another dentist. These teeth exist for a reason, and mine - luckily - were developed in a perfectly straight way in line with the rest of my teeth. Suggesting to remove them seems just ridiculous to me and a greedy way for the dentist to make some hundreds of euros extra by butchering me off.
- massysett 11y ago
  I thought they existed because eons ago humans lost molars in young age, so there was room for those third molars when they came in? With modern dental care, if you keep all your teeth there isn't room for the third ones?
  - jbssm 11y ago
    Many people think that but archeological evidence says the contrary. Caries only started showing up in humans 3000-4000 years ago when we started doing agriculture and eating cereals. Before that we practically didn't had caries (just like wild animals also don't). Throughout human history humans would have the full set of teeth in the vast majority of cases, until we started settling and switched from hunter-gatherer to agricultural society (which is a very recent time in human species development).
ams6110 11y ago
If you're having your wisdom teeth out like most surgery it's prudent to get a second opinion. Also I'd strongly advise local anesthesia. IMO general anesthesia should be avoided whenever possible. I'm not a medical person but I've seen too many people who had bad side effects from general anesthesia and some who were never the same again.
- ZanyProgrammer 11y ago
  " I'm not a medical person"-then I'm not going to take your scare mongering anecdotal evidence.
  - bsder 11y ago
    Um, the complications from general anesthesia are not fiction. There is a reason why a general anesthetics normally require the presence of an anesthesiologist. A local is always a better option if available. It's less invasive and has fewer complications.
    - existencebox 11y ago
      Unfortunately for some of us; it's not an option. I have an extremely physical neurologically induced response ("weak stomach" more technically), but to the point that during a minor growth removal I ended up vomiting continuously while passing in and out; needing a day in the hospital on an IV drip for recovery. (couldn't stand up and walk out, despite trying.) This is not meant as a "pity me" by any extent, I find it hilarious given that my parents would have liked me to be a doctor and enjoy sharing the story. However, it puts me in a "screwed if I do, screwed if I don't" situation when it comes to going under, and for something like wisdom teeth; they can't really have me going all human-fountain on them. In short, the "if available" bit is the kicker, I'm curious enough to be googling around for non-anecdata research on the actual risk distributions since while comments like yours certainly make me nervous, after years of going under with no issues and doctors recommending it given my situation, I wonder to what extent I'm stressing myself out over a very uncommon occurrence.
cpncrunch 11y ago
All of the RCTs conclude that there is no evidence that removing unsymptomatic wisdom teeth is beneficial: http://bestpractice.bmj.com/best-practice/evidence/intervention/1302/0/sr-1302-i1.html http://bestpractice.bmj.com/best-practice/evidence/intervent... Given the major surgery involved, it seems best avoided. I have had two impacted wisdom teeth for over 20 years with no problems (using good dental hygiene).
- dsjoerg 11y ago
  My only regret is that I have but one upvote to give. All these anecdotal comments, and only one reference to RCT. However, this link appears to be paywalled. "You have tried to access content that requires a subscription to BMJ Best Practice."
  - gwern 11y ago
    I don't even get that. I get redirected to http://bestpractice.bmj.com/best-practice/verify-user-north-american-access.html http://bestpractice.bmj.com/best-practice/verify-user-north-... which just says ' Please click here to go to BMJ Best Practice US. Alternatively click here to go to the BMJ Best Practice site intended for users outside the US. '
    - cpncrunch 11y ago
      Yeah, actually I get that now as well. It seems to work fine if you google "bmj clinical evidence wisdom tooth" (without the quotes. Sorry about that...I didn't realise it was behind a half-assed paywall :)
- Avshalom 11y ago
  If major surgery is involved then they were almost certainly symptomatic. I had mine out at 18 because "eh might be a good idea" and my mom had dental insurance. 45 minutes and I was eating nachos the next day. Took two of the pain killers the first night just in case and none again. Which on a scale of surgery puts it slightly above "ingrown toenail".
WalterBright 11y ago
When I was 21, my dentist wanted to remove my wisdom teeth. I asked him why, he said "because wisdom teeth are difficult to clean and you'll likely lose them by age 30 anyway because of that." I replied that since they were healthy now, I'd wait and see, and got a new dentist. I'm 56 now and my wisdom teeth are still there and still healthy.
- meric 11y ago
  I agree. I think it's fine to wait till you're getting issues from your wisdom teeth before thinking about removing it. If it costs nothing to delay a major surgery by a day, you should do it.
  - deleted 11y ago
    [deleted]
  - sergiotapia 11y ago
    Most of the time it's not major surgery, in those cases I would just get on with it.
  - whatusername 11y ago
    Isn't that the point though? I had 2 of mine removed at 19.. A jab of local anasthetic, some tugging with some pliers (I'm sure the dentist might call them something else) and 20 mins later I was sitting in a lecture at university. That certainly wasn't major surgery.
  - mixmastamyk 11y ago
    Unfortunately, iff you do have a problem though, it gets worse the longer you wait.
- kls 11y ago
