The wisdom teeth industry is probably a scam
fusion.net
fusion.net
* The teeth are growing in a strange orientation.
* You have cavities on them and your jaw shape is such that you can't brush them properly.
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The major problem with the molars is that they are notoriously difficult to keep clean. They all eventually become abscessed (on a long enough timeline). Might as well remove them. So removing wisdom teeth is not really a scam, it's something you will need sooner or later unless you're really anal about keeping your wisdom teeth clean. Can you brush all the way back there? How about behind the wisdom tooth?
I have also noticed a trend here in the US that dentists put you under general anesthetic for this procedure. When in reality, unless you -really- need surgery, it's just overkill. For example, when I had my wisdom teeth removed in Bolivia, I was entirely awake, they only used local lidocaine (or similar) using a syringe, and they pull them out using hand tools and levers. Some antibiotics for a couple of days, and I was on my way.
In Australia I know it's fairly common to have general anaesthetic for wisdom teeth, but I'm not sure we're quite as into preemptive removal as the US seems to be by the looks of this article?
I can see why general anesthetic might be desired, the amount of force required to break the tooth is downright disturbing. I remember wondering if the surgeon ever slips with that punch and that the sound of breaking teeth in the absence of any other feeling was eery.
Also interesting in this life event was that it was done by the same surgeon at a separate private hospital. It was covered by private medical insurance, but the hospital took a $500 contingency payment up-front. The next week for my follow-up, I asked if there were any unusual costs, because I hadn't got my 'contingency' money back. He (quietly) hit the roof that this was an unnecessary payment and I never should have paid in the first place. He told me that I should demand the money back. This was at 5:30pm. 9:02 the next day, as I'm gearing up to do phone battle, I get a call from the hospital's finance department asking where to send the refund - apparently in the intervening hours, this surgeon had torn the financial controller of the hospital a new one at the unethical behaviour. Colour me pleasantly surprised!
20 minutes one side, came straight out, 45 the other fought ever step of the way, relief was immediate, couple of weeks and all mended.
Not sure why you'd need to go under or have nitrous.
Many people (myself included) have anxiety around dental work. Just like going into an MRI might be fine for you but people with even a mild claustrophobia may find it unbearable.
The other thing is not everyone's procedure is as simple as yours. Your tooth was exposed, thus easy to extract. Your teeth were not fully impacted, for example. This - https://www.youtube.com/watch?v=SNLuyFaOQoo - shows the procedure for removing impacted wisdom teeth.
Wouldn't call my second one simple, dentist asked if she could preserve it and send it to local uni as her words "that's the largest root structure I've ever seen", at one point I didn't think she could get enough force on it, had to get a different tool.
Lovely woman and amazing dentist.
You could open up my abdomen and take out my kidney while I was awake and it would not bother me as long as I didn't feel it. Go near my mouth or eyes though and I have unbearable anxiety. I'd let all my teeth rot out of my face before undergoing tooth extraction awake, its that bad.
This is a fairly common fear.
Even without anxiety my oral surgeon strongly recommended at least nitrous due to the procedure being performed.
Your procedure was simple enough for a dentist to perform, and didn't require an oral surgeon, so pretty simple.
I see that many doctors do extra studies and interventions so that they can charge for it to the medical insurance. For example, every time I go to a new dentist (covered by the insurance) they always want to do a 'dental cleaning', as that is something extra they can charge, and the medical insurance always authorize it when they have a new patient.
I don't think is the default. They offer it amongst a range of options, but it's expensive usually on the order of a few hundred dollars extra. I think most people do local + nitrous.
The few people who serve really upper middle class areas might offer it by default, but it's generally just not the case for most of the US.
I could be wrong though, I don't have actual data, just my own experiences.
It is not the default. Patients are advised of their choices based on their situation. Many people get only local anesthesia.
The process was not at all pleasant...I refused general anesthetic, so had lidocaine and a couple of minutes of nitrous oxide...
By the time the dentist was finished we were both in a noticeable sweat...
I was put in mind of a cartoon I once saw of a dentist in the late 1800s with his foot up on the patient's chest, trying for all the leverage he could get...
