Tooth extraction not so wise

Until a recent dental X-ray, I’d assumed I had no wisdom teeth. To be perfectly honest I’d worn my lack of wisdom teeth with somewhat of a badge of honour, and rather than worrying that wisdom may have eluded me, had arrogantly wondered if my lack of vestigial third molars might signify a superior level of evolutionary advancement. In a few thousand years maybe no-one would have them, I’d figured.
Sadly, radiology shattered my pompous, tongue-in-cheek illusion. Rather than being absent my wisdom teeth were “impacted”; rather than being advanced, I was impaired.
Although many people choose extraction, it only took me a nanosecond to decide to keep my newly-discovered teeth, and I was fascinated to read an article yesterday about this very issue.
Writing in the journal, Health Policy and Ethics, retired US dentist, Dr Jay Friedman is scathing about the unnecessary prophylactic removal of wisdom teeth, which he labels a public health hazard.
“At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability”, he writes.
According to Friedman, the evidence to justify preventative surgery simply doesn’t exist, although it does line the pockets of the dental profession, especially oral and maxillofacial surgeons who earn on average over half a million US dollars a year from the eight minute procedure.
Instead of evidence, misinformation and myths drive the multibillion-dollar industry, Friedman says, one of the most common being that wisdom teeth have a high level of pathology, whereas in reality no more than 12% of impacted teeth are affected. This is similar to the incidence of appendicitis and cholecystitis but we don’t routinely remove these organs just in case.
Neither is it true that the pressure of erupting wisdom teeth causes crowding of other teeth, he claims, saying it’s just not possible for one tooth which develops in spongy superficial bone with little firm support to push over 14 other well-implanted teeth.
Furthermore, third molar extractions are far from harmless, with sixteen known complications including infection, permanent paraesthesia, dry socket, trismus, pain and swelling, he says.
Far from the standard of care, prophylactic extraction is a silent epidemic, Friedman says and I’m convinced.
What about you?
Health Policy and Ethics 2007; 97; 1554-59.