  I had mine well into my late 30's but I could not brush behind them as they where so close to my jaw. I have very strong teeth but eventually age caught up with them. Funny part was I would occasionally suffer from headaches but they where so infrequent that I just assumed they where normal headaches. Years later, after having them removed I realized that I had not had a headache in years.
degenerate 11y ago
I used to get lots of headaches from 15-25, maybe 3 a week. I learned to live with it. At 25 I had my wisdom teeth removed for the regular reasons, and noticed that I got a lot less headaches in the next few weeks. I now get maybe 2 headaches a month. I've never heard of this from anyone except myself, and doctors just go "hmm. intereseting." -- just wanted to share this.
- baconner 11y ago
  Tooth root sensitivity is a well know cause of headaches as i recall. You aren't alone. I had years of terrible headaches spawning from an enflamed area above one of my molars (not wisdom tooth though). After finally getting a root canal the frequency dropped dramatically.
- StavrosK 11y ago
  Two headaches a month? That's a lot of headaches, no?
  - stordoff 11y ago
    Compared to three a week, it's a significant decrease, even if it wasn't a complete cure. Personally, I wouldn't be all that worried about two headaches a month or so (then again, I've had a near-constant headache for the last two years, so my perception may be a little skewed).
  - jerf 11y ago
    Yes, but when you've been doing 2-4 a week for most of your life, it still seems like a godsend. (My reasons for headache (long story short, celiac) are completely different but that part of my story is similar.) I clock in at maybe 1 bad one a month now and I usually know what I did to screw up.
- bane 11y ago
  I have chronic headaches and my dentist mentioned that when mine were removed it might help. It didn't, but it was certainly something that they knew about.
akeck 11y ago
Another angle to consider... My oral surgeon said the nerves in your face migrate around as you age. Later in life, one of those nerves is closer to the wisdom teeth, so the chance of nerve damage during extraction is higher. Edit: I did local anesthesia in the USA. They shot everything up, let it take effect, and then yanked them out. I'll never forget that sound...
analog31 11y ago
Throughout my life, dentists have wanted my wisdom teeth. I've opted to keep them. At my last checkup, my dentist told me that he had changed his opinion, and no longer takes them out if they're healthy.
eric_h 11y ago
My dad who's a year or two short of 70 has wisdom teeth that never "erupted". Personally mine did at the age of ~20, but my orthodontist at the time thought they needed to be removed a couple of years before because they were pointing the wrong way. My dentist thought otherwise and I took his advice. I'm half convinced that the whole "wisdom teeth industry" is just a great way to legally get some opioid painkillers.
narrowrail 11y ago
My grandfather started practicing dentistry in the '20s and my mother in the '50s, so my thoughts come from them (paraphrasing): While many people may not have an urgent need to get rid of their wisdom teeth at age 18 (or even 50), it is a very simple extraction before these teeth have taken root. After they have rooted, it is more complicated, and more painful. These teeth are unnecessary, and one can eat perfectly fine without them. The most horrible stories I heard as a kid were mostly about wisdom teeth causing crowding and/or gum issues. To each their own, of course, but I believe the prudent route is to have them removed when you are 18 (or whenever they start to come in for you).
gilgoomesh 11y ago
The article claims "intensive" and "major" surgery. I had local anesthesia and 15 minutes in the dental surgeon's chair. Is it done differently in the U.S.?
- swang 11y ago
  I'm in the US. Mine were already growing above the gums so I could feel/touch them. The dentist I went to put me on novocaine and used a diamond drill to split my wisdom teeth into halves that he then extracted out. I think people who have surgery, are the ones whose wisdom teeth have not really grown out yet. So maybe that's what the article is referring to.
- bane 11y ago
  It depends, mine was pretty major (general anesthesia, 3 hour surgery, etc.) and I had a very long recovery. The lower ones never breached my gums and had created an untreatable infection and the surgeon had to partially break my jaw to get them out. It was a real mess. Other people I know went through a fairly normal tooth extraction like yourself, it just depends.
- baobrien 11y ago
  I'm in the US. Had mine removed when I was 17 before they broke through the surface, I think. They offered general* and local anesthetic. I asked for general, but nobody told me you couldn't eat or drink anything in the 18 hours or so before the surgery, so they ended up using local. It was a pretty quick procedure. * It might have been sedation they offered, not general anesthesia.
- stordoff 11y ago
  I suspect it is variable from patient to patient (and possibly dentist to dentist). I had one removed a few years ago, and it was done in about ten minutes and left me with no discomfort post-surgery. OTOH, I have friends who've had ostensibly similar work done which took much longer, and they had some discomfort for a few days after the procedure.
- nommm-nommm 11y ago
  It depends on the individual patient.
sergiotapia 11y ago
