Is wisdom teeth removal a racket?

Digg is an online magazine, a news aggregator, and yesterday they published a particularly ignorant article under the banner, “Wisdom Tooth Removal Is a Racket and Other Facts.” It definitely needs a response.

The author, Rob Wile, relates his own bloody wisdom tooth removal experience, which ended in his catching pneumonia. His description of the experience leaves me wondering if he is exaggerating, it seems so far out of the normal, but let’s accept it as true.

He says that he had his wisdom teeth removed when he was in his early teens. If that is true, that could explain some of his problem. At that age, if the wisdom teeth are even present as tooth buds. they are round and slippery and often deeply embedded in the bone. Because of their shape and slipperiness, sectioning them is difficult, so you have to cut a hole in the bone as big as the tooth to get them out. And even then, it’s difficult to grab them. In my practice, I took out hundreds of wisdom teeth. It’s easiest to take them out when the roots are mostly, but not completely, formed, and the teeth are close to the surface, which usually happens in the later teens.

He then cherry-picks some published articles by various scientific journals to give credibility to his argument. None of the articles, however, would lead to the extreme conclusion that he draws that wisdom tooth removal is a scam. But let’s examine a quote from one of them, a Dr. Jay Friedman. Wile’s article says this, quoting Dr. Friedman:

“It is specious to contend that less than 3 days of temporary discomfort or disability is a small price to pay to avoid the future risks of root [destruction], serious infections, and cysts,” he wrote in his paper. “Also ignored is the risk of incidental injury such as broken jaws, fractured teeth, damage to the [mouth] joints, temporary and, especially, permanent paresthesia or dysesthesia (numbness and dysfunction of the lower lip and the tongue).”

I looked up this Dr. Friedman. He’s a dentist, it turns out. He had an article published in the American Journal of Public Health titled “The Prophylactic Extraction of Third Molars: A Public Health Hazard.” In there he lists what he calls myths about wisdom teeth removal. One is given thus: “Myth Number 2–early removal of wisdom teeth is less traumatic.” That is simply not true, and no one who has taken out many wisdom teeth would say that. Actually, I don’t think any dentist who has taken out many teeth of any type would say that. As patients get later into their 20s, 30s, and older, the bone gets increasingly unyielding. The roots of the teeth also get fully formed and then begin to accumulate more cementum, often making them fatter toward the end of the root than they are closer to the surface, a factor which greatly complicates their removal. That’s a well-known fact among all dentists who do many extractions on patients of varying ages.

So I decided to check out this Dr. Friedman. Turns out he is not a practicing dentist. He’s a dental insurance consultant. I should have known. He has a DDS degree and then a Masters in Public Health, and has been working as an insurance consultant since 1962. Clearly it is in the interests of his insurance company to discourage the removal of wisdom teeth. In his Linked-In profile he describes himself as a “consumer advocate” and a “gadfly.” You don’t say!

In the cited American Journal of Public Health article he states: “Furthermore, dry socket, secondary infection, and paresthesia are less likely to occur in persons aged 35 to 83 years than in those aged 12 to 24 years, who experience more third-molar extractions.” As one who took out hundreds of wisdom teeth in my career, I will tell you that is completely foreign to my experience. I witnessed all of those complications in my practice, but never in a teenager. If you can take out the wisdom teeth when the roots are not quite completely formed and the tooth is close to the surface, the surgery is predictably straightforward and quick.

But what annoys me the most about Rob Wile’s article is the impugning of the integrity of the dental profession. Now I am one who has been highly critical on this blog of many dentists. Nevertheless, from my observation, as a whole, the dental profession has more integrity than any other profession with which I have been closely associated. And from dealing with the dental insurance industry, of which Dr. Friedman is a member, it has been clear to me that they have a lower average level of integrity than dentists. By far.

Here’s a challenge for anyone who feels that wisdom tooth removal is a scam. Ask the families of oral surgeons who extract a lot of wisdom teeth. Do they have the wisdom teeth extracted on their own children? I’ll wager that they do, but you can go ahead and do a survey. I extracted the wisdom teeth on my children, all when they were in their late teens, because I’m confident it was in their best interest. And I’m confident that other dentists feel the same way.

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