About four weeks ago, a high school senior from Long Island, Maine, died two days after wisdom tooth surgery. As a parent, I ache for his family. As a physician, I wonder about the circumstances.

I have no direct knowledge about the student’s condition prior to his surgery, the surgery itself or what happened afterward. I do know that upward of two-thirds of routine third molar extractions performed in the U.S. are not needed, according to “The Prophylactic Extraction of Third Molars: A Public Health Hazard,” by Jay W. Friedman, DDS, MPH.

How can this be? How can $2 billion a year in unnecessary and non-indicated surgeries to extract wisdom teeth be done each year here in the U.S., exposing many patients to serious complications?

As a practicing orthopedic surgeon, I can relate that a number of techniques and practices I was taught in good faith 20 years ago are now known to be ineffective or even harmful.

This is true across the field of medicine. After all, 300 years ago common practice included “bloodletting” patients when they were sick, leading to the death of our first president, George Washington.

Please consider that all procedures recommended by a health care provider are based on many things: the provider’s experience; his/her interpretation of the literature and published papers concerning the diagnosis; his/her training, and sometimes – perhaps unconsciously – financial incentives.


The American Public Health Association opposes “prophylactic removal of wisdom teeth.” In England, the British National Institute for Clinical Excellence states rather bluntly: “The practice of prophylactic removal of pathology-free impacted third molars should be discontinued.”

In this era of shared decision making, it’s important to be skeptical. This is especially the case when it comes to elective surgery to take care of a “problem” that may not be a problem at all.

Stephen J. Barr, M.D.
North Yarmouth


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