Shortly before my next-door neighbor shipped her daughter off to college, she took her to an oral surgeon to have her wisdom teeth removed. The teen was not experiencing dental problems of any kind, but taking out wisdom teeth before they cause concern has become a routine rite of passage for many American adolescents, just as getting your tonsils out was in my generation. In fact, last year the American Association of Oral and Maxillofacial Surgeons issued a statement recommending that young people have their wisdom teeth removed regardless of whether or not the teeth are “diseased or symptomatic” — but personally Iâm not convinced, and neither are a growing number of patients and dental professionals. To put it bluntly, I suspect a case of procedures for profit… and not for health.
A WISE DECISION? DO THE MATH
Some wisdom about those wisdom teeth: They are the third and final set of molars that most people get generally in their late teens or early 20s. Sometimes they grow in perfectly fine, but other times theyâre impacted, meaning that they donât have enough room to emerge from the gum or grow normally. They can be “fully” impacted (they havenât yet broken through the gums) or “partially” impacted (they have somewhat broken through the gums — but not completely). Depending on the position of these impacted wisdom teeth, they might cause pain, inflammation of the gum and/or bone disease, along with damage to adjacent teeth. If those health problems occur, few health professionals would disagree that removal is warranted. But when it comes to taking out impacted teeth that arenât currently causing any health problems — and donât seem like they will in the future — itâs not so black and white.
Data actually show that removing them may be unnecessary. The well-respected Cochrane Collaboration, a UK-based nonprofit group that analyzes multiple studies on a single topic, concluded from a review of numerous clinical trials and other oral-health data spanning 1966 to 2004 that prophylactically removing wisdom teeth neither prevents nor reduces the crowding of front teeth. The American Public Health Association also weighed in on the issue, observing that reasons commonly cited to justify prophylactic removal — e.g., potential gum disease and damage to other teeth — donât happen often enough to justify the dangers associated with this practice.
ITâS REAL SURGERY
Like any surgery, wisdom tooth removal (whether the tooth is fully or partially impacted) poses health risks, notes Jay W. Friedman, DDS, MPH, author of The Intelligent Consumerâs Complete Guide to Dental Health: How to Maintain Your Dental Health and Avoid Being Overcharged and Overtreated. In the case of tooth removal, these risks are serious and include…
- Nerve damage, which can cause numbness of the lips, tongue and cheek. In most cases, these injuries are temporary, but in up to 1% of patients, they are permanent.
- An average of nearly three days of difficult recovery — which could include pain, swelling, bruising and malaise as well as absences from school or work.
- Accidental jaw fracture, damage to sinuses and/or other teeth and, in rare cases, death due to an unexpected reaction to anesthesia.
- Infection in the socket from bacteria or trapped food particles after surgery.
Are you sitting down? Oral surgeons remove about 10 million wisdom teeth from approximately five million Americans each year at an annual total cost of more than $3 billion! According to the Cochrane Collaboration, only 40% of these extractions may have been necessary. Meanwhile, if even 1% of patients develop permanent nerve damage from wisdom tooth extraction, thatâs still 50,000 people a year!
CONSIDER “PERIODIC MONITORING”
Dr. Friedman advises that if one of your wisdom teeth becomes repeatedly infected or damages adjacent teeth or you develop a cyst, tumor or abscess, then removing the tooth is a smart idea. But if a dental-care professional recommends prophylactic extraction, consider a more moderate wait-and-see approach. Everyone should have at least biannual oral examinations by a general dentist, who will monitor all teeth. And if your wisdom teeth have come in, make sure you reach back when you brush and floss to include them, which will help prevent them from becoming “diseased or symptomatic.”
Jay W. Friedman, DDS, MPH, a former researcher at the UCLA School of Public Health in California, and author of The Intelligent Consumerâs Complete Guide to Dental Health: How to Maintain Your Dental Health and Avoid Being Overcharged and Overtreated (AuthorHouse). He is based in Los Angeles.