Double standards, double standards.

People hold double standards about pretty much everything. This includes wisdom teeth. People in general and dentists in particular don’t hesitate to condemn overtreatment or unnecessary procedures… but when it comes to unnecessary wisdom teeth removals, suddenly, nobody seems to care.

I remember a former confrère of mine who was very concerned with radioprotection measures. He would always choose the minimum exposure time for taking sectorial x-ray images (bite wings or periapical x-rays). He was deeply conscious about the risks of radiation.

Awesome, isn’t it? A great professional that really cared about his patients. He wanted the best for them, including preventing them from undergoing unnecessary exposure to x-rays.

What’s the matter, then? Well, simple: this same dentist is also a defender of the prophylactic removal of wisdom teeth. So, he cares about the wellbeing of his patients… but selectively. Exposing them to x-rays for 0.2 instead of 0.1 seconds is awful, but removing four teeth without a real need is totally fine.

Nonsensical, don’t you think? I think this is a perfect example of how the non-exact and artistic nature of dentistry can result in illogical decision-making. Of course, I am not a better dentist than him, just like Diegodoal is not a better cook than Jamie Oliver. But you will be with me on this: such an approach doesn’t make any sense! If he’s concerned about his patients’ wellbeing, like any dentist should be… he should not recommend them unnecessary surgeries.

What’s worse is that this is not the only such case I have encountered throughout my career. During one of my trainings in Paris, we discussed a clinical case with a lecturer. He was an old school French dentist. We were seeing a pediatric case. I suggested that a specific kind of x-ray image could have been taken, and the lecturer sharply opposed my suggestion: to him, irradiating a child like I was suggesting didn’t make any sense. He thought it was risky and unnecessary.

Later on, discussing other clinical cases, this man told us that he was also in favor of removing impacted, healthy and asymptomatic wisdom teeth “just in case”.

You see the double standard again. These two dentists were so concerned with the risks of radiation. Even if, as far as I know, there are no documented cases of patients developing a specific medical problem because of clinical x-rays. But sure thing, ionizing radiation is a serious thing, and this is a fair, logical concern. On the other hand, side effects from the removal of wisdom teeth are fairly common, and yet, this isn’t enough for these two dentists to stop recommending it when not needed.

There are even more examples. Have you seen those disturbing cases of influencers getting their front teeth destroyed to get crowns, purely for aesthetics? Google “influencers destroying teeth” and you will immediately find it.

A crown is a highly invasive reconstruction option, indicated in cases where the tooth is already quite damaged to begin with. Doing them on healthy teeth purely for aesthetics is complete madness.

Everybody understands that this is madness, including almost any dentist. Plenty of dentists active on social media have rightfully condemned this practice.

And yet, I don’t see them condemning the unnecessary removals of wisdom teeth. And I don’t even mean the unnecessary removal of impacted, healthy wisdom teeth: I mean the removal of perfectly positioned and functional wisdom teeth. This outrageous practice, this literal mutilation, happens A LOT. A lot more than crazy people getting crowns on healthy teeth, actually. And yet, we barely see any other dentist condemning it.

Again: a double standard. Probably, because they fail to understand that wisdom teeth are teeth like any other. But they are. Destroying a healthy, whole incisor to put a crown on it is wrong. Removing a molar for no reason, including a third molar or wisdom tooth, is also wrong.

I can think of another double standard. I know of dentists that don’t like it when people that are not dentists condemn the unnecessary removals of wisdom teeth, even if they are right in everything they say. Because, according to them, “people that are not specialists should not be giving medical advice”. However, when I as a specialist express the exact same idea, they still don’t like it. Because they don’t care about the truth or the wellbeing of the people: they are just elitist people who can’t stand divergent opinions. Similarly, these dentists will remain silent when people like Kevin Haney, with no medical or dental training whatsoever, publish a shameful article telling Medicaid recipients to hurry up and remove the wisdom teeth of their children before they turn 18.

There are also dentists who don’t approve of me seeing a simple x-ray and recommending the person to keep their wisdom teeth. Because, according to them, an x-ray doesn’t provide enough information about the patient’s clinical case. However, these same dentists will jump straight to recommending the removal… based on the x-ray alone!

I know a pretty crazy example: a young woman in Spain was undergoing chemotherapy, and I think bisphosphonates too. When her dentist saw her impacted wisdom teeth on the panoramic x-ray, she immediately tried to give her an appointment to get them removed, based on her x-ray alone. The patient needed to inform her dentist that she couldn’t undergo such a complex oral surgery for the moment, because of her delicate health condition.

And a final double standard I can think of is about the easiness of the surgery. Many dentists and surgeons are for performing it as soon as possible because they believe that the sooner, the easier. This is only partially true. In many cases, the removal will become EASIER with time, for a variety of reasons. Yet, do we ever see these dentists or surgeons arguing in favor of waiting? The universal mantra they repeat is that “earlier is easier” without a second though, and without conceding that the opposing might be true in many cases.

There are certainly many more examples of double standards we could bring up. I mean, from the moment dentists fail to see that wisdom teeth are nothing more than teeth like any other, pretty much everything they say about third molars could be dismissed as a double moral. So, I will stop here.

This article has been a bit more philosophical than usual. I invite you, my dear reader, to keep reflecting about this. Understand that only pathology can justify removing a tooth (and that lacking space or having an impacted tooth is not a pathological situation), and everything else follows logically.

A Spanish proverb goes: A Dios rogando y con el mazo dando. Literally meaning: Begging to God and hitting with the rod. Its main meaning has changed with time, but nowadays it is used to point out precisely those that hold double standards.

So many dentists beg to God, while they hit with the rod!

Saludos cordales.