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Wisdom Teeth Advice and New Dental Schools

Posted on 29. Oct, 2011 by wisdom.

A new article in the New York Times titled “Wisdom of Having that Tooth Removed” written by Roni Caryn Rabin published September 5, 2011, is an interesting articles for those considering whether or not to have healthy wisdom teeth extracted. The article is located at http://www.nytimes.com/2011/09/06/health/06consumer.html

The article explores some of the issues regarding whether or not you should or not have have healthy wisdom teeth extracted.

The article discusses how the American Association of Oral and Maxillofacial Surgeons (AAOMS) held a press conference back in October of 2010, http://www.aaoms.org/docs/media/third_molars/key_findings.pdf, in which one of the key findings was

“Retained, asymptomatic wisdom teeth are eventually extracted between 25% and almost 70% of the time.”

The author of the New York Times article questioned AAOMS on this statement which appeared on their website. The response from AAOMS was

“Yet when asked, the association was not able to produce the evidence for these figures.”

The author concludes

“As for my daughter Emma, we have opted for watchful waiting. She went off to college last month, wisdom teeth and all.”

An interesting article by the American Dental Association (ADA) titled “Special Report: An in-depth look at new dental schools” by Karen Fox published September 5, 2011, located at http://www.ada.org/news/6173.aspx explores new dental schools which are now opening in the U.S. This is partly driven due to new academic health centers which believe dental school is essential to their mission.

The ADA is concerned about the opening of these new dental schools as additional dentists can potentially bring down the overall average salaries of dentists.

The ADA is concerned with the extremely high costs of dental education as those who graduate from dental school from public schools paid an average of $124,397 for their education while those in private schools paid $223,788. These high costs can affect how a dentist practices. The ADA is also concerned with the research that may not be conducted by these new dental schools. The ADA is further concerned that many of these new dentists will work in more affluent areas and not serve those most in need of dental care in undeserved areas. The ADA maintains that it can not control the supply and demand of dentists, although I do not entirely agree.

“But it’s up to the governing board of an institution of higher education to decide to open or close a dental school. “The ADA has no role in the creation of new dental schools. A professional organization cannot control supply and demand,” said Dr. Brain T. Kennedy … chair of the ADA Council on Dental Education and Licensure.”

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ADA Breaking Down Barriers to Oral Health for All Americans: Repairing the Tattered Safety Net

Posted on 15. Aug, 2011 by wisdom.

On August 12, 2011, the American Dental Association (ADA) released the second paper in their series of papers on access to oral health.

The paper is available for download from the ADA at http://www.ada.org/sections/advocacy/pdfs/breaking-down-barriers.pdf

The first paper released on February 22, 2011, was titled Breaking Down Barriers to Oral Health for All Americans: The Role of Workforce as available for download from the ADA at http://www.ada.org/sections/advocacy/pdfs/ada_workforce_statement.pdf. I have previously commented on this first paper here http://blog.teethremoval.com/breaking-down-barriers-to-oral-health-for-all-americans-ada-workforce-statement/

Like the first paper, in the opening of the document is a message from Raymond Gist, D.D.S. and President of the American Dental Association. In this message Dr. Gist states

“…increasing numbers of Americans find themselves unable to pay for dental care….For this growing population, the so-called oral health safety net is the only recourse for preventing and treating oral disease….the general definition of safety net is the sum of the individuals, organizations, public and private agencies and programs involved in delivering oral health services to people who, for reasons of poverty, culture, language, health status, geography or education, are unable to secure those services on their own…..With the acknowledgment that change to the current system is necessary and is a process and not an event, the ADA is determined to lead what must be the concerted efforts of not only the dental profession, but also governments at all levels, the private and charitable sectors, and all Americans with the will and desire to achieve the goal of a healthier, more productive nation. If all of the stakeholders involved keep that goal at the forefront of our thinking and actions, we can truly progress toward better oral health for all Americans.”

