
The wisdom teeth industry is probably a scam - thebent
http://fusion.net/story/252916/should-i-get-my-wisdom-teeth-removed-no
======
sergiotapia
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
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?

~~~
noir_lord
Had mine out via local as well in the UK I had one crack and one filled that
wouldn't stay filled, exposed nerve etc.

20 minutes one side, came straight out, 45 the other fought ever step of the
way, relief was immediate, couple of weeks and all mended.

Not sure why you'd need to go under or have nitrous.

~~~
nommm-nommm
>Not sure why you'd need to go under or have nitrous.

Many people (myself included) have anxiety around dental work. Just like going
into an MRI might be fine for you but people with even a mild claustrophobia
may find it unbearable.

The other thing is not everyone's procedure is as simple as yours. Your tooth
was exposed, thus easy to extract. Your teeth were not fully impacted, for
example. This -
[https://www.youtube.com/watch?v=SNLuyFaOQoo](https://www.youtube.com/watch?v=SNLuyFaOQoo)
\- shows the procedure for removing impacted wisdom teeth.

~~~
noir_lord
Granted the edge cases require it but anaesthesia is dangerous.

Wouldn't call my second one simple, dentist asked if she could preserve it and
send it to local uni as her words "that's the largest root structure I've ever
seen", at one point I didn't think she could get enough force on it, had to
get a different tool.

Lovely woman and amazing dentist.

~~~
nommm-nommm
Of course sedation is dangerous. Sedation and nitrous both have dangers but so
does avoiding dental work because of patient anxiety. So does a patient moving
during the procedure due to anxiety or being uncooperate. Its all a cost
benefit analysis, like everything in medicine, and each patient and case is
different. Nitrous is fairly safe and very effective and should probably be
suggested more as an alternative to sedation.

You could open up my abdomen and take out my kidney while I was awake and it
would not bother me as long as I didn't feel it. Go near my mouth or eyes
though and I have unbearable anxiety. I'd let all my teeth rot out of my face
before undergoing tooth extraction awake, its that bad.

This is a fairly common fear.

Even without anxiety my oral surgeon strongly recommended at least nitrous due
to the procedure being performed.

Your procedure was simple enough for a dentist to perform, and didn't require
an oral surgeon, so pretty simple.

------
veidr
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
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...

------
cpncrunch
All of the RCTs conclude that there is no evidence that removing unsymptomatic
wisdom teeth is beneficial:

[http://bestpractice.bmj.com/best-
practice/evidence/intervent...](http://bestpractice.bmj.com/best-
practice/evidence/intervention/1302/0/sr-1302-i1.html)

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
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
I don't even get that. I get redirected to [http://bestpractice.bmj.com/best-
practice/verify-user-north-...](http://bestpractice.bmj.com/best-
practice/verify-user-north-american-access.html) 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
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 :)

------
WalterBright
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
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.

~~~
whatusername
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.

------
narrowrail
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).

------
schainks
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.

------
notacoward
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.

------
degenerate
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.

~~~
StavrosK
Two headaches a month? That's a lot of headaches, no?

~~~
jerf
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.

------
horsecaptin
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.

------
csours
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.

------
analog31
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.

------
gilgoomesh
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
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.

------
jessaustin
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...

------
akeck
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...

------
ionised
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.

------
bane
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.

------
collyw
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
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.

------
kevin_thibedeau
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.

------
eric_h
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.

------
taivare
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.

------
beloch
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.

------
superuser2
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.

------
bgilroy26
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.

------
damm
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.

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

~~~
awqrre
The higher the cost of treatments, the higher the costs of premiums...

~~~
cheriot
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.

------
jbssm
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
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
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
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
" I'm not a medical person"-then I'm not going to take your scare mongering
anecdotal evidence.

~~~
bsder
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
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.

~~~
bsder
> I wonder to what extent I'm stressing myself out over a very uncommon
> occurrence.

Probably too much. Modern medicine actually does work for the vast majority of
people--"Hospital does 42 surgeries today--all of them went just fine" never
gets reported. However, humans are biological organisms with lots of
variations. Exceptions _always_ exist.

If you've gone under more than once without complications, you're probably
mostly in the clear. It means that a whole host of things that can go wrong
have already been screened against. One of the big ones is having a problem
with your pseudocholinesterase but no family history to tip off the
anesthesiologist that this might be an issue (I think they screen for this
now).

As you point out, the issue is also "if available". In your case, it's what
needs to be done, so don't stress over it. The complications of _NOT_ doing it
are far worse for you, as you point out. However, too many people just go "put
me out" without the idea that, yes, complications do occur and, really, less
invasive is almost always better.

