Differing Views in Medicine and Dentistry Applied to Wisdom Teeth

An interesting article appears in the 2014 version of the Journal of Oral and Maxillofacial Surgery titled “Asymptomatic Third Molars Under Nominalist and Essentialist Lenses,” written by V. Wallace McCarlie and Daniel L. Orr II, pp. 658-659.  The authors define two differente views: 1) essentialism and 2) nominalism and then try to apply them to the management of wisdom teeth. The authors state

“Essentialism is the notion that underlying every properly defined disease is an unchanging reality causing illness. Conversely, nominalism is not concerned with underlying causes, but rather with signs and symptoms of illness.”

In the article the authors mention a study which says that dentists detect rather than diagnose. The authors later say that detection implies nominalism and diagnosis implies essentialism. The authors give some downsides to both points of view. For example, they say essentialism is less focused on the patient and treatment. They say nominalism does not focus on causes which may be important for prevention.

The authors state

“An example of the importance of not focusing solely on symptoms (nominalism) is the case of asymptomatic impacted third molars. Life-threatening head and neck pathology, such as space infections, necrotizing fasciitis, osteomyelitis, and cysts or tumors, may arise from initially asymptomatic third molar impactions that have not been objectively evaluated and addressed appropriately in a timely fashion.”

The authors then say that impacted wisdom teeth should be removed if evidence suggests they are likely to be a problem in the future. No numbers on the incidence of such life threatening pathology is mentioned however in this article.

The authors later state

“Harmonizing the 2 paradigms in dentistry overcomes respective essentialist and nominalist shortcomings. Clinical researchers and attentive practitioners are well positioned to investigate and understand the 2 approaches in furthering the art and science of dental medicine. By doing so, practitioners can continue to provide the highest level of patient care.”

I don’t necessarily agree with the authors opinions in the article. In my experience physicians in the U.S. tend to be more focused on current symptoms and managing symptoms although this is not true with all medical issues. The authors don’t put forth any theories towards the underlying illness of third molars and how to tell which wisdom teeth are likely to cause such life threatening problems in the future.

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