In defense of third-molar extractions

Apr 12, 2009

Editor's note: Helaine Smith's column, The Mouth Physician, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

I have been in private practice for 17 years and have witnessed only a handful of patients who do not have problems with their wisdom teeth when they erupt. The other thousands of patients have oral health compromise due directly to their third molars.

From a prevention standpoint, I am a strong advocate of removal of third molars when they have communicated through the gingiva into the oral cavity. I am not an oral surgeon so I cannot speak to the statistics of cysts forming around impacted third molars, but I can speak to the decay and periodontal disease I see due to third molars.

Some of the most common problems I have encountered are deep occlusal decay with difficult access for restoring the tooth, and the need for endodontic therapy on second molars due to distal decay from food impaction. And periodontal pockets readings are conservatively 4-6 mm, which always compromises the integrity of the second molars as rarely do third molars erupt in a cleansable position.

Another problem I have seen is, as patients age and the mandible reabsorbs, many impacted wisdom teeth begin to erupt through the gingiva. It is not fun to be 50 and require a partial boney extraction. Additionally, I have had a healthy patient who was close to hospitalization due to a deep soft-tissue infection from a mandibular fully erupted wisdom tooth. When I educate my patients about the risks involved with keeping third molars, they understand and are able make an informed decision.

All of this said, I was disappointed to read retired dentist Jay Friedman's view that some $4 billion would be saved if wisdom teeth were only removed when necessary. How does he define necessary? What were his criteria in making such a bold statement that blatantly ignores the rest of the oral cavity and disease states that occur in teeth and supporting tissue?

Dr. Friedman did not take into account all the restorative procedures necessary over a lifetime for these teeth and the periodontal work that will be needed due to periodontal disease. I am sure that would add up to more than $4 billion. But let's not talk about money; this is about patients' health and treating them accordingly.

Dr. Friedman's view perpetuates the public's perception that we as dentists are trying to scam them by performing unnecessary procedures. Enough! We are mouth physicians who treat our patients with their best interests in mind. We follow high standards and ethics of practice. It is hard enough that the public is misinformed about dentistry and is always quick to pass judgment on us as a profession. We do not need a retired dentist adding fuel to the fire.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.