The Prophylactic Extraction of Third Molars: A Public Health Hazard
ncbi.nlm.nih.gov
ncbi.nlm.nih.gov
When I was younger, my parents had to change insurance plans, so I got a new dentist. In the first visit, he takes a quick look at my mouth (with no tools, mind you) and confidently says I had 8 cavities that need drilling ASAP.
My previous dentist mentioned no such thing, so my mom took me back to him for a second opinion. He used tools to check, then told us the other dentist was full of shit and that this was surprisingly common.
The new dentist would have drilled 8 healthy teeth out of greed.
She'd never had a cavity in her life and goes in for a routine cleaning. The guy said she had SIX cavities that needed drilling immediately (wanted to do it that afternoon) and needed a root canal and crown on one of her back teeth. And of course had generous financing options for the amount that this would go over our dental coverage (which he assumed we would be blowing all at once).
She left there in tears and came home.
It sounded like a crock, so we asked at our workplaces and chose a different dentist to get a second opinion. He looks around in her mouth for a few minutes and says the the other guy is crazy, she has one area that just needs to be watched but everything else looked fine. Even said her teeth were in outstanding shape.
If something seems off with any health-related diagnosis, always get a second opinion.
That same crook dentist talked me into a gold crown on what turned out to be a wisdom tooth that was supposedly removed 20 years prior (they extracted the other three but apparently decided to save time and leave one in). My dentist now still shakes his head as to why anyone would have recommended a gold crown over extraction of that tooth.
I don't know if there is a way to find quality dentists but I'm realizing that this country (US) is rife with crook dentists.
Have a similar story here. Went to a family friend who was a dentist, until he sold his practice. The new dentist wanted to do a $600 procedure every six months like clockwork. And I didn't have insurance at the time, so the charges really added up. I wised up after a couple times and switched to a new dentist who isn't in the "drill baby drill" contingent. My oral health has been just fine.
Apparently, around the year 2000, the UK's health care system introduced some new rules about managing third molars called NICE (probably to try to save some money country-wide not extracting so many wisdom teeth), and now they're learning that NICE was maybe not the greatest policy. NICE recommended that dentists do not extract wisdom teeth until their is evidence of disease, and so for the most part the dentists followed suit and stopped extracting them. Now, fifteen years later, they have found the policy has had no cost-cutting effect - extractions are at the same level as before, only now people's mouths are much less healthy.
Diseased wisdom teeth often spread their bacteria on to teeth around them, in the "one bad apple spoils the bunch" way, and people often are unable to actually brush their wisdom teeth properly, especially if they're impacted. Furthermore, given that people are in general reluctant to see the dentist unless they have oral pain, they're often not discovered until the situation's already critical. When discovered, people will often have gum diseases or cavities in second molars caused by the diseased wisdom tooth nearby.
See articles from the British Dental Journal such as "NICE or not so NICE?", and "The effects of NICE guidelines on the management of third molar teeth".
Either way, I'm very sad I wasn't able to have my wisdom teeth removed as a child, and the anguish of spending ten years with these things wrecking my mouth was not worth it.
https://www.nice.org.uk/guidance/ta1
You don't have to look hard to find criticism of it, but then that's true of most things. There's going to be a review, slated for publication next year:
That's a strange follow-up. Nothing in NICE prevented you from removing the teeth if they were wrecking your mouth.
The conversation always goes along the lines of "ohhh, I see you still have those wisdom teeth in there" and then that they are "impacted and going to cause lots of problems." To this day, I haven't had a single problem.
My biggest concern is the effect it will have on my airways -- I have sleep apnea so I'm worried that removing the teeth will cause the size of my already-small airways to become even smaller, causing even more of a damaging effect on the quality of my sleep.
My airway is no smaller, as best I can tell.
http://cdn.ebaumsworld.com/mediaFiles/picture/276916/804033....
When I visited Dr. Kasey Li, I had the entire cross section of my airway imaged. He was able to measure the size of my airway (I can't remember the exact mm, but as he said, "thinner than a pencil").
Perhaps you can attach xrays of your airway, before and after, so we have hard data to work with instead of unbacked assertions?
Anyway, I'm quoting the doctor, but I'm not ruling out the possibility either that he might have exaggerated a bit in his sales pitch.
I still have them, and no horrible pain.
I guess it's possible they could cause even worse problems down the road, but for the time being, I think it's not worth the pain/hassle to have them out.
This article highlights many of my thoughts on it - if they aren't bothering me isn't the cure worse than the disease? I'm glad someone is looking into this and willing to go against what seems to be normal.
Because the teeth are anchoring the soft tissue of the palate in place, along with the tongue, preventing them from collapsing at night during REM sleep when one's muscles relax (including in the soft palate and airways).
Note that one standard surgical procedure -- maxillomandibular advancement -- for treating sleep apnea involves breaking the jaw and moving it forward ~10mm, which increases the size of the airways. This procedure has a 90% success rate.
Wisdom teeth extraction is essentially the "opposite" of this procedure -- fewer teeth means the jaw recesses farther back, making the airways smaller.
I wear a dental appliance right now to treat my apnea that is custom-molded to the shape of my teeth and moves my lower jaw forward. It's an Elastic Mandibular Advancement Appliance (EMA). I'm worried the dental appliance won't be as effective after I remove some of my teeth (each tooth helps anchor and support the appliance).
Considering how debilitating sleep apnea is, I just can't take any chances with it.
For the appliance, there are dentists that specialize in "dental sleep medicine." If you have good insurance, this is the way to go. Otherwise, you're looking at a $4,000 bill. It is the best option. If you're in Pittsburgh, I recommend Dr. Rob Rogers, DDS.
