Wisdom

Teeth, that is.

I grew up in a country where fluoride in water was not the norm. Also, I have to admit my primary family probably did not instill very good oral hygiene habits. I ended up losing a couple of permanent teeth as a preteen or early teenager to decay. By the time I was out of my teens, I had realized on my own that I should be doing much more for my teeth, I learned what I could, and adopted better preventative practices. The dentists I saw were not warm or fuzzy, but rather unpleasant, brutish, and condescending (as were the medical doctors where I grew up). I didn’t know there was such a thing as teeth cleaning until I came to the US; none was ever offered to me by any of the dentists I saw. I don’t think it was even part of the practice back then, I am not sure if it is now.

When I came to the US as a graduate student on crappy bare-bones covers-nothing insurance, not even getting cleaning or X-rays were covered and were thus very expensive out-of-pocket expenses. Since I’ve had a proper job, I have been extremely vigilant about my teeth and the teeth of my kids. As a result, while I don’t have the perfect American teeth, they are in decent shape, especially considering their initial condition. I am lucky that my teeth are nice and straight (no braces); I also have all of my wisdom teeth.

My vigilance extends to the teeth care of my kids, who brush and floss religiously, and I am proud to report that none of them have ever had any cavities.  Eldest will be 15 in couple of months; by that age I had already lost a couple of molars to decay, which is a real shame.

While dental care is in principle phenomenal in the US, the costs are exorbitant and not as accessible as it could or should be. I must say that I really dislike US dentists as a profession, but for different reasons than those from my ancestral home country. Sure, American dentists (and I saw dentists in 3 states) are pleasant and polished, if hurried. What I hate is that they all seem like ruthless deceitful sharks the moment we discuss anything other than routine cleaning, pushing costly and perhaps unnecessary procedures that help line the pockets of their specialist brethren.

Here’s an example. When Eldest was little, maybe 7 or 8, the dentist said he had too much room in his mouth for all the teeth so he would have to go to have his jaw surgically treated to reduce space. Husband and I thought that was stupid and didn’t do anything.

It’s years later, Eldest grew and is probably nearing his final height and head size. Now that same dentist says that his wisdom teeth don’t have enough room (see the irony of supposedly having had a too-wide-a-jaw previously), that the bottom ones are impacted and need to be taken out.

I am no dentist, but I looked at the X-ray and it looks the top ones will be out fine, and the bottom ones seem like they are not terribly impacted, the teeth are not completely formed, and he is still growing.

When Eldest had his latest X-rays (why once a year? All those X-rays seem really unnecessary), then there was half-an-hour of relentless propaganda between the dentist and even more the hygenist who worked on Eldest, about how 98% of all kids have their wisdom teeth removed, how everyone’s doing it, when you don’t have wisdom teeth then there are no issues with cleaning them that far in the back, they are prone to decay so you need to be out with them. Of course, conveniently across the parking lot is a dental surgery center.

Am I the only one who thinks this is idiotic, doing surgery to pull out the teeth of a not-yet 15-year-old while they are still in the bone? I did some research, and while the recommendations seem to be more along the lines of leave them alone in Europe, the US practice is to preventatively take them out. I generally believe strongly that getting rid of body parts without a good reason (a good reason being that they are diseased, causing pain, endangering well-being) is just wrong.  Why don’t we just cut out everyone’s  appendix? [Yes, I am also very strongly against circumcision. People in the US sure circumcise their boys supposedly to help prevent urinary infections, but that’s bull$hit for any developed nation (continental Europe rarely circumcises), and for most people the real reason is tradition more than anything else (either religion or the simple “dad is circumcised, so the son should be too”).]

Oral surgery is serious surgery, I cannot believe it’s a good idea to do routinely. The problem is that I don’t trust my dentist’s recommendation, but it’s not like any other general dentists I have ever seen in the US have been trustworthy. I always feel they are trying to pull a fast one. Several times, this happened to my husband “All is fine, (6 mo later) all is fine, (6 mo later) all is fine, (6 mo later) oops we need a root canal here, and since you have a root canal the tooth is brittle so we better do a crown too.” And you are out a few thousand dollars and thinking WTF, why didn’t they catch it sooner before it became so bad to need a root canal? What’s the point of these 6-month visits and stupid goddamn X-rays all the time?