The paper goes on to discuss the safety net for the roughly 82 million people in the U.S. in low income families of which only 27.8% visit the dentist each year.

The ADA is adamant about keeping non-dentists from not providing dental services such as extractions and  restorations”

“The ADA remains unequivocally opposed to proposals for these so-called “midlevel providers,” believing that adding lesser-trained “surgeons” to the workforce has the potential to erode the superlative quality of American dental care….The problem is not how many dentists there are; but rather where they are, and whether they are able to serve disadvantaged patients, either in private practices or in connection with clinics, health centers or other facilities.”

The ADA believes that Americans don’t take their oral health seriously:

“Major improvements in the dental safety net will not occur until the nation places greater value on oral health. Despite a growing appreciation in many quarters that oral health is integral to overall health; it remains the poor stepchild of health care in America. This phenomenon extends from government to the media to other health professions to the public at large. This lack of recognition of the importance of oral health is manifest in government policy, in public and private health plans, in the educational system and even in the priorities that individuals set for themselves and their families.”

Unfortunately I think the ADA is thinking and focusing on issues here without recognizing that there other issues that need to be addressed in the current system. As illustrated in the first paper dentists, oral surgeons, and doctors/physicians in private practice in the U.S. clearly have some financial incentives which are in opposition to achieving the goal of a healthier nation. This is simple economics and understandable.

As eloquently put by someone who suffered from a constant headache after having wisdom teeth removed just like myself:

“In our society, protection from liability is primary, profit is secondary, preserving the posterity and ego of the medical profession is tertiary, and treating the patient is somewhere further down [the] priority chain.”

I have recently added a case to the complications from wisdom teeth page where a patient recently had wisdom teeth extracted by an oral surgeon and suffered from a scar on her cheek likely from thermal injury from the dental drill during surgery. She did not know about the injury until after surgery and was told by the oral surgeon’s office the “…condition was not related to the surgery. ” I had a similar experience when I had my wisdom teeth extracted. When I went back to my oral surgeon after having my wisdom teeth extracted preventatively at the age of 20 complaining of a chronic severe 24/7 headache I was told the headache was not from the surgery and to see my family doctor.

Both in my case and the case I just discussed where the woman suffered a thermal burn, there was no access to the court system of the United States. There is no such system that will pay patients who suffer from injury. In my case I had a 24/7 headache develop. This certainly has and will continue to happen to others who have wisdom teeth extracted in the name of prevention. No technology allows for a headache to be “seen” thus this makes it very difficult to have any sort of malpractice case or recover any fees.

Does it not make sense to focus on fixing some of the problems with the current system? I believe it is time for a no-fault insurance compensation system to be in place in the U.S.  Such a system has been successfully implemented in New Zealand. http://www.commonwealthfund.org/Publications/In-the-Literature/2006/Feb/No-Fault-Compensation-in-New-Zealand–Harmonizing-Injury-Compensation–Provider-Accountability–and.aspx

The ADA Repairing the Tattered Safety Net document states:

“A public health model based on the surgical intervention in disease that could have been prevented, after that disease has occurred, is a poor model. The nation will never drill, fill and extract its way to victory over untreated oral disease. But simple, low-cost measures like sealing kids’ teeth, educating families about taking charge of their own oral health, expanding the number of health professionals capable of assessing a child’s oral health, and linking dental and medical homes will pay for themselves many times over.”

Unfortunately, the current system in the U.S. allows for any young adult to go into their dentist or oral surgeon’s private office and have their wisdom teeth removed in the name of prevention.  Then if they suffer a chronic, severe 24/7 headache which severely impacts their life and future earning potential they have no access to receive any compensation and their is no universal healthcare system in the U.S. as it is not considered a right. Of course other possibilities are possible.

I have hence argued that the U.S. needs a single-payer health care in the United States, such as what is advocated by the Physicians for a National Health Program http://pnhp.org/, although this comes with many challenges as well.  The U.S. most certainly needs a major overhaul of the legal system as argued on the page of how the current U.S. legal system rewards doctors for malpractice.

