Friday, April 29, 2011

Prophylactic removal of asymptomatic impacted third molars: Evidence from randomized controlled trials and a local anecdote

I promised Tiff that I would fill in for her on the blog today since she went under the knife. If you have time to turn off the coverage of the embarrassing spectacle across the pond, keep reading.

The surgical removal of wisdom teeth to prevent potential problems with their eruption has become common practice in most developed countries. During a visit to the oral surgeon several weeks ago, Tiffany learned that her four wisdom teeth were destined to become impacted in coming years (if not months). Having foreseen this possibility in January, we were prepared with dental insurance adequate to cover the bulk of the costs of the extraction procedure, which easily register in four digits without such coverage.

Hence, we scheduled the extraction procedure for this morning. Was this the correct decision? The evidence is unclear. At least in terms of the "incisor crowding" consequences of wisdom teeth eruption, randomized controlled experiments fail (in the aggregate) to provide support for the preventative removal of said teeth, particularly in adults. These claims are debatable. Are meta-analyses reasonable methods for evaluating treatment effects? Am I cherry-picking one study from a vast literature? Should I actually read these studies instead of skimming the abstract and ignoring the jargon with which I am unfamiliar? Should I trust "scientists" with their fancy-pants "quantitative evidence" and "statistical rigor" or rely on my own instinct (and can I have "mommy instinct"?)? Did we transfer hundreds of greenbacks to a DDS to prevent a real problem, or did we do it to follow unverified common wisdom like lemmings? Will it even matter once I open our "high-yield" online savings account at American Express, earning roughly core inflation on our huge piles of spare cash? Should we be hoarding gold/sheep/organic food in preparation for the downfall of modern society at the hands of [insert political party you dislike]? Who really won the boxing match, Keynes or Hayek? I leave these to the reader as exercises.

At any rate, Tiffany was sedated with a general anesthetic while the doctor went to work with drills and knives and, presumably, bags and bags of money from past and current patients. We're glad we can keep the money flowing. An hour later, Tiff stumbled out the door and into a cab I had hailed which was driven by a man who multitasked by filling out paper work during our entire journey (at least he wasn't playing Angry Birds). I'm not going to criticize how he does his job--he's a professional.

After a dose of Vicodin, some ice packs, and a McD's chocolate shake, Tiff is back to her old self again. Maybe this experience will make us appreciate our gums more. Maybe it will make us reevaluate our non-medical career choices. Maybe Chairman Bernanke's actions in 2008 were driven more by his past research than by financial sector capture. In any case, Tiff's going to need a new excuse next time she wants a three-day weekend.


  1. man, you can drone on. I only went to about HALF the links, you were getting pretty 'economist' on us all.
    Get Tiff back on here.

  2. this has RYAN written all over the post. miss you guys.