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Wisdom teeth removal can be expensive for many patients. On top of this many people do not have dental insurance, with many people also not having health insurance. Even if you have both dental insurance and medical (health) insurance many of the costs associated with surgery to remove wisdom teeth will not be covered and you will be responsible for the bill. X-rays and anesthesia can also add to the cost of the surgery.

The actual costs of wisdom teeth extraction surgery vary and depend on numerous different factors. I have previously discussed this over at http://www.teethremoval.com/wisdom_teeth_extraction_cost.html. In this post I talk about how an impacted wisdom tooth can cost between $100 to $878 to be removed. Some of this cost depends on the location you live in and the skills and experience of the surgeon. In addition, the cost depends on the type of impaction you have.

The cost of extraction can increase depending on the type of anesthesia you have done and if you have a cone beam CT scan performed in addition to an x-ray. For many young patients these costs can be significant. In order to reduce costs, you could attempt to research online different surgeons in your community and try giving them a phone call or scheduling a consultation. You could also try to get the surgery done at a college or university where dental students that are training could use your case to attempt to learn. Of course having an inexperienced dentist or surgeon extracting your wisdom tooth may be more risky and could even be more costly in the end if complications occur after surgery.

Other options to attempt to save money include some sort of a payment plan or credit card. You could also attempt to haggle with your doctor as I discussed in this post Haggling With Doctors: Lower the Cost of Your Medical Bills but this may not go over particularly well.

If you are going to have a dentist or oral surgeon remove your wisdom teeth and do not have either dental insurance or a dental plan you should explore your options.  There are also discount dental plans available. For example, the Aetna Dental Access plan which can allow you to save hundreds and even potentially thousands of dollars on dental bills. It is important to note that the Aetna Dental Access plan is not insurance but is a plan that allows you to save some money each time you visit a dentist. This can save you some money on x-rays and extractions.

Of course I don’t think you should skimp on costs for wisdom teeth removal due to potential problems that could arise. I have even advocated for in this post Potential Alternatives to the Current Medico-Legal System in the United States bringing in a lot of cash and paying your surgeon more than he/she charges as a way to motivate them and make sure you receive quality care that is pain free.

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In the article “The tooth fairy and malpractice” by Sian Ludman, Hamid Daya, Polly S Richards, and Adam Fox, in BMJ Christmas 2012, 345, e3027, a very interesting discussion is made of the tooth fairy.

The article states

“We are concerned that the actions of the mythical character at the root of this report must be brought to the attention of the medical community, as it seems to represent the first signs of a worrying new trend in malpractice.”

The tooth fairy is widely considered to be benevolent but the authors present a disturbing report. A discussion is made of an 8 year old who presented with a foreign body in the left external auditory meatus (which showed up on a CT scan). The image is in the report.

The parents of the boy discussed how three years earlier the boy had woken from sleep and was extremely distressed because the tooth fairy had put a tooth in his left ear. The tooth had initially been left under his pillow for the tooth fairy to collect and to leave some money in its place. The parents tried to find the tooth but were unable to.

Once the tooth was located in his left ear the boy had an ENT surgeon remove it.

The authors also present two other cases involved a misbehaving tooth fairy

“The other cases involve a tooth in the upper oesophagus causing tracheal obstruction in a trauma situation, and a man who developed a nipple abscess after inserting his child’s milk tooth into the hole of his nipple piercing to keep his child’s tooth near to his heart.”

Perhaps certain guidelines should be developed to prevent children’s teeth from causing harm. Perhaps a tooth placed under a pillow should instead be placed in a plastic bag or small box or something similar.

Source: “Experts warn of misbehaving tooth fairy” http://group.bmj.com/group/media/latest-news/experts-warn-of-misbehaving-tooth-fairy

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An issue that one asks when having third molar surgery (wisdom teeth removal) is one whether should have antibiotics administered before or after surgery (or not at all). See for example http://www.teethremoval.com/antibiotic_resistance.html

In a recent article appearing in J Evid Base Dent Pract 2012, issue 12, pp. 149-150, Manal A. Awad, reviewed a study exploring amoxicillin administration to those who were having wisdom teeth extracted. The original study was titled “Efficacy of amoxicillin treatment in preventing postoperative complications in patients undergoing third molar surgery: a prospective, randomized, double-blind controlled study,” by Lopez-Cedrun JL, Pijoan JI, Fernandez S, and Santamaria J, Hernandez G and appeared in the electronic 2011 version pages 5 -14, issue 69, number 6. It is well known that amoxicillin is useful in treating oral infections.

In the study 123 healthy patients between the ages of 18 and 46 years which included mostly females (90) were randomly divided into 3 groups: 1) received amoxicillin preoperatively (n = 39), 2) received placebo (n = 44), and 3) received amoxicillin postoperatively (n = 40).  The patients in the study were having at least 1 impacted wisdom teeth removed. Patients and clinicians were blinded as to what group they were in (and what their treatment was).

The authors of the original study (Lopez-Cedrun and et. al)  looked at several clinically important outcomes in their patients after surgery. The researchers found that the patients who did not receive any amoxicillin and just placebo had statistically significantly more pain 7 days after surgery. Futhermore the patients who did not receive any amoxicillin and just placebo had statistically significantly more difficulty in opening their mouth 7 days after surgery. No statistically significant differences in swelling between the 3 study groups 7 days after surgery were found.

