6 ms·

The Prophylactic Extraction of Third Molars: A Public Health Hazard

45 points by nickgrosvenor 11y ago

santaclause33 11y ago
Dentists are often crooks. When I was younger, my parents had to change insurance plans, so I got a new dentist. In the first visit, he takes a quick look at my mouth (with no tools, mind you) and confidently says I had 8 cavities that need drilling ASAP. My previous dentist mentioned no such thing, so my mom took me back to him for a second opinion. He used tools to check, then told us the other dentist was full of shit and that this was surprisingly common. The new dentist would have drilled 8 healthy teeth out of greed.
- chrramirez 11y ago
  Same happened to me, but the second dentist told I had 16 cavities. That was just 3-4 months after a dentist told I had none.
- labster 11y ago
  I hope she told the new insurance company about this. Insurance companies protect us from greed in the medical and dental industries. And then they add their own greed on top of it. But they are really the best protection against unnecessary procedures in a field that most of us cannot understand. Have a similar story here. Went to a family friend who was a dentist, until he sold his practice. The new dentist wanted to do a $600 procedure every six months like clockwork. And I didn't have insurance at the time, so the charges really added up. I wised up after a couple times and switched to a new dentist who isn't in the "drill baby drill" contingent. My oral health has been just fine.
- schwap 11y ago
  1/3 == "often"?
- Zelphyr 11y ago
  I had to spend over $6000 last year to get an implant because I let a crook dentist do a root canal when he should have referred me to an endodontist. The endodontist that I eventually hat to go to (after infection had set up) who tried to save the tooth was pulling nasty black stuff out of it that the crook had shoved in. He said that was common amongst dentists "who like to cut corners". That same crook dentist talked me into a gold crown on what turned out to be a wisdom tooth that was supposedly removed 20 years prior (they extracted the other three but apparently decided to save time and leave one in). My dentist now still shakes his head as to why anyone would have recommended a gold crown over extraction of that tooth. I don't know if there is a way to find quality dentists but I'm realizing that this country (US) is rife with crook dentists.
- peckrob 11y ago
  This happened to my wife when we moved to a new city. We needed a new dentists, and chose one based on Angie's List reviews. She'd never had a cavity in her life and goes in for a routine cleaning. The guy said she had SIX cavities that needed drilling immediately (wanted to do it that afternoon) and needed a root canal and crown on one of her back teeth. And of course had generous financing options for the amount that this would go over our dental coverage (which he assumed we would be blowing all at once). She left there in tears and came home. It sounded like a crock, so we asked at our workplaces and chose a different dentist to get a second opinion. He looks around in her mouth for a few minutes and says the the other guy is crazy, she has one area that just needs to be watched but everything else looked fine. Even said her teeth were in outstanding shape. If something seems off with any health-related diagnosis, always get a second opinion.
linkregister 11y ago
Patients who might have avoided the surgery in the absence of confirmed pathology are consigned to a numb jaw or lip or tongue for the rest of their lives. I found this excerpt to be the most shocking of the article. The computer scientist in me should be more offended at the 2/3 spurious extraction rate and its subsequent drain on the economy, but that excerpt is what excited me.
- mchahn 11y ago
  > are consigned to a numb jaw or lip or tongue for the rest of their lives. My wife suffered from this, but the nerve grew back in about a year. When the novacaine went away she was very nervous about this and called the dentist. The dentist was angry, said it wasn't possible, and to not call back. My wife just wanted to know if there was anything she should do but the dentist was obviously covering his ass.
  - gohrt 11y ago
    Did you follow up with the authorities? Covering up medical malpractice is a serious misbehavior.
    - mchahn 11y ago
      Yes, the covering up is bad, but I would never sue a professional doing his job. Once I had an enhanced contrast MRI for my kidneys. To enhance it they injected a ton of iodine into my blood. They warned me that my prostrate would get hot (weird), which it did. Later when I was back at the urologist I was explaining that I was often experiencing a hot prostate, just like I had during the MRI. He then made a point of the fact that he had never heard of that happening in a MRI. I was surprised considering that he had prescribed the MRI and the nurse had warned me. I later read about a class-action suit against GE, who made the machine, and doctors who prescribed these tests. Now it all makes sense. He also was covering his ass.