DIY can get you almost the same thing though for an order of magnitude less (and is worth a shot depending on your insurance):
http://doctorstevenpark.com/an-in-depth-look-at-diy-snoring-...
After my employer downgraded their insurance post-Obamacare to only an HMO, and I needed a new dental appliance, I ordered the ProSnore, which was also laboratory molded. I had to send molds to their lab, and then they sent back the dental appliance that they fabricated.
The end result was more or less equivalent to what I had before from Dr. Rogers.
There's an opportunity here for a 3D printing startup to disrupt sleep apnea/snoring treatment... ;)
For the surgery, you really need to make sure you see a high quality surgeon. In Palo Alto, there is Dr. Kasey Li, possible the world's foremost expert in treating sleep apnea through jaw surgery:
http://www.sleepapneasurgery.com/
To answer your question, he is an MD, ENT, dentist, plastic surgeon, and researcher all-in-one.
It is a hefty penny though. You're looking at the cost of a Tesla Model S to get the procedure, and it is out-of-network for PPO insurance plans (he specifically mentioned to me that Apple and Google employees had a lot of trouble getting it covered, but NVIDIA did not, I know that Stanford student insurance also covers it).
I would research this procedure first. There's a lot of blog posts on patient outcomes. It really is effective, but so is CPAP, and you can still drive your Elon Musk mobile afterwards with the money you saved lol!
Also, "if all you have is a hammer, everything looks like a nail" certainly applies here, especially when the hammer stands to make $100k. :)
Patients who might have avoided the surgery in the absence
of confirmed pathology are consigned to a numb jaw or lip
or tongue for the rest of their lives.
The computer scientist in me should be more offended at the 2/3 spurious extraction rate and its subsequent drain on the economy, but that excerpt is what excited me.
My wife suffered from this, but the nerve grew back in about a year. When the novacaine went away she was very nervous about this and called the dentist. The dentist was angry, said it wasn't possible, and to not call back. My wife just wanted to know if there was anything she should do but the dentist was obviously covering his ass.
Once I had an enhanced contrast MRI for my kidneys. To enhance it they injected a ton of iodine into my blood. They warned me that my prostrate would get hot (weird), which it did.
Later when I was back at the urologist I was explaining that I was often experiencing a hot prostate, just like I had during the MRI. He then made a point of the fact that he had never heard of that happening in a MRI. I was surprised considering that he had prescribed the MRI and the nurse had warned me.
I later read about a class-action suit against GE, who made the machine, and doctors who prescribed these tests. Now it all makes sense. He also was covering his ass.
Brief searching points to lawsuits involving an agent using gadolinium instead of iodine. When I looked into the agents for my scan, the obvious literature indicated that they chose iodine compounds that were not biologically active.
That's stupid. If a surgeon amputates the wrong limb, is he just doing his job?
No, I would consider that outside of his job description (grin). I didn't say it, but I meant that if he was following standard modern procedure it was excusable.
P.S. One time I had shoulder surgery and the nurse drew a large target with a permanent marker on my shoulder and made be verify that was the bad one.
Let's say that out of bad luck, 0.5% of patients getting their wisdom teeth out lose all sensation in their jaw for the rest of their life. But if your dentist doesn't follow the standard procedure, there is a 30% chance of that.
You get your wisdom teeth out, and you lose all sensation in your jaw for the rest of your life. How do you determine if standard procedure was followed or not?
Seriously, guys, the best way to have permanent damage done to your body is getting treatment while your body is healthy. Regularly let them check your teeth but be careful with stuff like that. I would never ever do anything with my teeth again unless there is pain or clear evidence that something bad is going on, like an infection.
I do get routine dental cleanings every 6 months though. Luckily my dentist is an ethical guy and never pushes anything unnecessary.
Dental cavities are caused by bacteria which eat sugar/starch. If you don’t eat sugar, and only eat moderate amounts of starch, you generally won’t get cavities, regardless of how much teeth brushing you do. If you eat lots of sugary and starchy foods, drink sugary drinks, etc., you will be at high risk for cavities, even if you brush your teeth frequently. Applying topical fluoride paste from time to time certainly helps, but not nearly as much as cutting out the sugar.
There are real social consequences in American culture caused by not brushing your teeth. Other people will get offended by your bad breath and yellow teeth (especially those of the opposite sex).
It might be a "weird" ritual, but it's also part of our culture and how people judge you (which actually does matter a lot in society).
Similar arguments apply to things like not bathing and drinking soylent.
Most of the time if there’s obvious plaque growing on your teeth, it’s because you were eating something sugary immediately beforehand.
In my anecdotal experience, halitosis is also diet related, and brushing teeth has only very short term effect on it. Most of the time, bad breath is neutralized better and for longer by just eating a meal than by brushing teeth.
However, other people notice even subtle differences/inadequacies in one's hygiene.
As professional advice, I strongly caution against not brushing your teeth, or at least, telling others that you do not brush your teeth in public.
It's a shame downvote has become an "I disagree with you" button instead of a way of signalling "low quality content." I counter-upvoted you, which also abuses the downvote button, but at least two wrongs somewhat make a right here.
Aristotle: "It is the mark of an educated mind to be able to entertain a thought without accepting it."
In retrospect, the idea that wisdom teeth must be extracted because modern people's mouths just can't handle them really should have seemed spurious. What — everyone who's not a relatively wealthy American is in agonising pain his entire adult life? That just doesn't compute.