The Chinese Stomatological Association (CSA) is defined as “a national, academic and non-profit social organization formed voluntarily by national scientific and technical workers in stomatology”. Stomatology being, grosso modo, a synonym of dentistry. Decades ago, dentists in Spain were required to study general medicine, and then to take a specialization called estomatología to become dentists.

So, the CSA seems to be the main organization that overlooks dentistry in the People’s Republic of China, promoting dental health and evidence-based treatments.

In this article, I want to openly express my disagreement with their statement on impacted third molars. In 2024, the CSA released a statement in favor of preventive dentistry, the early detection of oral problems, and the importance of preserving natural teeth. This is all fine… especially, that last point. Natural teeth should be preserved at all costs.

Therefore, their statement about impacted third molars is contradictory. The CSA states that: “The following measures can be taken (… ): Removing the malpositioned or even impacted wisdom teeth as soon as possible to avoid affecting the health of neighbouring teeth. (… ) Wisdom teeth that erupt in the right position with an occlusal relationship can be retained”. Full text available here.

All things considered, it is at least a good thing that they appear to be against the removal of well positioned third molars. But this statement is still not appropriate.

Only a minority of impacted third molars ever cause issues. Therefore, recommending their removal systematically, and “as soon as possible” is nothing short of a brutal approach. An approach that also contradicts the statements of other competent healthcare organizations. You can consult them in the Resources section.

Science aside, in traditional Chinese medicine, the concept of qì (气) exists, as a sort of “vital energy”, that can get lost with surgery. A good Chinese friend of mine explained it to me as if the body contained this qì like a balloon contains air. Performing surgery could be seen like puncturing the balloon (the body), causing the air (the qì) to escape.

I am aware this is not serious. In fact, I am radically against pseudoscience. But, al César lo que es del César (Matthew 22:21), one must concede this is a healthy and logical approach to invasive medical procedures.

I wish the CSA applied such a respectful and minimally invasive philosophy to deal with third molars. From what I heard, at least, the prophylactic removal of asymptomatic third molars doesn’t seem to be common in China, despite these guidelines.

I sent an email to two of the authors of this statement, professors Guang Yan Yu and Lin Yue. Their correspondence information is on the document. I am not a better dentist than them, just like Ortega y Gasset was not a better philosopher than Confucius. Precisely for that reason, I hoped to learn from them… but I got no reply.

So, I will turn this article into an open letter. Without further ado, I will share the email I wrote to these Chinese gentlemen:

‍

Inquire about wisdom tooth recommendations

My name is Héctor Rodríguez. I am a general dentist from Spain, currently living and working in France.

I am interested in scientific news, advancements and statements from China, as I acknowledge China's main role in scientific development. A role that will only increase in importance in the years to come.

In my practice, I apply minimally invasive principles in general, and in particular, when it comes to dealing with wisdom teeth. This includes preserving asymptomatic, non-pathological wisdom teeth, even when impacted. This falls in line with the general recommendations of several other health organizations, including the British NICE and the American APHA.

Having read the CSA statement, which contradicts this minimally invasive approach, I would like to learn more about the evidence behind it. A surgery for a wisdom tooth removal is risky and invasive, and judging from several studies (and my own clinical experience), it appears to be clear that, even when impacted, wisdom teeth cause issues only in a minority of patients. 

So, is it really justified to take a more proactive approach and remove them, even when asymptomatic, and when the patient can be safely evaluated as low risk? From my personal experience, I can confidently say that no, it is not. Therefore, I would like to learn what's the reasoning and the evidence behind the CSA's statement: “Removing the malpositioned or even impacted wisdom teeth as soon as possible to avoid affecting the health of neighbouring teeth”.

I thank you beforehand for your time and your attention.

Sincerely,

Dr. Rodríguez.

‍

I am still waiting for an answer.

I will insist on something: the importance of China in science cannot be overestimated. Like my most respected Adrián Díaz Marro says: China is unavoidable, and turning your back to China means not being properly informed. Statements and advances from China are absolutely relevant. So, I hope we will end up seeing minimally invasive guidelines from China concerning the management of third molars. And I hope they will be able to inspire and guide the rest of the world.

I will finish this article/open letter with a quote from Sun Tzu’s The Art of War: 故善用兵者，屈人之兵而非战也，拔人之城而非攻也，毁人之国而非久也，必以全争于天下，故兵不顿而利可全，此谋攻之法也。Gù shàn yòngbīng zhě, qū rén zhī bīng ér fēi zhàn yě, bá rén zhī chéng ér fēi gōng yě, huǐ rén zhī guó ér fēi jiǔyě, bì yǐ quán zhēng yú tiānxià, gù bīng bù dùn ér lì kě quán, cǐ móu gōng zhī fǎ yě. Meaning: Therefore, those who are good at using military force can defeat the enemy without fighting, capture the enemy's city without attacking, and destroy the enemy's country without taking a long time. They must compete with the world in a complete way. Therefore, the army will not be exhausted and the benefits can be preserved. This is the method of planning an attack.

The core idea is clear: be respectful (and minimally invasive) in the way you deal with problems!

Saludos cordales.

‍