      - maxerickson 11y ago
jacobolus 11y ago
Modern culture has somewhat weird oral hygiene rituals and poor public awareness of the causes of tooth decay. There’s no inherent reason humans should need to brush their teeth multiple times per day. In many places around the world, people never brush their teeth and most adults keep healthy teeth well into old age. Dental cavities are caused by bacteria which eat sugar/starch. If you don’t eat sugar, and only eat moderate amounts of starch, you generally won’t get cavities, regardless of how much teeth brushing you do. If you eat lots of sugary and starchy foods, drink sugary drinks, etc., you will be at high risk for cavities, even if you brush your teeth frequently. Applying topical fluoride paste from time to time certainly helps, but not nearly as much as cutting out the sugar.
- mchahn 11y ago
  I didn't brush my teeth until I was 25 and I had no particular problems before or after. Well, I had one problem. My new wife demanded I brush my disgusting teeth.
  - johnloeber 11y ago
    If you're an adult drinking fluoridated water and your diet doesn't consist entirely of Coca Cola, then indeed you have little to worry about in terms of cavities. Brushing one's teeth twice a day is then mostly a matter of grooming (read: not having bad breath).
    - stcredzero 11y ago
      With regards to grooming: Brush only once a day, but floss twice daily. Most people walk around with all this gristle between their teeth and gums, but it's covered up by minty flavor and smell just after they brush. Then it degenerates to a mixture of the gristle and the minty-toothpaste, which is actually worse!
    - mchahn 11y ago
      I have quit using toothpaste. I researched what it was for and it was reported to have grit to polish the teeth, mouthwash action, and fluoride. I don't need fluoride and I don't want to grind my teeth down. I also haven't heard any reports of bad breath from no mouthwash. My teeth still feel cleaner, bits of food are removed, and don't look any uglier.
Hydraulix989 11y ago
I still have my "wisdom teeth" and I push back on having them out every time I visit the dentist. The conversation always goes along the lines of "ohhh, I see you still have those wisdom teeth in there" and then that they are "impacted and going to cause lots of problems." To this day, I haven't had a single problem. My biggest concern is the effect it will have on my airways -- I have sleep apnea so I'm worried that removing the teeth will cause the size of my already-small airways to become even smaller, causing even more of a damaging effect on the quality of my sleep.
- davidw 11y ago
  I was told, 20 years ago, that "in the next few years" I would have horrible pain from my wisdom teeth. I still have them, and no horrible pain. I guess it's possible they could cause even worse problems down the road, but for the time being, I think it's not worth the pain/hassle to have them out.
  - twothamendment 11y ago
    It has only been 6 years for me since the dentist told me I'd be begging him to pull my wisdom teeth in the next few months. Since then I've chipped a corner off of it and it still doesn't bother me one bit. This article highlights many of my thoughts on it - if they aren't bothering me isn't the cure worse than the disease? I'm glad someone is looking into this and willing to go against what seems to be normal.
- AnimalMuppet 11y ago
  Why would removing your wisdom teeth make your airways smaller? (Other than, perhaps, tissue swelling for a few days after the extraction.)
  - Hydraulix989 11y ago
    "Why would removing your wisdom teeth make your airways smaller?" Because the teeth are anchoring the soft tissue of the palate in place, along with the tongue, preventing them from collapsing at night during REM sleep when one's muscles relax (including in the soft palate and airways). Note that one standard surgical procedure -- maxillomandibular advancement -- for treating sleep apnea involves breaking the jaw and moving it forward ~10mm, which increases the size of the airways. This procedure has a 90% success rate. Wisdom teeth extraction is essentially the "opposite" of this procedure -- fewer teeth means the jaw recesses farther back, making the airways smaller. I wear a dental appliance right now to treat my apnea that is custom-molded to the shape of my teeth and moves my lower jaw forward. It's an Elastic Mandibular Advancement Appliance (EMA). I'm worried the dental appliance won't be as effective after I remove some of my teeth (each tooth helps anchor and support the appliance). Considering how debilitating sleep apnea is, I just can't take any chances with it.
awalton 11y ago
