
The Prophylactic Extraction of Third Molars: A Public Health Hazard - nickgrosvenor
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963310/
======
santaclause33
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.

~~~
peckrob
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.

------
awalton
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.

~~~
Pitarou
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)

~~~
twic
The NICE guidance from 2000:

[https://www.nice.org.uk/guidance/ta1](https://www.nice.org.uk/guidance/ta1)

You don't have to look hard to find criticism of it, but then that's true of
most things. There's going to be a review, slated for publication next year:

[https://www.nice.org.uk/guidance/indevelopment/gid-
tag525](https://www.nice.org.uk/guidance/indevelopment/gid-tag525)

------
Hydraulix989
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.

~~~
sliverstorm
Had mine removed because they were doing one of these[0] that was also
partially erupted. (I consented because I don't think I would have been able
to keep it clean)

My airway is no smaller, as best I can tell.

[http://cdn.ebaumsworld.com/mediaFiles/picture/276916/804033....](http://cdn.ebaumsworld.com/mediaFiles/picture/276916/804033.jpg)

~~~
Hydraulix989
That xray image you attached doesn't show any of your airway though.

When I visited Dr. Kasey Li, I had the entire cross section of my airway
imaged. He was able to measure the size of my airway (I can't remember the
exact mm, but as he said, "thinner than a pencil").

Perhaps you can attach xrays of your airway, before and after, so we have hard
data to work with instead of unbacked assertions?

~~~
sliverstorm
So your airway is less than 6mm? OK, had no idea you were that much of an edge
case. You're literally breathing through a coffee stirrer.

~~~
Hydraulix989
And that's why I have severe obstructive sleep apnea even though I don't fit
the profile for it at all (I'm 150 lbs, 26 years old, and otherwise healthy).

Anyway, I'm quoting the doctor, but I'm not ruling out the possibility either
that he might have exaggerated a bit in his sales pitch.

------
linkregister

        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
> 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
Did you follow up with the authorities? Covering up medical malpractice is a
serious misbehavior.

~~~
mchahn
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
I recently had a contrast CT with an iodine contrast agent. I would guess the
doctor had never heard of the flushing happening after the initial injection,
as the agent is normally out of your body quite quickly (I guess kidney issues
might change that). It's a very strange sensation.

Brief searching points to lawsuits involving an agent using gadolinium instead
of iodine. When I looked into the agents for my scan, the obvious literature
indicated that they chose iodine compounds that were not biologically active.

~~~
mchahn
I'm sorry if I get too personal, but years later I found out I have prostate
cancer (so slow I will die of old age first). I have wondered if that
procedure caused it. I'll never know and it doesn't matter.

------
Kenji
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
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.

------
jacobolus
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.

~~~
Hydraulix989
The hacker in me cautions those who might think that not brushing is a good
idea to save some time:

There are real social consequences in American culture caused by not brushing
your teeth. Other people will get offended by your bad breath and yellow teeth
(especially those of the opposite sex).

It might be a "weird" ritual, but it's also part of our culture and how people
judge you (which actually does matter a lot in society).

Similar arguments apply to things like not bathing and drinking soylent.

~~~
jacobolus
You can get almost the same effect brushing your teeth a few times per week,
if you’re worried about it.

Most of the time if there’s obvious plaque growing on your teeth, it’s because
you were eating something sugary immediately beforehand.

In my anecdotal experience, halitosis is also diet related, and brushing teeth
has only very short term effect on it. Most of the time, bad breath is
neutralized better and for longer by just eating a meal than by brushing
teeth.

~~~
Hydraulix989
Yes, there are other things that can cause plaque and bad breath as well.

However, other people notice even subtle differences/inadequacies in one's
hygiene.

As professional advice, I strongly caution against not brushing your teeth, or
at least, telling others that you do not brush your teeth in public.

~~~
jacobolus
Indeed, apparently even discussing the subject will cause Hacker News readers
to aggressively downvote you. :-)

~~~
Hydraulix989
I actually think that downvoting you is counterproductive to this discussion
though. :)

It's a shame downvote has become an "I disagree with you" button instead of a
way of signalling "low quality content." I counter-upvoted you, which also
abuses the downvote button, but at least two wrongs somewhat make a right
here.

Aristotle: "It is the mark of an educated mind to be able to entertain a
thought without accepting it."

------
zeveb
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
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.

------
uslic001
/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.

------
cookrn
Note, this was published in 2007.