My wife is a dentist. She told me that you really should have your wisdom teeth removed in two general instances: * The teeth are growing in a strange orientation. * You have cavities on them and your jaw shape is such that you can't brush them properly. --- The major problem with the molars is that they are notoriously difficult to keep clean. They all eventually become abscessed (on a long enough timeline). Might as well remove them. So removing wisdom teeth is not really a scam, it's something you will need sooner or later unless you're really anal about keeping your wisdom teeth clean. Can you brush all the way back there? How about behind the wisdom tooth? I have also noticed a trend here in the US that dentists put you under general anesthetic for this procedure. When in reality, unless you -really- need surgery, it's just overkill. For example, when I had my wisdom teeth removed in Bolivia, I was entirely awake, they only used local lidocaine (or similar) using a syringe, and they pull them out using hand tools and levers. Some antibiotics for a couple of days, and I was on my way.
- ajdlinux 11y ago
  When I had my wisdom teeth removed in Australia - they were impacting and causing me some very real grief - I had them taken out under local lidocaine. My dentist was of the view that general was overkill and would simply be more expensive for very limited gain. In Australia I know it's fairly common to have general anaesthetic for wisdom teeth, but I'm not sure we're quite as into preemptive removal as the US seems to be by the looks of this article?
  - deleted 11y ago
    [deleted]
  - acveilleux 11y ago
    I had my wisdom teeth removed (in Canada) under local anesthesia. Two of them didn't strictly have to go and were pulled out in a couple minutes, the remaining two were impacted and pushing against the next molar. I can remember no pain during the procedure so lidocaine was quite sufficient. I can see why general anesthetic might be desired, the amount of force required to break the tooth is downright disturbing. I remember wondering if the surgeon ever slips with that punch and that the sound of breaking teeth in the absence of any other feeling was eery.
veidr 11y ago
Just one data point, but: as a teenager I was told "your wisdom teeth might end up being fine, but most people end up having to get them pulled; it's up to you." I passed. Fast-forward a decade or so, one of them was, to use the technical term, totally fucked. It was impacted, uncleanable in parts and thus had to be removed, but had gotten so wedged in that it not only pushed my other teeth crooked, but was extremely hard to extract, requiring the dentist to go fetch some other stronger dentist and then they both worked on it and it took way longer than planned to get all the pieces out. That was lame, but I still have the other three, and now my dentist says the same thing is happening to those (and even I can tell, it is). So now I am 41 with a busy job and young children, and I have to find time to have three wisdom teeth extracted in a procedure that is now going to be much more difficult than the simple extraction suggested by my dentist 20 years ago. So, in my case, I wish I did it then.
- mixmastamyk 11y ago
  Indeed, if you need it done, the older you are the harder it becomes as they grow and dig-in and fuck up their neighbors. In my case I desperately needed it (8 wisdom teeth), but no one was around to tell me as a teenager. So there I am a few decades later with power tools in my mouth for hours, dental assistant was about to faint...
- lips 11y ago
  It would seem that modeling the patient jaw development over time would be appropriate. But of course this would cost $$$ as well. Then again, if docs were to charge smaller repeating sums for the modeling, and remove the problematic cases for free, they might end up making the same amount, with less liability and work.
bane 11y ago
I remember when my wisdom teeth started causing me problems in my early 20s. The lower ones caused some kind of infection that wasn't treatable and my gums started leaking a terrible puss that was pretty disgusting to be frank about it. Perhaps it would have all sorted itself out in a few months. But throwing up 4 or 5 times a day was making it hard to get nutrients so I went in, got knocked out, and them hacked out of my head. The were so impacted the dentist had to break part of my jaw and I was unable to open my mouth for about 8 weeks while it healed and it was months before I could fully open my mouth again. But guess what? No puss, no more barfing and I haven't had any problems since. So I think that was probably the right choice and if I had to do it over again I would have had them carved out of my skull 5 years earlier before they had become a painful and disgusting problem.
notacoward 11y ago
The basic point - that many people have their wisdom teeth removed unnecessarily - might be valid, but the author does a poor job proving it. Cherry-picking one study that followed young adults for only one year doesn't address the issue of orthodontic and periodontal problems that take decades to manifest fully - a pretty obvious point that remains unaddressed through the remainder of the article. When I see such blatant intellectual malfeasance, I just stop reading. If it's really a valid point, someone else will make it without distorting or misrepresenting the truth. If it's not - which is what usually turns out to be the case - I will have saved time and energy. Life's too short to waste it on polemicists.
beloch 11y ago
I'd be interested in seeing studies done on recovery times from dental procedures pitting local vs. general anesthesia. If you're awake, it seems more likely that the dentist will practice extra caution, so it seems logical that recovery times for procedures done under local should be better.
schainks 11y ago