Based on my experience, general dentists definitely seem to be a little to happy to lean towards the costly procedures. Similarly, I have no doubt oral surgeons advocate for routine removal of wisdom teeth from every human, because that’s a steady revenue stream.

So how do I get an opinion on my son’s wisdom teeth from someone who is not just looking to rip me off or enable their colleague across the parking lot to rip me off?

What do you say, my American readers? Do you have your wisdom teeth? How about your kids? Do you regret keeping them/taking them out? What made you decide one way or another (for yourselves or your kids)? 

24 comments

  1. I still have my wisdom teeth. Very small teeth in normal sized mouth, I think? Have not caused me any problems… Like you, I’d wait until there’s an ACTUAL problem before pulling teeth out. ugh.

  2. All 4 of my wisdom teeth were impacted, and we knew early on they’d have to be removed. I grew up in the US. However, due to money, scariness, and not being needed, I didn’t have them removed UNTIL they started causing me constant pain. When they caused me pain and started janking up my back molars, I finally had them surgically taken out. if they hadn’t hurt so much, I might have them still.

  3. Mine got taken out in grad school. Two of them were impacted but the other two were fine, but they were the bottom two instead of just one side, so I was going to have to go under anyway and was given the choice to get just the two or all four. Nothing was ever pushed on me growing up– no braces, no surgeries.

    The town we’re living in now has a lot more predatory dentists, but I think the one we have now is pretty good about only doing things that are necessary when they’re necessary. He’s really into teeth. (One of the ways we can tell is if the dentist gives different recommendations for me and DH– we have VERY different teeth profiles and good dentists pick up on that. Bad dentists recommend the same crappy extras we don’t need.)

  4. I think depending where you live there can be predatory dentists – I saw someone once who wanted to drill into 12 of my teeth because they were “precavities”. I have excellent teeth & do excellent preventative care. 2nd opinion said everything was fine and in the intervening 10 years I haven’t had any problems.

    My brother had ample room for his wisdom teeth but then got a 5th (teeth are so weird!) so had them removed our Dr said it was fine to keep. Mine were removed. The concern with waiting to see if there was a problem was potentially messing up expensive orthodontia.

  5. I’ve had four separate oral surgeries so far and I’m only 26. I live in the US, and I’m also wary of too much unnecessary dental care, but I feel very certain that all of my surgeries were absolutely necessary. I had my wisdom teeth removed in middle school, after knowing for several years that I would need them out – my orthodontist had shown my parents and I my x-rays from elementary school which very clearly showed all four wisdom teeth positioned horizontally. I’ve since had three gum graft surgeries, all of which were scheduled after I went in to the dentist and said, “Hey, the roots of my teeth are totally exposed, and it hurts.” Between the extensive orthodontic work I needed as a kid and the TMJ and gum recession issues I inherited from my mother and grandmother, there was never going to be any way around it, but I’m the first in my family to need gum grafts at age 20! I have no other evidence of gum disease.

    My dad is an immigrant from a European country and he has not-so-good gums or dental hygiene but never needed orthodontia of any kind. When I was a kid and we were living in our country of origin, my (American) mom was Shocked when I came home from school one day and announced that my whole class had been to the dentist. She had no idea they would do something like send me for routine medical care without even notifying her! I don’t think any of my European cousins have had their wisdom teeth out (but that side of the family seems to all have good teeth – I wish I had gotten those genes!)

  6. Keep the teeth. I got my top wisdom teeth out when they started growing into my cheeks and it hurt. Got braces this year because my top teeth were starting to stick out far enough that it changed my speech. (On very cold days I had a hard time making the F or TH sound when entering a building from the cold.) Avoid dentists otherwise to the max extent possible. I have the same feelings as you: always something horrible to prevent that probably won’t happen, and always some expensive way of making it pretty rather than doing the functional and time-honored thing.

    My father is an immigrant so we never saw a dentist in childhood. I couldn’t afford it in college, so first saw one in grad school. I guess I had 7 cavities. Haven’t had one since.

    On the other hand, this (http://aeon.co/magazine/health/the-shame-of-poor-teeth-in-a-rich-world/) was an interesting read. Teeth are definitely a class marker in America and in a lot of other countries I was not pegged as American while traveling because I am well-educated, well-dressed for a nerd, and I had these crooked teeth.

