This story explores a simmering debate among dentists and oral surgeons over the wisdom of preventative wisdom tooth removal. This issue primarily affects 17-25 year olds, since that is the age when the third molars typically appear and when they are least resistant to removal. The story thoroughly surveys the landscape, giving readers a nice synopsis of each camp’s argument and the evidence (or lack thereof) that supports it. Costs are closely examined. The story would have been stronger had it attached a few more numbers to the potential risks and benefits of each approach.
Preventative removal of wisdom has been an accepted standard of care for decades. Absent universal agreement among doctors and oral surgeons on how to treat non-symptomatic wisdom teeth, it’s very important that young adults understand that there is no absolute right or wrong answer. Whether your dentist falls into the preemptive or the “wait and see” camp, patients should be aware of the risks associated with each approach.
This article talks about the overall costs of removing wisdom teeth — $3 billion annually, according to the American Public Health Association (which opposes preventative extraction) — as well as the costs of removing a single molar. A single extraction can range from $230 to $400 according the story source, the Healthcare Bluebook.
The story would have added more value if it had mentioned a range of costs associated with surgical complications or treatment for infections following surgery.
While thorough in its discussion of the potential benefits and risks of either preventative surgery or a “wait and see” approach, this story is rather thin on numbers. This is a deficiency we’ll address here rather than under the “Harms” or “Evidence” criteria — both of which we rated as satisfactory.
For example, the story gives plenty of space to discussion of the benefits that may be realized with preventative wisdom tooth removal — including the convenience of being able to plan your surgery and recovery dates and a reduced risk of facing a more complicated extraction in the future. But it does not attach any numbers to these benefits. An expert story source points out that older people have a higher risk of complications, experience more pain due to more deeply rooted wisdom teeth, and face a longer period of recovery from surgery. But how much less often do these complications occur in younger people and how much shorter is the recovery time for earlier surgery?
Similarly, when discussing the benefits of a “wait and see approach,” the debate is framed in general terms and there is little quantification. The story notes that the risk of surgical complications may outweigh any benefit from preventative removal. But it would’ve been nice to have some estimate of how frequently wisdom teeth will end up overcrowding if they are left in, or how often patients experience surgical complications if they opt for the preventative surgery.
Risks associated with wisdom tooth extraction are clearly spelled out in the story. These include “poor wound healing, infection, pain, and uncontrolled bleeding” along with nerve injury which can, in rare cases, leave people with permanent facial numbness. As noted above, some quantification of these results would have been ideal.
The story discusses and links readers to many expert sources for data including a Cochrane review, the American Public Health Association and the American Association of Oral and Maxillofacial Surgeons. It notes that the 2012 Cochrane review of randomized clinical trials found there’s no evidence that removing wisdom teeth will prevent or reduce crowding of other teeth down the line. It’s clear from the story that the evidence on this topic isn’t settled and that various expert groups have differing interpretations.
The story would have been even stronger had it discussed the position of the American Dental Association, the largest membership association of dentists claiming 157,000 members. A visit to the ADA website suggests that the association advocates a “wait and see” approach for wisdom teeth removal.
The story doesn’t exaggerate the possible harms of preventative wisdom tooth extraction or of the wait and see approach.
Sources include a dentist and two oral surgeons as well as numerous published reports and professional association position reports. The story also reminds us that “oral surgeons make a good chunk of their paychecks by removing wisdom teeth, so there is a financial incentive involved.”
The story adequately weighs the benefits of both approaches — early removal or waiting to see if complications develop later on.
The story doesn’t acknowledge the gap in dental care access and how that might affect the numbers of people having wisdom teeth removed. Uninsured people are far less likely to pay out-of-pocket for elective surgery. These issues could have been addressed with one additional sentence
The story suggests that this is a long-running debate and there is no attempt exaggerate the newsworthiness of the issue. With that being said, the story could have traced the origins of the debate even further back in time. The story seems to credit a 2007 editorial by Dr. Jay Friedman for sparking current discussion over the risks and benefits of preventative wisdom tooth removal. That may well be the case, but expert groups in the United Kingdom have been recommending against routine removal of wisdom teeth since 1998 at least.
Because the story includes direct quotes from three dental experts and several groups and publications, we can be sure the story isn’t based entirely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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