What Rob (the author) went through is hard, and left him understandably butthurt about oral operations. Maybe he's one of the people who didn't need the operation but had it done, and there were complications. If he posted his taken-then x-rays online today, maybe other dental professionals could weigh in on whether it was a good idea at the time? What this article doesn't emphasize enough is: 1) Like fingerprints, teeth are unique from person to person. 2) There are legitimate medical reasons to remove wisdom teeth, and those reasons vary from person to person. Like a cartoon, I have a small mouth with big teeth. Thus, like San Francisco, I've had "space scarcity" for the better part of 2 decades. My dental journey took over a decade of planning and execution, as well as 10s of thousands of dollars so I'd have some kind of decent smile as an adult. (thanks Mom and Dad!) Had I "passed" on this work, I wouldn't have anything close to resembling a smile today - a high price to pay. Maybe Rob's family should have consulted second more dentists/oral surgeons. Maybe they didn't have the resources. Technology will likely help us make better decisions about these procedures in the future so "unnecessary" treatment spending goes down.
csours 11y ago
My wisdom teeth pointed pretty much straight forward, so removing them was pretty much mandatory. I don't appreciate the title. This is one of the first times I've seen that the actual article has a less editorial title.
damm 11y ago
I'm almost 40 and have not had my wisdom teeth out. I can tell you they hurt from time to time; and they have caused other molars to crumble as a result. It's not really a scam; the way the wisdom teeth roots grow in make it very hard to remove.
taivare 11y ago
Last visit to dentist ,he mentions his parents are both doctors. I asked , why didn't you go into medicine. He told me his parents urged him into dentistry. They felt their professions had changed ( negatively ) so much from their early careers. He said mostly due to pharma taking over and they no longer had any autonomy. They knew he would have more freedom and autonomy as a dentist.
cheriot 11y ago
Why is the insurance industry tolerating this? Do the not have an incentive to avoid unnecessary procedures?
- awqrre 11y ago
  The higher the cost of treatments, the higher the costs of premiums...
  - cheriot 11y ago
    Once a premium has been sold, they can be aggressive in trying not to pay for procedures. It's strange that they're so silent on this one.
bgilroy26 11y ago
There is a lot of variation in people's mouths. My teeth are really big and I was really bad about wearing a retainer. If I didn't have 4 teeth removed, my bottom set would have become more crooked than my baby teeth were if I let my wisdom teeth come in.
jessaustin 11y ago
The "10M teeth/yr" statistic, assuming it's even accurate, doesn't seem like that much to me. Most people have four wisdom teeth. That seems to imply that less than half the people in USA have gotten this procedure. (It also makes one wonder why TFA didn't work a little harder to get current/relevant/accurate statistics.) It's true that many people who have had their wisdom teeth pulled didn't need that. It's also the case that many people who didn't have them pulled while they were young, have lived to regret that. Most dentists would be happy to never pull another wisdom tooth. However, they've taken an oath to provide a standard of care, and they can't refer every wisdom tooth case to expensive oral surgeons. (Well, I think some dentists do refer every one of these out, but that's a threat to patient retention.) USA simultaneously has too many and not enough dentists. Too many, because there are lots of unnecessary procedures done. Not enough, because many poor people don't go to the dentist until they're in severe pain, and at that point they need many teeth pulled. Those who live long enough eventually need all their teeth pulled anyway...
kevin_thibedeau 11y ago
Mine were horizontal and were going to be a problem. The surgery was a breeze and almost painless afterwards. Going through the constant ache of braces for a few years is far worse.
superuser2 11y ago
I had a dentist tell me I should get my wisdom teeth pulled within the next year. Next year, same place, different dentist at my regular cleaning. He gave me a clean bill of health. I asked him, "What about my wisdom teeth?" He said "What about them? Are the bothering you?" "Well, no..." "Then you're fine." And he left.
ionised 11y ago
I'm 29 years old and have six wisdom teeth at the moment. I have two protruding out of the upper jaw which haven't caused me any problems, so the (UK NHS) dentist said they don't need to come out. X-rays showed that there was actually another unemerged tooth behind each of them as well. These upper teeth have all been there for for about 7 or 8 years now and haven't caused me any discomofort beyond the initial breaking of the gum. On the lower jaw however, both teeth are impacted. The left wisdom tooth is completely horizontal and pushing up against the molar in front and the lower right wisdom tooth is impacted at an angle and irritates the gum around it from time to time. I usually pop some ibuprofen when it gets uncomfortable. I've wouldn't say I've experienced serious pain from these teeth, more just a dull ache or discomfort or irritation of the gum, but I was referred to a dental surgeon a year or so ago who basically told me he wouldn't take them out. He claimed that the lower teeth were so well developed at this point that removing them might expose the nerve in my jaw underneath and leave the lower half of my face numb, potentially for the rest of my life. As a risk/benefit calculation he decided against taking them out for now, but may change his mind if they cause problems in the future, which they likely will. This is an NHS dental surgeon though and I'm wondering if I might be best served getting an a second opinion from a private dentist as well. The last few days my lower right tooth has been really irritating the gum around it that I've been taking ibuprofen for two or three days. If I went to the dentist when these originally started to emerge instead of waiting until they started to cause some discomfort I could have had them removed with much less risk. I was however under the assumption that wisdom teeth should only be removed when they cause problems, which for the first few years mine didn't really.

