wisdom teeth controversy

Review of the Wisdom Behind Third Molar Extractions

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Back in 2009, an article titled  The wisdom behind third molar extractions” by “S Kandasamy and DJ Rinchuse appeared in the Australian Dental Journal (54. pages 284-292. 2009) I discussed some of the provocative comments in this article in the post Bringing About Healthcare Change. To reiterate he states “…in the 21st century, the routine removal of asymptomatic pathology- free third molars has become a dated practice that is rapidly running out of valid excuses, and it has no justification in contemporary dentistry and medicine.” Earlier this year an article titled “Patient Specific Variables are a Consideration in the Decision to Extract Asymptomatic Third Molars” by Katerine W. L. Vig appeared in the J Evid Base Dent Pract. (2012 12 pp. 92-94) The conclusion of this article is “The removal of third molars to avoid lower incisor crowding is not justified. … Read more

Management of Wisdom Teeth without Symptoms

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An article by Raymond P. White and William R. Proffit titled “Evaluation and management of asymptomatic third molars: Lack of symptoms does not equate to lack of pathology” appeared in the July 2011 issue of the American Journal of Orthodontics and Dentofacial Orthopedics (Vol 140, Issue 1). The article states “Some patients have third molars that are “symptom free and pathology free.” More often, however, third molars are “symptom free, and pathology exists,” requiring a clinical or radiographic examination for confirmation.” The authors state that a recent report suggests that limited periodontal examination in the United States in the National Health and Nutrition Estimates Survey…”underestimated the prevalence of periodontal disease.” A study carried out at the University of North Carolina and the University of Kentucky is mentioned which included 409 healthy young adults who averaged 25 years old and had … Read more

The Evidence Base for Third Molar (Wisdom Teeth) Decisions

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An excellent editorial appears in the Journal of Oral and Maxillofacial Surgery in the August 2012 edition titled “Those Who Ignore the Evidence Are Doomed to Misuse It” by Dr. Thomas B. Dodson (70, pages 1765-1767). Dr. Dodson explains how the debate regarding whether or not to either 1) remove asymptomatic, disease-free third molars, or 2) retain asymptomatic, disease-free third molars has become highly controversial. He argues that there are an assortment of viewpoints that play a role here. A) Payer-based clinical decision making: “The payer is the invisible hand in the operatory, influencing the treatment plan with a bold line that determines whether a service is covered or not. With PBCD, there is little regard or sympathy for what the OMS perceives about the individual patients and their circumstances. Thus, PBCD risks moral hazard by pre-empting services that the … Read more