I developed a "dry socket" (clot broke loose) and walked the floor all night, in intense pain, waiting to get an appointment the following morning...he simply packed the hole with a piece of gauze soaked in oil of cloves...the relief was immediate...
Since that experience I've kept a bottle of oil of cloves in my medicine chest...the stuff is magic, and sold over the counter....I've used it for minor toothaches over the years with great results (until I could see a dentist)...can't recommend it highly enough...
The the brain impulses and patterns that comprise your soul are snuffed out during general anesthesia.
The new soul that takes rood in your brain will have access to your old memories but is a new set of patterns that only approximate the previous soul.
This new soul, of course, will claim to be you in order to preserve itself. Unless primed with the memory of this idea, the new soul won't know any better.
How about it? Ready to shake things up and get a fresh start?
We undervalue the healthcare we have now, even with all it's human flaws...
That's going to require a really long toothbrush...
Also: General anesthesia? That's often an excuse for the dentist to be a rough on you as convenient for them. No thanks.
In any case, I remember coming out of anesthesia and the doctor leaning over me, his bloody gloves now removed, and asking me how I was feeling. I was about to respond when, after a moment's pause to catch my breath, I suddenly awoke to a very large male nurse giving me chest compressions. The doctor yelled, "He's back! He's back!" and he made the man stop. I groggily looked about and noticed a female nurse cowering in the corner. She was sobbing uncontrollably and soon ran out of the room (maybe not the best nurse, but I guess she had never 'lost' someone before). I asked, fuzzy mouthed, what happened?
Apparently they pulled my IV out too soon and my forced dehydration and starvation made me faint once the fluids stopped. One of the possible side effects of fainting is a loss of heart beat. They told me "I had been dead" (which was inaccurate) "for about 90 seconds." What they meant was my heart had stopped beating for that long.
People always ask, so I'm obliged to say: I saw no tunnel of light or flashing of my life before my eyes. It was simply total sleep-like darkness with absolutely no concept of time passing. It was as if I had made a long hard blink, and been told later 90 seconds had elapsed. For all I knew, two seconds had passed, much like a deep solid sleep: It's not until you look at the clock that you know how much time has passed.
I had the other two wisdom teeth taken out at a dental school in Dallas. That was whole other ordeal. But I didn't "die" that time, at least.
i'm not quite so sure 'dead' isn't a good way to describe it, because that's probably what it feels like to be dead, and what it felt like before you were born.
Fast-forward a decade or so, one of them was, to use the technical term, totally fucked. It was impacted, uncleanable in parts and thus had to be removed, but had gotten so wedged in that it not only pushed my other teeth crooked, but was extremely hard to extract, requiring the dentist to go fetch some other stronger dentist and then they both worked on it and it took way longer than planned to get all the pieces out.
That was lame, but I still have the other three, and now my dentist says the same thing is happening to those (and even I can tell, it is).
So now I am 41 with a busy job and young children, and I have to find time to have three wisdom teeth extracted in a procedure that is now going to be much more difficult than the simple extraction suggested by my dentist 20 years ago.
So, in my case, I wish I did it then.
In my case I desperately needed it (8 wisdom teeth), but no one was around to tell me as a teenager. So there I am a few decades later with power tools in my mouth for hours, dental assistant was about to faint...
Then again, if docs were to charge smaller repeating sums for the modeling, and remove the problematic cases for free, they might end up making the same amount, with less liability and work.
http://bestpractice.bmj.com/best-practice/evidence/intervent...
Given the major surgery involved, it seems best avoided. I have had two impacted wisdom teeth for over 20 years with no problems (using good dental hygiene).
However, this link appears to be paywalled. "You have tried to access content that requires a subscription to BMJ Best Practice."
Please click here to go to BMJ Best Practice US.
Alternatively click here to go to the BMJ Best Practice site intended for users outside the US. 'I had mine out at 18 because "eh might be a good idea" and my mom had dental insurance. 45 minutes and I was eating nachos the next day. Took two of the pain killers the first night just in case and none again. Which on a scale of surgery puts it slightly above "ingrown toenail".
I'm 56 now and my wisdom teeth are still there and still healthy.