My dentist was just discussing this with me two weeks ago, as she's a strong believer in evidence-based medicine. Except she disagreed completely with this publication, citing numerous recent studies published in Great Britain. Apparently, around the year 2000, the UK's health care system introduced some new rules about managing third molars called NICE (probably to try to save some money country-wide not extracting so many wisdom teeth), and now they're learning that NICE was maybe not the greatest policy. NICE recommended that dentists do not extract wisdom teeth until their is evidence of disease, and so for the most part the dentists followed suit and stopped extracting them. Now, fifteen years later, they have found the policy has had no cost-cutting effect - extractions are at the same level as before, only now people's mouths are much less healthy. Diseased wisdom teeth often spread their bacteria on to teeth around them, in the "one bad apple spoils the bunch" way, and people often are unable to actually brush their wisdom teeth properly, especially if they're impacted. Furthermore, given that people are in general reluctant to see the dentist unless they have oral pain, they're often not discovered until the situation's already critical. When discovered, people will often have gum diseases or cavities in second molars caused by the diseased wisdom tooth nearby. See articles from the British Dental Journal such as "NICE or not so NICE?", and "The effects of NICE guidelines on the management of third molar teeth". Either way, I'm very sad I wasn't able to have my wisdom teeth removed as a child, and the anguish of spending ten years with these things wrecking my mouth was not worth it.
- gohrt 11y ago
  > Either way, I'm very sad I wasn't able to have my wisdom teeth removed as a child, and the anguish of spending ten years with these things wrecking my mouth was not worth it. That's a strange follow-up. Nothing in NICE prevented you from removing the teeth if they were wrecking your mouth.
  - awalton 11y ago
    I am not from the UK. I was a poor kid from Kentucky in the US.
- Pitarou 11y ago
  A small clarification: NICE is not the name of the guidelines. NICE is the name of the body that issues those guidelines. NICE issues guidelines for pretty much every kind of treatment throughout the NHS. https://www.nice.org.uk/about/who-we-are https://www.nice.org.uk/about/who-we-are
Kenji 11y ago
I had my third molars removed prophylactically and it was a complete disaster, including breaking a healthy tooth. /anecdote Seriously, guys, the best way to have permanent damage done to your body is getting treatment while your body is healthy. Regularly let them check your teeth but be careful with stuff like that. I would never ever do anything with my teeth again unless there is pain or clear evidence that something bad is going on, like an infection.
- ams6110 11y ago
  This is the same reason I avoid doctors unless I'm sick. With doctors it's like they think (or think you will think) that they are not doing their jobs if they don't find something wrong or you don't leave with a prescription for something. I do get routine dental cleanings every 6 months though. Luckily my dentist is an ethical guy and never pushes anything unnecessary.
zeveb 11y ago
I regret that I have only one upvote to give. I had two of my wisdom teeth out when I was younger, due to extreme pressure from my parents and dentist. Remembering the X-rays now, they would probably have grown in just fine (as did the other two). Adding injury to injury, during the procedure one of my healthy molars was broken, and the dentist (or oral surgeon — it was a long time ago) subsequently lied about it for years! In retrospect, the idea that wisdom teeth must be extracted because modern people's mouths just can't handle them really should have seemed spurious. What — everyone who's not a relatively wealthy American is in agonising pain his entire adult life? That just doesn't compute.
username223 11y ago
Heh. I remember when my dentist asked me to schedule an appointment to remove my wisdom teeth. She said they were coming in straight. I asked her why they should be removed. She said something like "because they're at the back of your mouth, and are therefore harder to clean and will decay sooner." I asked why this didn't apply to my next molars as well. She stopped bothering me, and I still have healthy, straight wisdom teeth a decade and more later.
cookrn 11y ago
Note, this was published in 2007.
danielshaw 11y ago
You might fins this start-up useful as the place to go to if you haven't got a recommendation from a good family or friend: https://www.globalclinicrating.com https://www.globalclinicrating.com - they don't book patients for clinics, just simply monitor and assess the apparent standards and expertise available in clinics worldwide.
uslic001 11y ago
/anecdote I still have my wisdom teeth and have never had a problem and never had to get braces. Now my children are reaching the age when the dentists have started pushing to have their wisdom teeth removed "before they can cause a problem". After reading this paper I am not so sure.

