When Abstinence is Evidence-Based

I came across a 2012 talk Jay W. Friedman gave titled “When Abstinence is Evidence-Based: The Case Against Prophylactic Third Molar Extractions,” at the 2012 National Oral Health Conference. The PowerPoint for the talk is located over at http://www.nationaloralhealthconference.com/docs/presentations/2012/05-02/Jay%20Friedman.pdf (I have mirrored it over at http://www.teethremoval.com/When_abstinence_is_evidenced_based.pdf). For those not aware of Jay W. Friedman you can start by reading the post American Journal of Public Health Author Jay W. Friedman is 2009 Author of the Year and Looking at the Concept of Prevention in Dentistry.
Some interesting graphics appear in the talk, a few which I have included in this post.

jay_w_friedman_third_molar_dds
The talk is very concise and to the point and very informative for anyone considering whether or not to extract wisdom teeth (third molars). I will now provide a brief overview of the talk, but encourage you to look at the full talk yourself.

Like usual (see http://www.teethremoval.com/controversy.html) several jabs are taken at AAOMS (the American Association of Oral and Maxillofacial Surgeons). For instance, he mentions how AAOMS placed a 4 page ad in USA Today in 2007 and didn’t mention any potential complications from extraction. He says that even though AAOMS has changed the language on their website on wisdom teeth in 2012, it still essentially says if wisdom teeth are less than perfect than they should be extracted.

Jay W. Friedman argues that normally developing wisdom teeth (third molars) are over-classified as being full bony impactions. He shows several pictures of wisdom teeth that may appear to be impacted at a younger age but then that erupt normally at an older age. For example see the progression of what appears to be an impacted wisdom tooth at age 13 to one that is erupted at age 18.

jay_w_friedman_impaction_to_eruption

Like usual he then argues that wisdom teeth have minimal pathology (around 12%) and prophylactic appendectomies and cholecystectomies are not advised due to their risks of surgical complications. Jay W. Friedman estimates that around 70 to 80% of third molars are extracted prophylactically in what he calls FUN surgery (or FUN dentistry). FUN meaning functionally unnecessary. He mentions that AAOMS sponsors most of the research of third molars and only found 9 journal articles mentioning third molars in periodontal journals.

He mentions in his talk about permanent nerve damage and argues that tens of thousands of patients each year are afflicted with permanent nerve damage from removing wisdom teeth for no good reason. He also discusses a study where prolonged mouth opening from wisdom teeth surgery may contribute to tmj symptoms. Dr. Friedman then alludes to the point that economic based surgery instead of evidence based surgery may be the case and presents some numbers to show that wisdom teeth removal is a $4 to $5 billion dollar industry. He implicates other dentists and dental educators and questions their ethics and morals.

Other interesting points and numbers are mentioned in the talk which I have glossed over. Jay W. Friedman essentially ends his PowerPoint by saying

“When there is sufficient evidence that abstention is evidence-based, we are ethically bound to inform the public so that it may avoid treatment that is potentially injurious.”

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