The wisdom of removing wisdom teeth

October 31, 2008 8:19:29 AM PDT
It's become almost a rite of passage to young adulthood for many Americans. But is wisdom tooth surgery really worth the pain and cost, especially if the teeth are not yet causing trouble?

In many cases, people are advised to have their wisdom teeth pulled before they create health problems. But not everyone agrees this is such a good idea. In fact on Thursday, the American Public Health Association adopted a policy recommending that the removal of wisdom teeth only be done when there is evidence of infection, pain or other problems.

"I have a hard time studying and exercising and waking up and going to sleep. So it's just been a struggle to function day by day and do what I use to be able to do," said patient Todd McCollough.

Twenty-two-year-old McCullough claims he hasn't been the same since having all four of his wisdom teeth removed two years ago. Just days after the surgery, the Northwestern University Evans scholar says he started having intense headaches. His mother said they've traveled from one doctor to another. They still don't have a definitive answer. But they suspect the surgery caused nerve damage.

"I thought it would be a routine procedure and there would be no complications. Certainly in my wildest imagination did I think this nightmare would occur," said Janet McCollough, mother.

Millions of Americans have their wisdom teeth removed every year. It almost seems to be a rite of passage for 16- to 21-year-olds. It's believed the earlier they're extracted, the easier the surgery with fewer complications. Also, wisdom teeth can cause trouble before they've erupted, including overcrowding, infection, even pain.

Tamika Gibson is 25. She put off having her wisdom teeth removed. Now, she's sorry she waited.

"Pain, pain, pain because they can't get through and it just hurts. Sometimes I can't eat," Gibson said.

Many dentists and surgeons agree. Troublesome wisdom teeth should go. But the benefits of surgery seem less clear when it comes to the removal of teeth that aren't causing problems.

"It really becomes an abuse of the public to recommend this type of treatment," said Jay Friedman, who says there is no good evidence to support pulling out wisdom teeth before trouble begins. The retired dentist has been documenting this practice for decades.

Other studies have also questioned the practice. Writing in the Journal Health Policy and Ethics, Friedman claims two out of three extraction's are unnecessary. And he estimates about 17,000 to 55,000 people suffer permanent injury from the surgery, including nerve and sinus damage.

Friedman also charges it's a practice driven more by profit than medical necessity. He urges patients to ask the question, "Why?"

"Tell me why I should have it done now. I would like to see the evidence that if I don't do what you tell me to do, I will suffer serious consequences in the future," Friedman said.

Michael Miloro heads the Department of Oral and Maxillofacial Surgery at University of Illinois at Chicago. He says Friedman's claims are extreme.

"Not every patient who's 17 to 20 years of age needs their third molars removed and no oral and maxillofacial surgeon believes that," Miloro said.

Miloro says there's plenty of proof removing wisdom teeth is safe. He says most doctors are making a call based on sound medicine. He adds that if there was good research showing what happens when impacted wisdom teeth are left in place, there wouldn't be as much debate. So his message is, the benefits outweigh the risks.

"If the complications were significant enough, we would hear about them," Miloro said.

McCollough has started a web site encouraging other patients with problems to speak out. The goal is to get would-be patients to take this routine surgery seriously.

"I really wasn't expecting this sort of complication to occur and I don't think other people are really aware of the possibility it can happen," he said.

Both sides of this issue do agree that any kind surgery of should never be taken lightly. And no matter how small the risk, patients should be informed. As for cost, each case is individual, but a rough estimate for the extraction of four impacted wisdom teeth is anywhere from $1,500 to 2,500 and sometimes higher.

American Public Health Association
www.apha.org

American Association of Oral and Maxillofacial Surgeons
www.aaoms.org

UIC Department of Oral and Maxillofacial Surgery
Michael Miloro, DMD, MD, FACS
College of Dentistry
801 S. Paulina St.
Chicago, Il. 60612
312-996-1053
http://dentistry.uic.edu/

Jay W. Friedman, DDS, MPH
310-838-8157
drjfriedman@sbcglobal.net

Todd McCollough's Web site
www.teethremoval.com


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