  7. I so totally agree with everything you say both on circumcision and wisdom teeth. I allowed my dentist to catch me at a weak moment and let her take out one of my wisdom teeth. Boy, was I sorry I agreed to this! A nerve in my cheek got damaged and I had no sensitivity in the right side of my face for 8 weeks!! And the dentist’s response was, “Well, dental surgery is unpredictable. ”

    I finally recovered the sensation in my cheek and the dentist started suggesting I take the rest of the wisdom teeth out. Obviously, I refused. I still consider myself lucky not to have remained disfigured for life.

  8. I had my wisdom teeth taken out while I was in grad school, because they started causing me pain. My dentist usually opts for cheaper procedures, taking a wait-and-see attitude on marginal problems, then doing the sandblast-and-cover approach to minor decay. I did have quite a bit done on my last visit, as two of the amalgam fillings that I got 45 years ago needed to be removed (still just sandblast, not drill, because they were small fillings).

    My son needed oral surgery and orthodontics to correct an undescended canine. The oral surgeon wanted to remove the wisdom teeth in a separate procedure, but we’ve taken a wait-and-see attitude on that—so far they have not caused a problem, but if they get badly impacted, he can get them out in his 20s. His orthodontist originally thought that they would need to come out, but now doesn’t think so.

  9. I had my bottom ones taken out as a teen as they were under my molars and my family had a history of problematic wisdom teeth. Opted not to wait for it to get painful or actually cause a problem.

  10. Don’t know about your son’s wisdom teeth but the NHS dental policy in the UK is no removal of wisdom teeth unless they’re causing consistent pain or get infected more than three times.

    One of mine partially erupted so I have to take special care with brushing the gum around it, and I had antibiotics for it once, when the gum got infected. I had an x-ray taken to look at the rest of my wisdom teeth and was lucky I did so because they found a large cavity in the back molar that hadn’t been causing me pain!

    My mum on the other hand had two of hers removed when she was in her early 20’s and had another one removed this winter because it had started causing issues. By all accounts having wisdom teeth removed is horrific so avoid the surgery if you can!

  11. For my routine preventative dental care, I go every three months to the office of a periodontist who has outstanding hygienists on staff. He doesn’t do any dental work, like fillings, extractions, or root canals, so he has no financial incentive to recommend that stuff unless it’s really necessary. I only go to a dentist if my perio tells me he’s got a specific concern, and that’s only happened once in the last twenty years: to fill a cavity.

  12. You can keep shopping around for dentists until you actually get a good vibe. I’m at a student practice where I have a new dentist every few visits. The last one asked me about getting my wisdom teeth removed every visit, for no other reason aside from “they get hard to clean.” My response was “why? will I not be able to brush my teeth when I’m old?” Before him, I had never been harassed about my wisdom teeth. My new dentist also has not made any comments. I don’t intend to have anything done unless it’s necessary.

  13. I recommend shopping around a bit more. I’ve had dentists like that but my last one was great. He and his wife (acting as hygenist) ran a two-person office. They were laid-back.

    Or maybe I’m just too old to push many procedures on anymore. They do seem to target braces and wisdom teeth removal for kids pretty hard. On the other hand, I remember my grandparents taking their teeth out at night. I think that’s a hell of a lot more rare now.

  14. NessieMonster said, ” By all accounts having wisdom teeth removed is horrific so avoid the surgery if you can!” It varies a lot. Mine were no big deal—I did not even require general anesthesia—just Valium and a local anesthetic. I took pain killers for a few hours afterwards, and avoided crunchy food for a couple of days. Other family members have had much more difficult extractions, so you can’t count on it being easy—but it isn’t often “horrific”.

  15. I was told as a kid that I had to have my wisdom teeth taken out because my mouth was too small. My parents ignored that. Then in my 20s it was because they were hard to keep clean, but I had no insurance so to hell with that. I still have them 25 years later and they cause no problems whatsoever. Apparently my mouth grew.

    I live in a city that is full of predatory dentists. One told me I had to have my teeth whitened (for hundreds of $$) because they were “disgusting.” They’re not perfect, but disgusting? Please. So now I see a very nice dentist once a year when I visit my inlaws.