That certainly wasn't major surgery.
While many people may not have an urgent need to get rid of their wisdom teeth at age 18 (or even 50), it is a very simple extraction before these teeth have taken root. After they have rooted, it is more complicated, and more painful. These teeth are unnecessary, and one can eat perfectly fine without them. The most horrible stories I heard as a kid were mostly about wisdom teeth causing crowding and/or gum issues. To each their own, of course, but I believe the prudent route is to have them removed when you are 18 (or whenever they start to come in for you).
What this article doesn't emphasize enough is:
1) Like fingerprints, teeth are unique from person to person.
2) There are legitimate medical reasons to remove wisdom teeth, and those reasons vary from person to person.
Like a cartoon, I have a small mouth with big teeth. Thus, like San Francisco, I've had "space scarcity" for the better part of 2 decades.
My dental journey took over a decade of planning and execution, as well as 10s of thousands of dollars so I'd have some kind of decent smile as an adult. (thanks Mom and Dad!)
Had I "passed" on this work, I wouldn't have anything close to resembling a smile today - a high price to pay.
Maybe Rob's family should have consulted second more dentists/oral surgeons. Maybe they didn't have the resources.
Technology will likely help us make better decisions about these procedures in the future so "unnecessary" treatment spending goes down.
When I see such blatant intellectual malfeasance, I just stop reading. If it's really a valid point, someone else will make it without distorting or misrepresenting the truth. If it's not - which is what usually turns out to be the case - I will have saved time and energy. Life's too short to waste it on polemicists.
Personally, I wouldn't be all that worried about two headaches a month or so (then again, I've had a near-constant headache for the last two years, so my perception may be a little skewed).
I think people who have surgery, are the ones whose wisdom teeth have not really grown out yet. So maybe that's what the article is referring to.
Other people I know went through a fairly normal tooth extraction like yourself, it just depends.
* It might have been sedation they offered, not general anesthesia.
It's true that many people who have had their wisdom teeth pulled didn't need that. It's also the case that many people who didn't have them pulled while they were young, have lived to regret that.
Most dentists would be happy to never pull another wisdom tooth. However, they've taken an oath to provide a standard of care, and they can't refer every wisdom tooth case to expensive oral surgeons. (Well, I think some dentists do refer every one of these out, but that's a threat to patient retention.)
USA simultaneously has too many and not enough dentists. Too many, because there are lots of unnecessary procedures done. Not enough, because many poor people don't go to the dentist until they're in severe pain, and at that point they need many teeth pulled. Those who live long enough eventually need all their teeth pulled anyway...
The lower ones caused some kind of infection that wasn't treatable and my gums started leaking a terrible puss that was pretty disgusting to be frank about it. Perhaps it would have all sorted itself out in a few months. But throwing up 4 or 5 times a day was making it hard to get nutrients so I went in, got knocked out, and them hacked out of my head.
The were so impacted the dentist had to break part of my jaw and I was unable to open my mouth for about 8 weeks while it healed and it was months before I could fully open my mouth again.
But guess what? No puss, no more barfing and I haven't had any problems since. So I think that was probably the right choice and if I had to do it over again I would have had them carved out of my skull 5 years earlier before they had become a painful and disgusting problem.
Mine do catch a fair bit of food and get minor infections relatively frequently (maybe every three months they hurt for a few days). I want them out but don't want to go through the process.
Have your hygienist pay special attention to cleaning them thoroughly during your regular cleanings.
I'm half convinced that the whole "wisdom teeth industry" is just a great way to legally get some opioid painkillers.
Next year, same place, different dentist at my regular cleaning. He gave me a clean bill of health. I asked him, "What about my wisdom teeth?"
He said "What about them? Are the bothering you?"
"Well, no..."
"Then you're fine." And he left.
My teeth are really big and I was really bad about wearing a retainer. If I didn't have 4 teeth removed, my bottom set would have become more crooked than my baby teeth were if I let my wisdom teeth come in.
It's not really a scam; the way the wisdom teeth roots grow in make it very hard to remove.
