The Wisdom of Keeping our Teeth

Upon hearing of the tragic passing of Sage Stallone after having five teeth pulled, I was reminded of the trauma that dental work can be.  I am grateful we have talented, dedicated dentists who work really hard doing such precise, demanding, and challenging work; however, with the gifts of modern medicine comes the caveat of being overly pathologized.  We tend to implicitly trust our health care providers, and take the necessity of certain procedures for granted.  Prophylactic wisdom tooth removal is one such procedure.

People do not realize how serious dental surgery is, and the agony it can cause. Because dangerous pain killers like vicodin are often prescribed after the surgery, this is also a concern for young people, especially those prone to addiction.  With addiction to pain pills sky rocketing, keeping kids away from them when possible is a good idea.

Dentists agree that impacted wisdom teeth should be removed if there are pathological changes in them, including pain, infection, decay, lesion, or cyst.  But when there is absolutely nothing wrong with them, their removal becomes more of an antiquated habit, rather than a health-promoting procedure.

Most of us will experience having this procedure done without questioning the reasons for doing so.  But perhaps we should not let our teeth be pulled out of our heads without first asking a few more questions.

This is a video of a very good-natured young man named Chaddy after his wisdom tooth surgery:

http://www.youtube.com/watch?v=8rNeKS22Wsg

He is being a great sport, and everyone seems to think this is hilarious.  I think it is horrific: an unnecessary, traumatic cranial injury – not at all funny.  Young people trust their parents and doctors to do the right thing.  Prophylactic removal of wisdom teeth is a racket.  Our teeth are an important part of our skulls, and whenever possible we should keep them.  No reliable research evidence exists to support claims of health benefits to patients from the prophylactic removal of pathology-free impacted wisdom teeth.

Dr. Eric Curtis, DDS, spokesman for the Academy of General Dentistry, says, “In the public’s mind, dentistry is really routine.  You turn 18, and you think it is time for wisdom teeth to come out. It is almost ubiquitous, a rite of passage.”  At least 5 million people undergo the surgery every year at a cost of 3 billion dollars.  It is so common that patients have stopped thinking of it as a serious medical procedure.

This widespread surgery “subjects individuals and society to unnecessary costs, avoidable morbidity and the risks of permanent injury.”  According to a 2007 report published in the American Journal of Public Health, more than 11,000 people each year sustain permanent nerve damage following wisdom tooth extraction.  Tragically 17-year-old Jenny Olenick of Maryland and 14-year-old Ben Ellis of Georgia both died from unnecessary wisdom tooth extraction in 2011.

It is not the dentists’ (and oral surgeons’) fault that they are inclined to do these procedures.  This is what their training and schooling prepares them for; and so in order to change national policy and dental education, a decision to institute policy change needs to be made by those in charge of dental colleges and organizations.

“Everybody is at risk for appendicitis, but do you take out everyone’s appendix?” asks Dr. Greg Huang, chairman of orthodontics at the University of Washington in Seattle.  “I’m not against removing wisdom teeth, but you should do an assessment and have a good clinical reason.”  Studies suggest that no more than 12 percent of impactions lead to infections or damage to adjacent teeth – about the same incidence as appendicitis.  Yet, no medical associations recommend prophylactic appendectomy.

In 2006, the Cochrane Collaboration published a review of the practice and suggested that the number of surgeries could be drastically reduced using “prudent decision-making, with adherence to specified indicators for removal.”  Prophylactic extraction is “likely to be ineffective or harmful.”  The report advised against extracting asymptomatic, disease-free wisdom teeth because of the risks, which include permanent nerve damage, hemorrhage, dry socket, and infection, and extreme pain and swelling caused by the operation.

Sometimes it is said the surgery will prevent crowding, but this concern is overblown.  “Removal of third molars to prevent late incisor crowding cannot be justified.”  An on-going study in Denmark indicates that “watchful monitoring” is an appropriate strategy.  This means going to a dentist periodically throughout one’s life for teeth cleaning and checking to make sure the wisdom teeth are still doing well, just as the rest of the teeth are checked.  (On a side note, if a filling is ever needed for a tooth, make sure to get the white composite filling, rather than the silver filling which contains the poison mercury!)

The American Public Health Association recommends against prophylactic wisdom tooth removal because “the removal of these teeth, like the removal of any teeth, should be based on evidence of diagnosed pathology or demonstrable need, rather than anticipated future pathology.”  The APHA’s position is drawn from scientific research that documents the risks of injury to the nerves of the jaw, which can cause permanent numbness of the tongue, lips, and cheeks, as well as damage to the temporomandibular (jaw) joint and adjacent teeth.

During the surgery, the patient receives anesthesia, and afterwards strong pain killers like Vicodin may be prescribed, which can set a young person up for addiction.  Best not to endure this type of invasive injury in the first place – having your teeth carved out of your skull sounds like something that should only be done as an absolute last resort any way.

Every operation carries risk, especially those that are done near the brain, so why put ourselves through this torture voluntarily?  Please educate those you know in the age range of 17-24 (when the operation is usually performed) that they should make sure they actually absolutely have to go through with this.  If it is not medically necessary, then brushing your teeth and healthy eating might be better for your dental and overall wellbeing than major surgery.

Sources:

1.     Moisse, Katie.  “Parents Sue After Teen Dies During Wisdom Tooth Surgery.”  ABC News.  15 December 2011.  Web.  23 August 2012.

2.     Rabin, Roni Caryn.  “Wisdom of Having That Tooth Removed”  The New York Times.  05 September 2011.  Web.  23 August 2012.

3.     “No Wisdom In Routinely Pulling Wisdom Teeth, Study Says.”  Science Daily.  29 April 2005.  Web.  23 August 2012.

4.     “Wisdom teeth – removal (TA1).”  National Institute for Health and Clinical Excellence.  10 January 2011.  Web.  23 August 2012.

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