73 points by thebent 11y ago

In the UK my dentist said its up to me. They don't recommend it any more but are happy to do it if you want. Mine do catch a fair bit of food and get minor infections relatively frequently (maybe every three months they hurt for a few days). I want them out but don't want to go through the process.

WalterBright 11y ago
Mine do too, but what helps is to use one of those rubber tipped pointy sticks to work round it, and to use a plastic syringe to squirt it good with an anti-gingivitis mouthwash. Have your hygienist pay special attention to cleaning them thoroughly during your regular cleanings.

horsecaptin 11y ago

Get em' removed when if (when) they become a problem. I still have mine. My Dad got his removed when he was 50-something. He says that it's a lost easier to clean behind the teeth, and that he used to have gum growth over the wisdom teeth before along with bleeding as a result, which is no longer a problem.

jbssm 11y ago

My thoughts exactly. I'm in my 30's, I've never had dental problems and every time I go to a dentist and he suggests to remove my wisdom teeth, I change to another dentist. These teeth exist for a reason, and mine - luckily - were developed in a perfectly straight way in line with the rest of my teeth. Suggesting to remove them seems just ridiculous to me and a greedy way for the dentist to make some hundreds of euros extra by butchering me off.

massysett 11y ago
I thought they existed because eons ago humans lost molars in young age, so there was room for those third molars when they came in? With modern dental care, if you keep all your teeth there isn't room for the third ones?
- jbssm 11y ago
  Many people think that but archeological evidence says the contrary. Caries only started showing up in humans 3000-4000 years ago when we started doing agriculture and eating cereals. Before that we practically didn't had caries (just like wild animals also don't). Throughout human history humans would have the full set of teeth in the vast majority of cases, until we started settling and switched from hunter-gatherer to agricultural society (which is a very recent time in human species development).

ams6110 11y ago

If you're having your wisdom teeth out like most surgery it's prudent to get a second opinion. Also I'd strongly advise local anesthesia. IMO general anesthesia should be avoided whenever possible. I'm not a medical person but I've seen too many people who had bad side effects from general anesthesia and some who were never the same again.

ZanyProgrammer 11y ago
" I'm not a medical person"-then I'm not going to take your scare mongering anecdotal evidence.
- bsder 11y ago
  Um, the complications from general anesthesia are not fiction. There is a reason why a general anesthetics normally require the presence of an anesthesiologist. A local is always a better option if available. It's less invasive and has fewer complications.
  - existencebox 11y ago
    Unfortunately for some of us; it's not an option. I have an extremely physical neurologically induced response ("weak stomach" more technically), but to the point that during a minor growth removal I ended up vomiting continuously while passing in and out; needing a day in the hospital on an IV drip for recovery. (couldn't stand up and walk out, despite trying.) This is not meant as a "pity me" by any extent, I find it hilarious given that my parents would have liked me to be a doctor and enjoy sharing the story. However, it puts me in a "screwed if I do, screwed if I don't" situation when it comes to going under, and for something like wisdom teeth; they can't really have me going all human-fountain on them. In short, the "if available" bit is the kicker, I'm curious enough to be googling around for non-anecdata research on the actual risk distributions since while comments like yours certainly make me nervous, after years of going under with no issues and doctors recommending it given my situation, I wonder to what extent I'm stressing myself out over a very uncommon occurrence.

cpncrunch 11y ago

All of the RCTs conclude that there is no evidence that removing unsymptomatic wisdom teeth is beneficial: http://bestpractice.bmj.com/best-practice/evidence/intervention/1302/0/sr-1302-i1.html http://bestpractice.bmj.com/best-practice/evidence/intervent... Given the major surgery involved, it seems best avoided. I have had two impacted wisdom teeth for over 20 years with no problems (using good dental hygiene).

dsjoerg 11y ago
My only regret is that I have but one upvote to give. All these anecdotal comments, and only one reference to RCT. However, this link appears to be paywalled. "You have tried to access content that requires a subscription to BMJ Best Practice."
- gwern 11y ago
  I don't even get that. I get redirected to http://bestpractice.bmj.com/best-practice/verify-user-north-american-access.html http://bestpractice.bmj.com/best-practice/verify-user-north-... which just says ' Please click here to go to BMJ Best Practice US. Alternatively click here to go to the BMJ Best Practice site intended for users outside the US. '
  - cpncrunch 11y ago
    Yeah, actually I get that now as well. It seems to work fine if you google "bmj clinical evidence wisdom tooth" (without the quotes. Sorry about that...I didn't realise it was behind a half-assed paywall :)
Avshalom 11y ago
If major surgery is involved then they were almost certainly symptomatic. I had mine out at 18 because "eh might be a good idea" and my mom had dental insurance. 45 minutes and I was eating nachos the next day. Took two of the pain killers the first night just in case and none again. Which on a scale of surgery puts it slightly above "ingrown toenail".