45 points by nickgrosvenor 11y ago

Dentists are often crooks. When I was younger, my parents had to change insurance plans, so I got a new dentist. In the first visit, he takes a quick look at my mouth (with no tools, mind you) and confidently says I had 8 cavities that need drilling ASAP. My previous dentist mentioned no such thing, so my mom took me back to him for a second opinion. He used tools to check, then told us the other dentist was full of shit and that this was surprisingly common. The new dentist would have drilled 8 healthy teeth out of greed.

chrramirez 11y ago
Same happened to me, but the second dentist told I had 16 cavities. That was just 3-4 months after a dentist told I had none.
labster 11y ago
I hope she told the new insurance company about this. Insurance companies protect us from greed in the medical and dental industries. And then they add their own greed on top of it. But they are really the best protection against unnecessary procedures in a field that most of us cannot understand. Have a similar story here. Went to a family friend who was a dentist, until he sold his practice. The new dentist wanted to do a $600 procedure every six months like clockwork. And I didn't have insurance at the time, so the charges really added up. I wised up after a couple times and switched to a new dentist who isn't in the "drill baby drill" contingent. My oral health has been just fine.
schwap 11y ago
1/3 == "often"?
Zelphyr 11y ago
I had to spend over $6000 last year to get an implant because I let a crook dentist do a root canal when he should have referred me to an endodontist. The endodontist that I eventually hat to go to (after infection had set up) who tried to save the tooth was pulling nasty black stuff out of it that the crook had shoved in. He said that was common amongst dentists "who like to cut corners". That same crook dentist talked me into a gold crown on what turned out to be a wisdom tooth that was supposedly removed 20 years prior (they extracted the other three but apparently decided to save time and leave one in). My dentist now still shakes his head as to why anyone would have recommended a gold crown over extraction of that tooth. I don't know if there is a way to find quality dentists but I'm realizing that this country (US) is rife with crook dentists.
peckrob 11y ago
This happened to my wife when we moved to a new city. We needed a new dentists, and chose one based on Angie's List reviews. She'd never had a cavity in her life and goes in for a routine cleaning. The guy said she had SIX cavities that needed drilling immediately (wanted to do it that afternoon) and needed a root canal and crown on one of her back teeth. And of course had generous financing options for the amount that this would go over our dental coverage (which he assumed we would be blowing all at once). She left there in tears and came home. It sounded like a crock, so we asked at our workplaces and chose a different dentist to get a second opinion. He looks around in her mouth for a few minutes and says the the other guy is crazy, she has one area that just needs to be watched but everything else looked fine. Even said her teeth were in outstanding shape. If something seems off with any health-related diagnosis, always get a second opinion.

linkregister 11y ago

Patients who might have avoided the surgery in the absence of confirmed pathology are consigned to a numb jaw or lip or tongue for the rest of their lives. I found this excerpt to be the most shocking of the article. The computer scientist in me should be more offended at the 2/3 spurious extraction rate and its subsequent drain on the economy, but that excerpt is what excited me.

mchahn 11y ago
> are consigned to a numb jaw or lip or tongue for the rest of their lives. My wife suffered from this, but the nerve grew back in about a year. When the novacaine went away she was very nervous about this and called the dentist. The dentist was angry, said it wasn't possible, and to not call back. My wife just wanted to know if there was anything she should do but the dentist was obviously covering his ass.
- gohrt 11y ago
  Did you follow up with the authorities? Covering up medical malpractice is a serious misbehavior.
  - mchahn 11y ago
    Yes, the covering up is bad, but I would never sue a professional doing his job. Once I had an enhanced contrast MRI for my kidneys. To enhance it they injected a ton of iodine into my blood. They warned me that my prostrate would get hot (weird), which it did. Later when I was back at the urologist I was explaining that I was often experiencing a hot prostate, just like I had during the MRI. He then made a point of the fact that he had never heard of that happening in a MRI. I was surprised considering that he had prescribed the MRI and the nurse had warned me. I later read about a class-action suit against GE, who made the machine, and doctors who prescribed these tests. Now it all makes sense. He also was covering his ass.
    - maxerickson 11y ago