The reviewer (Awad) took issue with what the researchers said was a clinically important difference in mouth opening. The authors said that a 5 mm difference  in mouth opening is clinically important, but the researchers did not report the mean difference in millimeters in mouth opening between patients, only if the 5 mm difference was reached or not. The reviewer also questioned whether or not a large enough sample size was used in the study.

Awad states in the conclusion of his review (final paragraph):

“Whether antibiotic use is beneficial to patients who undergo surgical removal of third molars is still inconclusive. Clinical trials that are large enough to assess the effect of antibiotic use on the most common complication of surgical removal of third molars are still needed”

The review by Awad did not go into all of the findings in the original study. Five sockets in the study became infected after surgery and they were all from the group which did not receive any amoxicilin.  Several side effects were reported by patients but no statistically significant differences between the groups occurred for side effects.

Regarding taking an antibiotic before and/or after wisdom teeth removal essentially 3 options can occur.

1.  an antibiotic before surgery in a single dose or multiple doses started several days before
2. an antibiotic after surgery in a single dose or multiple doses maintained for several days afer
3. an antibiotic before surgery and after surgery

The researchers in this study reviewed tested option 1 and option 2 above and not option 3. In addition, they state their findings seems to show that an antibiotic after surgery produce better study results than an antibiotic before surgery.

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In an article titled “Migraine and migraine subtypes in preadolescent children Association with school performance,” appearing in Neurology in 2012 by Marco A. Arruda and Marcelo E. Bigal, a discussion is made that children with migraine may have below average school performance than kids who do not have headaches.

The study looked at 5,671 children ages 5 to 12 from Brazil and found that those with migraine were 30% more likely to have below average school performance than those children with no headaches. The researchers collected information from the student’s teachers on their performance and also completed a questionnaire screening for emotional and behavioral problems. Further, the researchers interviewed parents of the students from medical history and other potential useful information.

Of the 5,671 children around 0.6% had chronic migraine occurring 15 or more days per month and 9% had episodic migraine.

The researchers found that the link between migraine and poor performance in school was even stronger for children with migraines that were more severe, lasted longer, or for children with chronic migraine.

The researchers believe that for those children having headaches with migraine features this is a serious problem and needs to be taken seriously. Further, children need to receive medical treatment and attention.

I believe that this study is accurate although it would be interesting to see a similar study of teenagers. For those who suffer from migraines you may want to see some of my previously posts such as Migraines – Cause and Effect and Daily Preventative Therapies Can Reduce Migraine.

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An interesting article appears in Science in May 2013, titled Morals and Markets (A. Falk, and N. Szech.vol., 340, pp. 707-711). The article sets out to explore how market participants change their attitudes towards harm and damage done to third parties.

The act of producing and trading goods in a market produces negative externalities that can lead to exploiting the workforce through poor working conditions, child labor, and environmental damage. It has been observed that people who participate in markets buy goods without much regard to their own moral standards. The researchers devised an experiment to show that if people participate in markets than their moral standards are lowered.

The researchers state

“Our paradigm for studying moral values and detrimental effects on third parties is the trade-off between a mouse life and money. In our main treatments, human subjects faced the decision to either receive no money and to save the life of a mouse, or to earn money and to accept the killing of a mouse.”

The mice used in the study were young healthy mice that would be expected to live over 2 years in an appropriate environment. The subjects were further given an instructional video showing how the mouse would be killed if they decided to kill their mouse. The mice used in the study were surplus mouse that had been bred with genetic changes that had failed for the intended study purpose. The default protocol for mice in these types of experiments would be to kill them but this information was only told to the participants after the study. Mice that were chosen by the participants to survive were purchased and allowed to live.

Three different conditions were explored: 1) individual treatment , 2) a bilateral trading market, and 3) a multilateral trading market. The last 2 conditions represent market conditions.

In the first study (individual treatment) participants were given two options.

“Option A implied that the mouse would survive and that the subject would receive no money. Option B implied the killing of the mouse and receiving 10 euros. “

In the bilateral trading market,  one seller and one buyer bargained over killing a mouse for a total of 20 euros that the two parties could split up between themselves.

The researchers state

“If a buyer and a seller agreed on a trade, the buyer received 20 euros minus the price agreed upon. The seller received the price. In addition, the mouse of the seller was killed, reflecting a situation in which trade takes place to the detriment of a third party. If a seller or a buyer did not trade, earnings for both were zero and the mouse survived.”

Hence in the bilateral trading market if a trade occurred the mouse died if a trade did not occur the mouse survived.

In the multilateral trading market it was exactly like the bilateral market as just described, except seven buyers and nine sellers bargained over prices.

The researchers found that for the individual decision treatment, 45.9% of subjects were willing to kill their mouse for 10 euros. In the bilateral market, 72.2% of sellers were willing to kill a mouse for less than or equal to 10 euros.  In the multilateral market,  75.9% of sellers were willing to kill a mouse for less than or equal to 10 euros. A statistically significantly higher amount of subjects were willing to kill a mouse in both market conditions when compared to the individual condition. The researchers state this is they key result of their study and suggests that markets erode moral values.

The authors actually present several other studies which I won’t go into and also have a detailed section near the end where they discuss 3 potential concerns that one may raise from their study and their rationale for why their study is valid. The authors conclude by saying

“The point of this study is not to question market economies in general. Indeed, other organizational forms of allocation and price determination such as in totalitarian systems or command societies do not generically place higher value on moral outcomes….We therefore agree with the statement quoted at the beginning that we as a society have to think about where markets are appropriate and where they are not.”

While the authors attempt to be robust in their study, I do question if using something more morally reprehensible than killing a mouse  would alter the results.

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