I participate in a world-wide group of health care providers that exchanges information about the high costs of health care and overtreatment in our respective countries. (It’s not just an American problem!)
One provider recently shared for our consideration a paper that stated too many third molars (aka wisdom teeth) were being unnecessarily removed in the US.
Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion.
In addition, more than 11 million patient days of “standard discomfort or disability”—pain, swelling, bruising, and malaise—result postoperatively, and more than 11000 people suffer permanent paresthesia—numbness of the lip, tongue, and cheek—as a consequence of nerve injury during the surgery. 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.
Although the paper dated from 2007, the statistics have not changed much. I also found that the biggest predictor of whether or not someone had their wisdom teeth removed was not that it was medically necessary, but that the patient (or the parents) had dental insurance.
I had my wisdom teeth removed at age 18, as did my husband and all our siblings. My son had his removed a few years ago just after graduating from high school. I never really considered he wouldn’t have his wisdom teeth removed, and was just waiting to hear our dentist tell us when it was time.
X-rays in hand, we dutifully went to see the oral surgeon and I was told all four of my son’s wisdom teeth were impacted and needed to come out. The cost was approximately $2,000. As we didn’t have dental insurance, he gave us a 10% discount for paying in full at time of service.
My son’s experience was miserable, although probably not unusual. He was in a lot of pain, and I was being miserly with the pain meds because I was worried about acetaminophen overdose from the Percocet. Then one of his sockets got infected and we had to go back to the oral surgeon to have it cleaned out (really, really painful) and get a prescription for an antibiotic.
Was his trauma unnecessary? I don’t know.
Most oral surgeons (85%) say yes. Just do it. But isn’t that one of our problems with health care in this country? We look to the experts for advice, even though they are also the ones profiting from the procedure. It sets up a conflict of interest.
What would I do differently now that I’m a Frugal Nurse and ask lots more questions?
My understanding has always been that wisdom teeth will eventually cause problems, and it’s less painful to take them out when you are young. (Try telling that to my son!)
The above-mentioned paper addresses these myths, as he calls them.
Myth Number 1—Third Molars Have a High Incidence of Pathology
Not more than 12% of impacted teeth have associated pathology. This incidence is the same as for appendicitis (10%) and cholecystitis (12%), yet prophylactic appendectomies and cholecystectomies [gall bladder removal] are not the standard of care. Why then prophylactic third-molar extractions?
Myth Number 2—Early Removal of Third Molars Is Less Traumatic
Early removal of third molars is actually more traumatic and painful than leaving asymptomatic, nonpathologic teeth in situ….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. The highest risk of complication is in persons aged 25 to 34 years.
A New York Times article on this topic offered some good advice:
IF EXTRACTION IS RECOMMENDED All surgery carries risks, and you should try to ensure that there is something to be gained from having your wisdom teeth removed. Ask what the reason is in your case. Is there a chance the wisdom teeth will grow in successfully? If you see a dentist on a regular basis, is watchful waiting an option?
IF YOU CHOOSE SURGERY Most dental plans cover at least some of the costs of extraction. If you don’t have dental insurance, pulling all four teeth may cost several thousand dollars.
Ask if you can have local anesthesia, which is considered safer than general anesthesia.
IF YOU DECIDE AGAINST EXTRACTION Good dental hygiene will be even more important for you. The teeth in the back of the mouth are often harder to reach and clean well. Get frequent cleanings, and X-rays if necessary.
And I liked this quote from an article earler this year in the Los Angeles Times: Dentists debate need to extract wisdom teeth
Scott Tomar, a professor of community dentistry and behavioral science at the University of Florida, considers removing healthy wisdom teeth no different than removing a healthy appendix just in case it might burst. “I don’t know of any other surgical treatment still done in the United States where we prophylactically do an invasive surgical procedure unless there’s pretty strong evidence supporting it. We’ve abandoned that idea long ago.”
So would my son still have his wisdom teeth if I knew then what I know now? I don’t know. But I would have paid a lot more attention to the x-rays and asked more thoughtful and specific questions of both our dentist and the oral surgeon rather than just blindly following their instructions.
I’m glad to say I don’t do that anymore.