WalterBright 11y ago

When I was 21, my dentist wanted to remove my wisdom teeth. I asked him why, he said "because wisdom teeth are difficult to clean and you'll likely lose them by age 30 anyway because of that." I replied that since they were healthy now, I'd wait and see, and got a new dentist. I'm 56 now and my wisdom teeth are still there and still healthy.

meric 11y ago
I agree. I think it's fine to wait till you're getting issues from your wisdom teeth before thinking about removing it. If it costs nothing to delay a major surgery by a day, you should do it.
- deleted 11y ago
  [deleted]
- sergiotapia 11y ago
  Most of the time it's not major surgery, in those cases I would just get on with it.
- whatusername 11y ago
  Isn't that the point though? I had 2 of mine removed at 19.. A jab of local anasthetic, some tugging with some pliers (I'm sure the dentist might call them something else) and 20 mins later I was sitting in a lecture at university. That certainly wasn't major surgery.
- mixmastamyk 11y ago
  Unfortunately, iff you do have a problem though, it gets worse the longer you wait.
kls 11y ago
I had mine well into my late 30's but I could not brush behind them as they where so close to my jaw. I have very strong teeth but eventually age caught up with them. Funny part was I would occasionally suffer from headaches but they where so infrequent that I just assumed they where normal headaches. Years later, after having them removed I realized that I had not had a headache in years.

degenerate 11y ago

I used to get lots of headaches from 15-25, maybe 3 a week. I learned to live with it. At 25 I had my wisdom teeth removed for the regular reasons, and noticed that I got a lot less headaches in the next few weeks. I now get maybe 2 headaches a month. I've never heard of this from anyone except myself, and doctors just go "hmm. intereseting." -- just wanted to share this.

baconner 11y ago
Tooth root sensitivity is a well know cause of headaches as i recall. You aren't alone. I had years of terrible headaches spawning from an enflamed area above one of my molars (not wisdom tooth though). After finally getting a root canal the frequency dropped dramatically.
StavrosK 11y ago
Two headaches a month? That's a lot of headaches, no?
- stordoff 11y ago
  Compared to three a week, it's a significant decrease, even if it wasn't a complete cure. Personally, I wouldn't be all that worried about two headaches a month or so (then again, I've had a near-constant headache for the last two years, so my perception may be a little skewed).
- jerf 11y ago
  Yes, but when you've been doing 2-4 a week for most of your life, it still seems like a godsend. (My reasons for headache (long story short, celiac) are completely different but that part of my story is similar.) I clock in at maybe 1 bad one a month now and I usually know what I did to screw up.
bane 11y ago
I have chronic headaches and my dentist mentioned that when mine were removed it might help. It didn't, but it was certainly something that they knew about.

akeck 11y ago

Another angle to consider... My oral surgeon said the nerves in your face migrate around as you age. Later in life, one of those nerves is closer to the wisdom teeth, so the chance of nerve damage during extraction is higher. Edit: I did local anesthesia in the USA. They shot everything up, let it take effect, and then yanked them out. I'll never forget that sound...

analog31 11y ago

Throughout my life, dentists have wanted my wisdom teeth. I've opted to keep them. At my last checkup, my dentist told me that he had changed his opinion, and no longer takes them out if they're healthy.

eric_h 11y ago

My dad who's a year or two short of 70 has wisdom teeth that never "erupted". Personally mine did at the age of ~20, but my orthodontist at the time thought they needed to be removed a couple of years before because they were pointing the wrong way. My dentist thought otherwise and I took his advice. I'm half convinced that the whole "wisdom teeth industry" is just a great way to legally get some opioid painkillers.

narrowrail 11y ago

My grandfather started practicing dentistry in the '20s and my mother in the '50s, so my thoughts come from them (paraphrasing): While many people may not have an urgent need to get rid of their wisdom teeth at age 18 (or even 50), it is a very simple extraction before these teeth have taken root. After they have rooted, it is more complicated, and more painful. These teeth are unnecessary, and one can eat perfectly fine without them. The most horrible stories I heard as a kid were mostly about wisdom teeth causing crowding and/or gum issues. To each their own, of course, but I believe the prudent route is to have them removed when you are 18 (or whenever they start to come in for you).

gilgoomesh 11y ago

The article claims "intensive" and "major" surgery. I had local anesthesia and 15 minutes in the dental surgeon's chair. Is it done differently in the U.S.?

swang 11y ago
I'm in the US. Mine were already growing above the gums so I could feel/touch them. The dentist I went to put me on novocaine and used a diamond drill to split my wisdom teeth into halves that he then extracted out. I think people who have surgery, are the ones whose wisdom teeth have not really grown out yet. So maybe that's what the article is referring to.
bane 11y ago
It depends, mine was pretty major (general anesthesia, 3 hour surgery, etc.) and I had a very long recovery. The lower ones never breached my gums and had created an untreatable infection and the surgeon had to partially break my jaw to get them out. It was a real mess. Other people I know went through a fairly normal tooth extraction like yourself, it just depends.
baobrien 11y ago
I'm in the US. Had mine removed when I was 17 before they broke through the surface, I think. They offered general* and local anesthetic. I asked for general, but nobody told me you couldn't eat or drink anything in the 18 hours or so before the surgery, so they ended up using local. It was a pretty quick procedure. * It might have been sedation they offered, not general anesthesia.
stordoff 11y ago
I suspect it is variable from patient to patient (and possibly dentist to dentist). I had one removed a few years ago, and it was done in about ten minutes and left me with no discomfort post-surgery. OTOH, I have friends who've had ostensibly similar work done which took much longer, and they had some discomfort for a few days after the procedure.
nommm-nommm 11y ago
It depends on the individual patient.

