Why you might want to think twice about getting your wisdom teeth removed

As far as I can remember, when I had my wisdom teeth removed in my early teens, about 15 years ago, they were not causing any problems. I wasn’t in pain. They were somewhat impacted, or growing in at a bit of an angle. My parents decided to go ahead with the surgery to remove them anyway.

“There was a lot of blood,” the doctors told me first thing after waking up — i.e.,  hemorrhaging. That, and the lingering effects of anesthesia, explained why, for the next several hours, I had to be rolled around in a wheelchair.

The following weeks involved a mostly liquid diet and lots of pudding. I hate pudding.

The inside of my mouth, as one friend aptly put it, resembled a “lunar landscape.” And it hurt. My then-frail teenage body was not prepared to handle intensive surgery. Even as my mouth slowly began to heal, my body did not respond to the ordeal well, and I caught pneumonia. This entailed temperatures of 103 degrees and fever dreams of fighting the Nazis on Normandy beaches.

I have never been sicker in my life.

And after researching this topic further, I am now convinced that the wisdom teeth industry is probably a scam.

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As of 2011, 10 million wisdom teeth get hacked out of the back of Americans’ mouths a year.

For decades, the procedure was performed only when the teeth, also known as third molars, were causing real trouble, like in the case of appendectomies. After World War II, however, the ranks of dentists exploded, and with them recommendations that people get their third molars removed as a precaution. As dental care got more advanced—and the financial incentive to perform the procedures increased—wisdom teeth removal began to become as routine as getting braces.

Today, many still undergo this procedure for legitimate reasons: ingrown or impacted wisdom teeth can lead to infections, tooth decay, and generally unpleasant levels of pain.

But a large percentage of patients choose to undergo this act of sawing, bleeding, and stitching merely as a precaution, often putting up more than $1,000 for the experience. This is not entirely surprising: America excels at ordering up unnecessary medical procedures. It’s an epidemic: By one count, Americans waste $750 billion a year on unproductive care, more than our nation’s entire budget for K–12 education.

For 30 years, Dr. Jay Friedman has been on a one-man crusade to halt the tide of wisdom teeth removal, which he says is one of the most egregious examples of unnecessary medical procedures. In 2007, Friedman published a study in which he estimated that at least two-thirds of the millions of wisdom teeth extracted each year could or should have stayed in, but were instead removed out of unfounded fears of what would happen otherwise.

In Friedman’s estimation, you risk more enduring complications from wisdom teeth removal surgery than just leaving the suckers in your mouth. Consider this list of potential complications from wisdom teeth removal surgery:

“It is specious to contend that less than 3 days of temporary discomfort or disability is a small price to pay to avoid the future risks of root [destruction], serious infections, and cysts,” he wrote in his paper. “Also ignored is the risk of incidental injury such as broken jaws, fractured teeth, damage to the [mouth] joints, temporary and, especially, permanent paresthesia or dysesthesia (numbness and dysfunction of the lower lip and the tongue).”

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Friedman is not a lone voice crying in the dental wilderness. A 2002 paper published in the Journal of the Canadian Dental Association estimated that the complication rate from wisdom teeth surgery was between 7% and 10%. A 2011 study of more than 6,000 patients in Greece found that only 2.7% of in-tact wisdom teeth result in problems. And an older study often cited by critics of routine extraction found that only 12% of surveyed middle-aged patients experienced a complication from keeping impacted wisdom teeth.

And then there’s the specter—rare, but possible—of death. Sydney Galleger, a teen in Minnesota, had just finished her junior year of high school last summer when she went under. Everything seemed to be going well until the very end, when Sydney’s blood pressure shot up, her pulse dropped, and she went into cardiac arrest. Press coverage of Galleger’s death pointed the finger squarely at her wisdom teeth removal procedure. An autopsy did not do much to dispel this as the main cause.

In the face of all of this, the other side of the debate maintains that, in fact, there is no debate. At the center is the American Association of Oral and Maxillofacial Surgeons (AAOMS), the doctors who specialize in wisdom teeth removal. In a just released white paper, the association gave this policy statement on the procedure:

…while not all third molars require surgical management, given the documented high incidence of problems associated with third molars over time, all patients should be evaluated by someone experienced and expert in third molar management.

As evidence of this “high incidence of problems,” they point to a review that looked at seven papers examining what happened when young adults left their wisdom teeth in. The review concluded that the risk of having to undergo removal appeared to increase as subjects aged.

But at least one of the studies in the AAOMS’ review concluded no such thing. Rather, the British study found that 83.13% of patients survived the one-year study period symptom-free, and just 5% had to have teeth removed.

Indeed, Britain’s National Health Service now advises the following on wisdom teeth removal:

Your wisdom teeth don’t usually need to be removed if they’re impacted but aren’t causing any problems. This is because there’s no proven benefit of doing this and it carries the risk of complications.

Even if they’re impacted!

Another study published in 2006 by the Cardiff University in Wales found a slightly higher incidence of teeth eventually having to be removed, but also concluded that there was “little support for the reintroduction of prophylactic removal of wisdom teeth,” referring to the already declining practice in the region.

Dr. Julia Boughner, a cell biologist at the University of Saskatchewan, has been following the debate closely for about five years since she opened a research lab to look into how human jaws evolved. In 2013, she published an article on the state of the debate, writing:

…Evidence directly linking third molars to oral diseases is lacking. Further, it is not clear if the age-associated risk of disease²³ (i.e., the older the patient, the greater the apparent risk posed by impacted third molars) is simply due to the increased likelihood of bacterial accumulation and tissue inflammation with time.

At a minimum, she told me, there remains a distinct absence of comprehensive, unbiased studies on the wisdom teeth question.

“The trick is that clinicians still don’t have all the tools and data available that would make them comfortable with a sit-and-wait approach,” she said.

In a 2011 New York Times story on this debate, health writer Roni Caryn Rabin said that the price of leaving your teeth in was that you’ll have to be extra fastidious about your own dental care, with frequent cleanings and X-rays if necessary.

If that’s the price to pay for avoiding major surgery, it seems like a bargain.

Rob covers business, economics and the environment for Fusion. He previously worked at Business Insider. He grew up in Chicago.