Monday, April 20, 2009

Wisdom Teeth Extractions: Do The Risks Outweigh the Benefits?


Jay Friedman,D.D.S. has been beating this drum since Flap was in dental school at the University of Southern California and long before the push for evidence-based dentistry.

Why, then, do so many general practitioners and virtually all oral surgeons recommend prophylactic extraction of third molars, as if every wisdom tooth was diseased or likely to become diseased? For oral surgeons, it is multibillion-dollar business. On average, oral surgeons in private practice gross more than $518,000 annually from third-molar extractions.

But for general practitioners there is little incentive. Rather, many of them believe current myths propagated by the AAOMS, such as that most wisdom teeth become pathological and will cause or contribute to systemic disease, and that they cause crowding and overlapping of anterior teeth (Journal of Oral and Maxillofacial Surgery, March 2007, Vol. 65:3, pp. 377-383; AAOMS advertisement, USA Today, September 28, 2007). Many general practitioners also confuse the prevalence of a disease with its incidence in their dental offices. Their opinions are not based on long-term scientific studies but rather on their impressions. They are either unfamiliar with or unaware of the principles of evidence-based practice -- the gold standard of responsible treatment of patients.

Here is the AAOMS (American Association of Oral and Maxillofacial Surgeons) White Paper on Third Molar Data - Pdf.

The above is an extensive 25 page paper on rationales for third molar removal (evidence-based and heavily referenced). Read it all.

Dr. Friedman is an activist and has been pushing his simplistic view of third molar (wisdom teeth) removal for many years. It is all about a conspiracy by the nasty money grubbing dentists and oral surgeons with him and left-wing politics (he declared he was a socialist in front of my dental school class). He has been paid by major labor unions to often review dental practice utilization for their trusts.

A little conflict of interest there?

The best course is to discuss your individual situation with your dentist or oral surgeon and make your own decision after reviewing both sides of the issue.

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