jacobolus 11y ago

Modern culture has somewhat weird oral hygiene rituals and poor public awareness of the causes of tooth decay. There’s no inherent reason humans should need to brush their teeth multiple times per day. In many places around the world, people never brush their teeth and most adults keep healthy teeth well into old age. Dental cavities are caused by bacteria which eat sugar/starch. If you don’t eat sugar, and only eat moderate amounts of starch, you generally won’t get cavities, regardless of how much teeth brushing you do. If you eat lots of sugary and starchy foods, drink sugary drinks, etc., you will be at high risk for cavities, even if you brush your teeth frequently. Applying topical fluoride paste from time to time certainly helps, but not nearly as much as cutting out the sugar.

mchahn 11y ago
I didn't brush my teeth until I was 25 and I had no particular problems before or after. Well, I had one problem. My new wife demanded I brush my disgusting teeth.
- johnloeber 11y ago
  If you're an adult drinking fluoridated water and your diet doesn't consist entirely of Coca Cola, then indeed you have little to worry about in terms of cavities. Brushing one's teeth twice a day is then mostly a matter of grooming (read: not having bad breath).
  - stcredzero 11y ago
    With regards to grooming: Brush only once a day, but floss twice daily. Most people walk around with all this gristle between their teeth and gums, but it's covered up by minty flavor and smell just after they brush. Then it degenerates to a mixture of the gristle and the minty-toothpaste, which is actually worse!
  - mchahn 11y ago
    I have quit using toothpaste. I researched what it was for and it was reported to have grit to polish the teeth, mouthwash action, and fluoride. I don't need fluoride and I don't want to grind my teeth down. I also haven't heard any reports of bad breath from no mouthwash. My teeth still feel cleaner, bits of food are removed, and don't look any uglier.

Hydraulix989 11y ago

I still have my "wisdom teeth" and I push back on having them out every time I visit the dentist. The conversation always goes along the lines of "ohhh, I see you still have those wisdom teeth in there" and then that they are "impacted and going to cause lots of problems." To this day, I haven't had a single problem. My biggest concern is the effect it will have on my airways -- I have sleep apnea so I'm worried that removing the teeth will cause the size of my already-small airways to become even smaller, causing even more of a damaging effect on the quality of my sleep.

davidw 11y ago
I was told, 20 years ago, that "in the next few years" I would have horrible pain from my wisdom teeth. I still have them, and no horrible pain. I guess it's possible they could cause even worse problems down the road, but for the time being, I think it's not worth the pain/hassle to have them out.
- twothamendment 11y ago
  It has only been 6 years for me since the dentist told me I'd be begging him to pull my wisdom teeth in the next few months. Since then I've chipped a corner off of it and it still doesn't bother me one bit. This article highlights many of my thoughts on it - if they aren't bothering me isn't the cure worse than the disease? I'm glad someone is looking into this and willing to go against what seems to be normal.
AnimalMuppet 11y ago
Why would removing your wisdom teeth make your airways smaller? (Other than, perhaps, tissue swelling for a few days after the extraction.)
- Hydraulix989 11y ago
  "Why would removing your wisdom teeth make your airways smaller?" Because the teeth are anchoring the soft tissue of the palate in place, along with the tongue, preventing them from collapsing at night during REM sleep when one's muscles relax (including in the soft palate and airways). Note that one standard surgical procedure -- maxillomandibular advancement -- for treating sleep apnea involves breaking the jaw and moving it forward ~10mm, which increases the size of the airways. This procedure has a 90% success rate. Wisdom teeth extraction is essentially the "opposite" of this procedure -- fewer teeth means the jaw recesses farther back, making the airways smaller. I wear a dental appliance right now to treat my apnea that is custom-molded to the shape of my teeth and moves my lower jaw forward. It's an Elastic Mandibular Advancement Appliance (EMA). I'm worried the dental appliance won't be as effective after I remove some of my teeth (each tooth helps anchor and support the appliance). Considering how debilitating sleep apnea is, I just can't take any chances with it.

