Jay W. Friedman was a very competent, intelligent and ethical dentist. In 2007, he published a convincing article about the myths and risks of prophylactic removals of third molars. This article has ever since worked as an eye-opener for many people.

In fact, for me, it was the first piece of information offering a critical point of view about the removal of wisdom teeth I ever encountered. I invite everybody to give it a read. Just like I invite everybody to check the Resources section of this web, for further reads on this topic. Including his presentation at the 2012 National Oral Health Conference.

Even if it was only an opinion essay, its impact has been great. All the points brought up by him still solidly stand up today, sadly. This very website probably wouldn't exist if it wasn't for Dr. Friedman's article. Given the highly artistic and subjective nature of dental care, individual opinions of competent professionals have a greater impact than in other disciplines.

Which is why I don't hesitate to offer and share mine too. My opinion is not any more valid than your dentist's opinion, just like Nino Bravo was not a better singer than Frank Sinatra. But you, my dear reader, have a right to know it.

I don't have much to say regarding Dr. Friedman's inspiring and convincing article. I second every single point brought up by him, and I can't but invite you, once again, to read it if you haven't.

Well... to be fair, I do have something to criticize: I don’t like how much he insists on the economical part of the problem.

Jay Friedman has received criticism from multiple people and sources, concerning pretty much everything he said in his 2007 article. But, in my opinion, the only sound criticism are the complaints about how he basically portrays dentists and surgeons in the USA as greedy, unethical and money-hungry. During his 2012 presentation, he went as far as to proclaim he supported an “evidence-based” approach, in opposition to a supposed “economic-based” approach.

I disagree. No, economic incentives are not to blame for excessive wisdom teeth removals. Or at least, they are not the main reason. Most of us dentists or oral surgeons do our best to work ethically and respectfully. Completing dental school takes passion, after all. And in completing it, one necessarily absorbs some rightful ideas and ways of working.

The profitable part of wisdom tooth removal certainly doesn’t help, and to some extent, it must contribute to excessive removals. And hey, corrupt, unethical, money-hungry dentists do exist. I haven’t met such a despicable colleague yet, but sure, scum exists in all professions. I strongly condemn any such case of economically-motivated bad practice and overtreatment.

To be honest, I understand why people would end up thinking that this is common. Especially, American patients that have been proposed to get all their four wisdom teeth removed, under sedation and with subsequent bone grafts, for the reasonable price of… 2,000 dollars? 3,000 dollars? 4,000? 5,000? The sky is the limit, I guess.

But I insist: I don’t think money is the real or main reason as to why unnecessary wisdom tooth removals are so common.

To prove my point: I work in France. Here, the prices of most treatments are fixed by the state. This includes dental extractions. Wisdom teeth don’t get any kind of special consideration. So, a general dentist removing a wisdom tooth in France would therefore only charge 39 euros! See this screenshot from the software I use at my work to note the dental acts:

There you have it: 39 euros for removing a lower right wisdom tooth. Roughly the same in USD. Furthermore: the price used to be even lower. The price for the removal of a single tooth was stable between 1980 and 2021, at 200 French francs first, 30.49 euros later.

And this ridiculous amount didn’t stop, and still doesn’t stop, dentists from removing wisdom teeth without a real need. The situation in France regarding this is as bad as in the USA, where removing wisdom teeth is actually profitable. Isn’t that really eye-catching?

And hey, if the French dentist went for removing all four wisdom teeth, don’t even think he would earn four times 39. In that case, the act for removing four permanent teeth would be noted as follows: 

So, 93 euros for removing all four wisdom teeth. Less then what a cleaning typically costs in the USA.

The maximum price I’m seeing for any third molar-related surgery is just 240.35 euros for the removal of four third molars when “retained” or “in the state of germ”:

Also ridiculous!

So, tell me again, how it’s “hunger for money” that mainly pushes dentists or surgeons towards the removal of wisdom teeth? I get it: such a sensationalist and controversial claim works great for attention seekers and magufos, that is, promoters of pseudoscience and “alternative” medicine. But please, let’s be serious!

The real reasons behind unjustified wisdom teeth removals are others. I would say it is mostly a matter of pure and real ignorance, rather than malice or perverse incentives. I invite you to read the article where I explained this for further insight.

To end this one, I will leave money talks aside, and I will go back to Jay W. Friedman with great respect and admiration, no matter my disagreements. He graduated in 1948, no less. I hope that is old enough for those who criticize me for being "only" a 2021 graduate. He was seen active online for the last time in 2017. Born in the 1920s, he must be in heaven with Ignaz Semmelweis. May their souls rest in peace. And may their legacy live on. Let this entire project be an homage to them.

I am convinced that Jay W. Friedman’s legacy and ideas will not be forgotten. I, for one, will do my part to make sure they are remembered, by spreading the minimally invasive word about wisdom teeth, and by helping people make wise choices about their oral health. Always keeping in mind what Napoleon Bonaparte, Emperor of the French, said: Je redoute trois journaux plus que 100.000 baïonnettes. Meaning: I fear three newspapers more than 100,000 bayonets.

Or, if you like: the pen is mightier than the sword!

Saludos cordales.