These teeth exist for a reason, and mine - luckily - were developed in a perfectly straight way in line with the rest of my teeth. Suggesting to remove them seems just ridiculous to me and a greedy way for the dentist to make some hundreds of euros extra by butchering me off.
Before that we practically didn't had caries (just like wild animals also don't).
Throughout human history humans would have the full set of teeth in the vast majority of cases, until we started settling and switched from hunter-gatherer to agricultural society (which is a very recent time in human species development).
I have two protruding out of the upper jaw which haven't caused me any problems, so the (UK NHS) dentist said they don't need to come out. X-rays showed that there was actually another unemerged tooth behind each of them as well. These upper teeth have all been there for for about 7 or 8 years now and haven't caused me any discomofort beyond the initial breaking of the gum.
On the lower jaw however, both teeth are impacted. The left wisdom tooth is completely horizontal and pushing up against the molar in front and the lower right wisdom tooth is impacted at an angle and irritates the gum around it from time to time. I usually pop some ibuprofen when it gets uncomfortable.
I've wouldn't say I've experienced serious pain from these teeth, more just a dull ache or discomfort or irritation of the gum, but I was referred to a dental surgeon a year or so ago who basically told me he wouldn't take them out.
He claimed that the lower teeth were so well developed at this point that removing them might expose the nerve in my jaw underneath and leave the lower half of my face numb, potentially for the rest of my life. As a risk/benefit calculation he decided against taking them out for now, but may change his mind if they cause problems in the future, which they likely will.
This is an NHS dental surgeon though and I'm wondering if I might be best served getting an a second opinion from a private dentist as well. The last few days my lower right tooth has been really irritating the gum around it that I've been taking ibuprofen for two or three days.
If I went to the dentist when these originally started to emerge instead of waiting until they started to cause some discomfort I could have had them removed with much less risk. I was however under the assumption that wisdom teeth should only be removed when they cause problems, which for the first few years mine didn't really.
A local is always a better option if available. It's less invasive and has fewer complications.
This is not meant as a "pity me" by any extent, I find it hilarious given that my parents would have liked me to be a doctor and enjoy sharing the story. However, it puts me in a "screwed if I do, screwed if I don't" situation when it comes to going under, and for something like wisdom teeth; they can't really have me going all human-fountain on them.
In short, the "if available" bit is the kicker, I'm curious enough to be googling around for non-anecdata research on the actual risk distributions since while comments like yours certainly make me nervous, after years of going under with no issues and doctors recommending it given my situation, I wonder to what extent I'm stressing myself out over a very uncommon occurrence.
Probably too much. Modern medicine actually does work for the vast majority of people--"Hospital does 42 surgeries today--all of them went just fine" never gets reported. However, humans are biological organisms with lots of variations. Exceptions always exist.
If you've gone under more than once without complications, you're probably mostly in the clear. It means that a whole host of things that can go wrong have already been screened against. One of the big ones is having a problem with your pseudocholinesterase but no family history to tip off the anesthesiologist that this might be an issue (I think they screen for this now).
As you point out, the issue is also "if available". In your case, it's what needs to be done, so don't stress over it. The complications of NOT doing it are far worse for you, as you point out. However, too many people just go "put me out" without the idea that, yes, complications do occur and, really, less invasive is almost always better.
Technically true, but the kind of sedation used for wisdom teeth removal is nowhere near as disruptive to your body as the general anesthesia you'd be under for, say, open heart surgery. The kind of sedation used for that is the same (or very close) to what they use for placing stents, doing arthroscopic surgery, etc. I can't even imagine how many patients are sedated every day around the US and there doesn't seem to be any epidemic of people having adverse reactions.
From what I've seen and read (including my own experience) wisdom teeth aren't taken out under general anesthesia, they're taken out under sedation. Now you might think "what's the difference" and to be fair they are on a spectrum, as opposed to it being a binary difference. But "general anesthesia" tends to be a much more serious scenario, where your heart rate and respiration are strongly affected by the anesthetic and you may need mechanical ventilation, etc. during the procedure. Sedation is nowhere near as invasive and you are usually actually conscious during the procedure (or can be awakened easily by the doctor). It feels like you're out the whole time because one of the drugs they use is a hypnotic agent that causes short-term amnesia.