sergiotapia 11y ago

My wife is a dentist. She told me that you really should have your wisdom teeth removed in two general instances: * The teeth are growing in a strange orientation. * You have cavities on them and your jaw shape is such that you can't brush them properly. --- The major problem with the molars is that they are notoriously difficult to keep clean. They all eventually become abscessed (on a long enough timeline). Might as well remove them. So removing wisdom teeth is not really a scam, it's something you will need sooner or later unless you're really anal about keeping your wisdom teeth clean. Can you brush all the way back there? How about behind the wisdom tooth? I have also noticed a trend here in the US that dentists put you under general anesthetic for this procedure. When in reality, unless you -really- need surgery, it's just overkill. For example, when I had my wisdom teeth removed in Bolivia, I was entirely awake, they only used local lidocaine (or similar) using a syringe, and they pull them out using hand tools and levers. Some antibiotics for a couple of days, and I was on my way.

ajdlinux 11y ago
When I had my wisdom teeth removed in Australia - they were impacting and causing me some very real grief - I had them taken out under local lidocaine. My dentist was of the view that general was overkill and would simply be more expensive for very limited gain. In Australia I know it's fairly common to have general anaesthetic for wisdom teeth, but I'm not sure we're quite as into preemptive removal as the US seems to be by the looks of this article?
- deleted 11y ago
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- acveilleux 11y ago
  I had my wisdom teeth removed (in Canada) under local anesthesia. Two of them didn't strictly have to go and were pulled out in a couple minutes, the remaining two were impacted and pushing against the next molar. I can remember no pain during the procedure so lidocaine was quite sufficient. I can see why general anesthetic might be desired, the amount of force required to break the tooth is downright disturbing. I remember wondering if the surgeon ever slips with that punch and that the sound of breaking teeth in the absence of any other feeling was eery.

veidr 11y ago

Just one data point, but: as a teenager I was told "your wisdom teeth might end up being fine, but most people end up having to get them pulled; it's up to you." I passed. Fast-forward a decade or so, one of them was, to use the technical term, totally fucked. It was impacted, uncleanable in parts and thus had to be removed, but had gotten so wedged in that it not only pushed my other teeth crooked, but was extremely hard to extract, requiring the dentist to go fetch some other stronger dentist and then they both worked on it and it took way longer than planned to get all the pieces out. That was lame, but I still have the other three, and now my dentist says the same thing is happening to those (and even I can tell, it is). So now I am 41 with a busy job and young children, and I have to find time to have three wisdom teeth extracted in a procedure that is now going to be much more difficult than the simple extraction suggested by my dentist 20 years ago. So, in my case, I wish I did it then.

mixmastamyk 11y ago
Indeed, if you need it done, the older you are the harder it becomes as they grow and dig-in and fuck up their neighbors. In my case I desperately needed it (8 wisdom teeth), but no one was around to tell me as a teenager. So there I am a few decades later with power tools in my mouth for hours, dental assistant was about to faint...
lips 11y ago
It would seem that modeling the patient jaw development over time would be appropriate. But of course this would cost $$$ as well. Then again, if docs were to charge smaller repeating sums for the modeling, and remove the problematic cases for free, they might end up making the same amount, with less liability and work.

bane 11y ago

I remember when my wisdom teeth started causing me problems in my early 20s. The lower ones caused some kind of infection that wasn't treatable and my gums started leaking a terrible puss that was pretty disgusting to be frank about it. Perhaps it would have all sorted itself out in a few months. But throwing up 4 or 5 times a day was making it hard to get nutrients so I went in, got knocked out, and them hacked out of my head. The were so impacted the dentist had to break part of my jaw and I was unable to open my mouth for about 8 weeks while it healed and it was months before I could fully open my mouth again. But guess what? No puss, no more barfing and I haven't had any problems since. So I think that was probably the right choice and if I had to do it over again I would have had them carved out of my skull 5 years earlier before they had become a painful and disgusting problem.

notacoward 11y ago

The basic point - that many people have their wisdom teeth removed unnecessarily - might be valid, but the author does a poor job proving it. Cherry-picking one study that followed young adults for only one year doesn't address the issue of orthodontic and periodontal problems that take decades to manifest fully - a pretty obvious point that remains unaddressed through the remainder of the article. When I see such blatant intellectual malfeasance, I just stop reading. If it's really a valid point, someone else will make it without distorting or misrepresenting the truth. If it's not - which is what usually turns out to be the case - I will have saved time and energy. Life's too short to waste it on polemicists.

beloch 11y ago

I'd be interested in seeing studies done on recovery times from dental procedures pitting local vs. general anesthesia. If you're awake, it seems more likely that the dentist will practice extra caution, so it seems logical that recovery times for procedures done under local should be better.