  16. I had my wisdom teeth out in high school because they were coming in under other teeth (I have a very tiny mouth, and had to have a palate expander when I was in elementary school in order to have a prayer of having all my teeth fit in my mouth). It was pretty chill – I took painkillers for 48 hours, ate soft-ish food for a week and was good to go. My sister is 25 and husband is nearing 30 and both of them still have their wisdom teeth.

  17. I’d shop around. I rank dentists by the amount of cosmetic dentistry they offer. My two front teeth are porcelain veneers, which have served me very very well, but I’ve had pressure to ‘upgrade’ to crowns. My bottom teeth are a bit crowded but my bite is fine; and Invisalign has been offered. If you can’t tell already, I’m firmly in the ‘leave well enough alone’ camp. I’ve been fortunate to find dentist who agree, They seem to tend towards minimal treatments (replace a filling, grind down a bit where a chunk fell away) where I think the opportunity to ‘offer’ a crown might have come from less conservative dentists.

    (I did have my wisdom teeth out surgically at 13, because they were horizontal)

  18. My wisdom teeth were taken out when I was 15 because they were coming in a screwy and were about to mess up the expensive straightening of my teeth that had just been completed. My sister’s stayed in, I think.

    Try shopping around for another dentist for a second opinion. It took me several tries to find one that wasn’t constantly upselling products/treatments I don’t really need. Now I have one I trust. Yelp, of all places, was helpful in my search.

  19. I agree with the second opinion (or just ignoring the first opinion if he’s not having any pain or issues I don’t see the point AT ALL). I’ve definitely been to the predatory type of dentist (the one thing they kept pushing was a special “periodontal cleaning” that was not covered by insurance, cost $300 and was done by the periodontist down the street. I had a friend in dental school at the time and she agreed that it was sketchy. I’ve been really lucky to find a dentist I really trust and like here.
    I did have my wisdom teeth out at 16, one was pushing through on each side and were painful. The surgery was ok but I was puffy/sore and couldn’t eat solid food for 3-4 days. I had a friend have a really bad experience with lots of bleeding/pain for days, so there is definitely a risk and not to be taken lightly.
    (I also agree on the circumcision, I think the AAP recently changed their position to support it as a way to prevent STDs/HIV, but that doesn’t sell it to me)

  20. On the whole, once I mention I’m a scientist, every doctor I’ve had that I’ve liked has gone out of his/her way to provide data on their recommendations for care (dental or otherwise).

    FWIW, I was born and raised in America by parents born and raised in America and have done all my schooling in the USA.

    I remember numerous dentists visiting my elementary school and giving talks on how to brush your teeth right. I think there were also segments on this on Sesame Street and Nickelodeon, so dental hygiene was instilled in me from a young age.

    I had my wisdom teeth out at 18, which was necessary as the top 2 were above my rear molars (obvious on X-ray) and the bottom two were coming in completely horizontally (also obvious on an X-ray). This was the 1st procedure aside from routine cleaning and fluoride treatments my childhood dentist ever recommended. I got the teeth out with only Novocaine, and took Advil and drank milkshakes for a couple days until my mouth felt better. No big deal.

    Went to the dental school attached to my University during college- no hassles, no problems.

    No dental coverage in grad school so I never went.

    Post-doc dentist noticed 1 potential cavity and pointed it out to me 2 years ago, and then only recommended doing anything about it (small filing) after it had visibly grown this year (again, obvious on X-rays).

    On a cultural note, it has been my impression that Americans pay more attention to quality of teeth than Europeans do as a marker of beauty. Both a cause and effect of more active dentists?

  21. This is kinda my field… My opinion is to leave wisdoms teeth in unless they cause a problem. If they aren’t causing him pain, leave them in. With a little luck, they’ll erupt fine and he’ll have a great chewing platform for life!

  22. I lucked out and got perfectly straight teeth. Every other kid I know had some sort of orthodontia growing up (in the US). I did have to have all my wisdom teeth out in middle school – they were impacted and growing in sideways. I felt bad for a friend whose swelling didn’t go down for a month, but after surgery my swelling was gone in 24 hours and I got all the soup and milkshakes I wanted for a week!

  23. I had all my wisdom teeth taken out a few years back. I had to get one taken out because it was coming out at a 90-degree angle, right into my cheek. Not pleasant. The others weren’t projected to come out well either, so we just did them all. It only took me about a week to get over the surgery/pain/etc. I don’t regret it, but I certainly wouldn’t make my kids get it done unless necessary.

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