The ADA needs to refocus it’s efforts on removing profits from patient care in the U.S., allowing the people who have been injured  compensation, dentists and doctors respecting and being ethical in their treatment of patients, and most certainly allowing all patients a right to have dental and health care. I can not and will not advocate for surgical extraction of healthy wisdom teeth unless there is clear scientific evidence to demonstrate that removing healthy wisdom teeth preventively is beneficial. Does not the ADA believe in scientific evidence? Current scientific evidence does not support nor refute preventative healthy wisdom teeth extractions and some argue:

“…removing organs such as tonsils and appendices for preventative reasons when they are healthy, have no pathology, and cause no symptoms would be irresponsible, unethical, and negligent and wisdom teeth should be in that category of organs.”

Now certainly this may not apply to all those low income families the ADA talks about in their report who do not regularly see the dentist. The majority of low-income patients maybe should be having their healthy wisdom teeth extracted preventatively particularly those who are uneducated and do not make their oral health a priority which may simply be do to not having the financial resources to do so. However, for the rest of the population particularly in those motivated and educated about making their oral health a priority it seems in most cases to be better served with a strategy of watchful monitoring of healthy wisdom teeth. This is an unfortunate reality of the current state of affairs in the U.S. and I hope and pray that very soon things will change for the better.

I am open to comments and criticisms. Post a comment below or send me an email.

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World Oral Health Day

Posted on 11. Sep, 2008 by wisdom.

Today, September 12th, 2008 has been declared as the First World Oral Health Day.

The American Dental Assocation (ADA) and the FDI World Dental Federation want to use the day to “boost awareness of oral health and its impact on general health and well-being.”

The date marks the anniversary of the FDI World Dental Federation and their groundbreaking International Conference on Primary Health Care, which was held on September 12, 1978. In addition the date honors Dr. Charles Godon, the FDI founder, who was born Sept. 12, 1854.

“We hope that awareness of the importance of oral health can be elevated through the worldwide recognition of this day,” said Dr. Burton Conrod, FDI president. “The dentists of the world are committed to helping each and everyone in achieving optimal oral health through prevention and the highest possible standard of care.”

Source: ADA News: ADA, FDI mark first World Health Day

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California Dental Association – Wisdom Teeth

Posted on 08. Sep, 2008 by wisdom.

I wanted to write briefly about the California Dental Association and applaud them for their current stance on wisdom teeth and their removal.

It is available to the public at http://www.cda.org/popup/Wisdom_Teeth

Here is an excerpt from the site.

“In addition to problematic impacted wisdom teeth, partially erupted wisdom teeth (poking through the gums a little bit) should also be removed. Bits of food and bacteria get trapped in the pockets between the partially erupted tooth and gum, and cause infections and gum disease, not to mention pain. But according to Dr. Robert Boyd, Orthodontist, Periodontist, and Chairman of the Orthodontics Department at University of the Pacific School of Dentistry, the trend today is to leave healthy, stable, wisdom teeth alone, monitoring them over the years to make sure they stay healthy and stable. Dr. Alex McDonald, Oral Surgeon and Director of the Implant Clinic at UOP agrees, pointing out that the risks involved when using anesthesia and the risk of nerve damage to the lower jaw when removing the lower wisdom teeth should be considered when recommending removal of impacted wisdom teeth.”

From looking around the internet this is the only current dental association in the United States that recommends watchful monitoring of healthy impacted wisdom teeth. The American Dental Association (ADA) offers no such information on their website. The American Association of Oral and Maxillofacial Surgeons (AAOMS) is using outdated information on their website and states that 85% of all wisdom teeth will need to be removed.

I applaud the California Dental Association for providing the public with up to date information and to keep them informed. I only hope that the ADA and AAOMS can soon follow.

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