schainks 11y ago

What Rob (the author) went through is hard, and left him understandably butthurt about oral operations. Maybe he's one of the people who didn't need the operation but had it done, and there were complications. If he posted his taken-then x-rays online today, maybe other dental professionals could weigh in on whether it was a good idea at the time? What this article doesn't emphasize enough is: 1) Like fingerprints, teeth are unique from person to person. 2) There are legitimate medical reasons to remove wisdom teeth, and those reasons vary from person to person. Like a cartoon, I have a small mouth with big teeth. Thus, like San Francisco, I've had "space scarcity" for the better part of 2 decades. My dental journey took over a decade of planning and execution, as well as 10s of thousands of dollars so I'd have some kind of decent smile as an adult. (thanks Mom and Dad!) Had I "passed" on this work, I wouldn't have anything close to resembling a smile today - a high price to pay. Maybe Rob's family should have consulted second more dentists/oral surgeons. Maybe they didn't have the resources. Technology will likely help us make better decisions about these procedures in the future so "unnecessary" treatment spending goes down.

csours 11y ago

My wisdom teeth pointed pretty much straight forward, so removing them was pretty much mandatory. I don't appreciate the title. This is one of the first times I've seen that the actual article has a less editorial title.

damm 11y ago

I'm almost 40 and have not had my wisdom teeth out. I can tell you they hurt from time to time; and they have caused other molars to crumble as a result. It's not really a scam; the way the wisdom teeth roots grow in make it very hard to remove.

taivare 11y ago

Last visit to dentist ,he mentions his parents are both doctors. I asked , why didn't you go into medicine. He told me his parents urged him into dentistry. They felt their professions had changed ( negatively ) so much from their early careers. He said mostly due to pharma taking over and they no longer had any autonomy. They knew he would have more freedom and autonomy as a dentist.

cheriot 11y ago

Why is the insurance industry tolerating this? Do the not have an incentive to avoid unnecessary procedures?

awqrre 11y ago
The higher the cost of treatments, the higher the costs of premiums...
- cheriot 11y ago
  Once a premium has been sold, they can be aggressive in trying not to pay for procedures. It's strange that they're so silent on this one.

bgilroy26 11y ago

There is a lot of variation in people's mouths. My teeth are really big and I was really bad about wearing a retainer. If I didn't have 4 teeth removed, my bottom set would have become more crooked than my baby teeth were if I let my wisdom teeth come in.

jessaustin 11y ago

The "10M teeth/yr" statistic, assuming it's even accurate, doesn't seem like that much to me. Most people have four wisdom teeth. That seems to imply that less than half the people in USA have gotten this procedure. (It also makes one wonder why TFA didn't work a little harder to get current/relevant/accurate statistics.) It's true that many people who have had their wisdom teeth pulled didn't need that. It's also the case that many people who didn't have them pulled while they were young, have lived to regret that. Most dentists would be happy to never pull another wisdom tooth. However, they've taken an oath to provide a standard of care, and they can't refer every wisdom tooth case to expensive oral surgeons. (Well, I think some dentists do refer every one of these out, but that's a threat to patient retention.) USA simultaneously has too many and not enough dentists. Too many, because there are lots of unnecessary procedures done. Not enough, because many poor people don't go to the dentist until they're in severe pain, and at that point they need many teeth pulled. Those who live long enough eventually need all their teeth pulled anyway...

kevin_thibedeau 11y ago

Mine were horizontal and were going to be a problem. The surgery was a breeze and almost painless afterwards. Going through the constant ache of braces for a few years is far worse.

superuser2 11y ago

I had a dentist tell me I should get my wisdom teeth pulled within the next year. Next year, same place, different dentist at my regular cleaning. He gave me a clean bill of health. I asked him, "What about my wisdom teeth?" He said "What about them? Are the bothering you?" "Well, no..." "Then you're fine." And he left.

ionised 11y ago

I'm 29 years old and have six wisdom teeth at the moment. I have two protruding out of the upper jaw which haven't caused me any problems, so the (UK NHS) dentist said they don't need to come out. X-rays showed that there was actually another unemerged tooth behind each of them as well. These upper teeth have all been there for for about 7 or 8 years now and haven't caused me any discomofort beyond the initial breaking of the gum. On the lower jaw however, both teeth are impacted. The left wisdom tooth is completely horizontal and pushing up against the molar in front and the lower right wisdom tooth is impacted at an angle and irritates the gum around it from time to time. I usually pop some ibuprofen when it gets uncomfortable. I've wouldn't say I've experienced serious pain from these teeth, more just a dull ache or discomfort or irritation of the gum, but I was referred to a dental surgeon a year or so ago who basically told me he wouldn't take them out. He claimed that the lower teeth were so well developed at this point that removing them might expose the nerve in my jaw underneath and leave the lower half of my face numb, potentially for the rest of my life. As a risk/benefit calculation he decided against taking them out for now, but may change his mind if they cause problems in the future, which they likely will. This is an NHS dental surgeon though and I'm wondering if I might be best served getting an a second opinion from a private dentist as well. The last few days my lower right tooth has been really irritating the gum around it that I've been taking ibuprofen for two or three days. If I went to the dentist when these originally started to emerge instead of waiting until they started to cause some discomfort I could have had them removed with much less risk. I was however under the assumption that wisdom teeth should only be removed when they cause problems, which for the first few years mine didn't really.