awalton 11y ago

My dentist was just discussing this with me two weeks ago, as she's a strong believer in evidence-based medicine. Except she disagreed completely with this publication, citing numerous recent studies published in Great Britain. Apparently, around the year 2000, the UK's health care system introduced some new rules about managing third molars called NICE (probably to try to save some money country-wide not extracting so many wisdom teeth), and now they're learning that NICE was maybe not the greatest policy. NICE recommended that dentists do not extract wisdom teeth until their is evidence of disease, and so for the most part the dentists followed suit and stopped extracting them. Now, fifteen years later, they have found the policy has had no cost-cutting effect - extractions are at the same level as before, only now people's mouths are much less healthy. Diseased wisdom teeth often spread their bacteria on to teeth around them, in the "one bad apple spoils the bunch" way, and people often are unable to actually brush their wisdom teeth properly, especially if they're impacted. Furthermore, given that people are in general reluctant to see the dentist unless they have oral pain, they're often not discovered until the situation's already critical. When discovered, people will often have gum diseases or cavities in second molars caused by the diseased wisdom tooth nearby. See articles from the British Dental Journal such as "NICE or not so NICE?", and "The effects of NICE guidelines on the management of third molar teeth". Either way, I'm very sad I wasn't able to have my wisdom teeth removed as a child, and the anguish of spending ten years with these things wrecking my mouth was not worth it.

gohrt 11y ago
> Either way, I'm very sad I wasn't able to have my wisdom teeth removed as a child, and the anguish of spending ten years with these things wrecking my mouth was not worth it. That's a strange follow-up. Nothing in NICE prevented you from removing the teeth if they were wrecking your mouth.
- awalton 11y ago
  I am not from the UK. I was a poor kid from Kentucky in the US.
Pitarou 11y ago
A small clarification: NICE is not the name of the guidelines. NICE is the name of the body that issues those guidelines. NICE issues guidelines for pretty much every kind of treatment throughout the NHS. https://www.nice.org.uk/about/who-we-are https://www.nice.org.uk/about/who-we-are

Kenji 11y ago

I had my third molars removed prophylactically and it was a complete disaster, including breaking a healthy tooth. /anecdote Seriously, guys, the best way to have permanent damage done to your body is getting treatment while your body is healthy. Regularly let them check your teeth but be careful with stuff like that. I would never ever do anything with my teeth again unless there is pain or clear evidence that something bad is going on, like an infection.

ams6110 11y ago
This is the same reason I avoid doctors unless I'm sick. With doctors it's like they think (or think you will think) that they are not doing their jobs if they don't find something wrong or you don't leave with a prescription for something. I do get routine dental cleanings every 6 months though. Luckily my dentist is an ethical guy and never pushes anything unnecessary.

zeveb 11y ago

I regret that I have only one upvote to give. I had two of my wisdom teeth out when I was younger, due to extreme pressure from my parents and dentist. Remembering the X-rays now, they would probably have grown in just fine (as did the other two). Adding injury to injury, during the procedure one of my healthy molars was broken, and the dentist (or oral surgeon — it was a long time ago) subsequently lied about it for years! In retrospect, the idea that wisdom teeth must be extracted because modern people's mouths just can't handle them really should have seemed spurious. What — everyone who's not a relatively wealthy American is in agonising pain his entire adult life? That just doesn't compute.

username223 11y ago

Heh. I remember when my dentist asked me to schedule an appointment to remove my wisdom teeth. She said they were coming in straight. I asked her why they should be removed. She said something like "because they're at the back of your mouth, and are therefore harder to clean and will decay sooner." I asked why this didn't apply to my next molars as well. She stopped bothering me, and I still have healthy, straight wisdom teeth a decade and more later.

cookrn 11y ago

Note, this was published in 2007.

danielshaw 11y ago

You might fins this start-up useful as the place to go to if you haven't got a recommendation from a good family or friend: https://www.globalclinicrating.com https://www.globalclinicrating.com - they don't book patients for clinics, just simply monitor and assess the apparent standards and expertise available in clinics worldwide.

uslic001 11y ago

/anecdote I still have my wisdom teeth and have never had a problem and never had to get braces. Now my children are reaching the age when the dentists have started pushing to have their wisdom teeth removed "before they can cause a problem". After reading this paper I am not so sure.