Routine dental X-rays are not backed by evidence

Other outdated yet still routine dental practices include polishing of teeth during checkups for any justification other than cosmetic reasons

and fees. But are checkups themselves backed by evidence? Unless you say “It hurts there”, will the dentist find anything on their own?

Don’t you polish your prized possessions?

Good question, cochrane says longer check-up intervals than the standard 6-months aren't any worse assuming you don't have pre-existing conditions

https://www.cochrane.org/news/featured-review-how-often-shou...

> will the dentist find anything on their own?

In my experience they always find something that they "have time to take care of right now if you want". I've heard anecdotes of folks going to get second opinions that reaches a different conclusion.

My bugbear with dentists in the US (after living my first 30 years in the UK) is that they all continually hassle me to have my wisdom teeth removed. Said teeth have never caused me any problems and are all through the gums. I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.

I was told they get harder to remove when you’re older

I asked mine, and he said the wisdom teeth can crowd teeth if the jaw size is too small causing buckling (a cosmetic issue). More seriously, it can interfere with nerves in your jaw (again because of size constraints) causing numbness / paralysis, etc. Likely the decision to remove them comes down to your genetic / jaw structure and whether they have fully come in yet or not.

https://www.webmd.com/oral-health/wisdom-teeth-removal-neces...

In Australia they always found me exactly 4 things to do for a total sum of just above $1000 (but never the same things to do). It’s so regular that I can only assume this is the recommended amount by the marketing that a dentist can extract each time.

I am in the US and I had my wisdom teeth filled. Granted after the procedure my dentist said he was never filling wisdom teeth again, lol.

Just for one anecdote, three years ago my then-dentist (who was a part of a franchise practice and probably under pressure to bill) told me that I had 12 (!!) cavities across all quadrants of my mouth that needed to be filled immediately.

I went to another dentist in the area, they took some x-rays themselves, and told me that there was nothing that needed immediate work - maybe one pre-cavity that would eventually turn in to something but certainly not worth doing anything with now.

Three years later (and sticking with that new dentist) I still haven't needed to have anything done (and certainly don't have any pain in my mouth anywhere either).

It's one of these areas where people (including medical professionals) hold strong beliefs, but then it turns out that there are other highly-developed countries where this is not routinely practiced, and the outcomes aren't necessarily different.

Routine wisdom teeth removal is not a thing in most of Europe. Another random example are colonoscopies and routine flu vaccines (except for the elderly).

The other thing that can interfere with the nerves in your jaw is having them extracted. One of my family members has no feeling there because the extraction was bungled years ago.

I've also retained my wisdom teeth, despite some of them not erupting and being impacted. It's certainly easier to get them out when you're young compared to when you're older, but if you've still got them as an adult, it's not worth removing them unless they're causing a problem, even if insurance is paying for it (all procedures can have side-effects).

Yes, it's much harder for a dentist to convince a 30 year old adult than is to convince a 12 year and his helicopter parents.

Filled? What does this mean?

I had mine done in college. I really didn't want to do it.

I would have been totally happy to buck the pressure of "this is what everyone does," but the thing that made me reluctantly agree to it was an explanation that if I didn't, they would bore holes into my then-back teeth as they grew in and I'd have a big problem to deal with.

As I understood it, teeth normally grow straight up, but wisdom teeth grow sideways (with the tops facing the front of your mouth). The wisdom teeth then hit the rest of your teeth and basically bulldoze your mouth.

I have no idea how true/bullshit that is, but it's what I was told to get me to finally acquiesce to the procedure.

I had the opposite experience. I told the dentist that I thought my wisdom teeth were causing my migraines, and they said it was possible but unlikely, and didn't really recommend removing them. I pushed, and they relented. They were right, it didn't make any difference.

Oddly, I only had wisdom teeth on one side, and not the other. So only 2 teeth were removed.

It means they fixed cavities on those teeth.

I've generally assumed the simplest explanation is that many of these weakly-supported procedures are regular, consistent income streams for the people who perform them in the US: my four wisdom teeth (that were causing me serious issues at age 19) cost $2k to remove nearly 20 years ago, and I know colonoscopies are billed to insurance in the thousands. There's not much incentive to move to cheaper tests or wait-and-see, when you can just do it to everyone who reaches a certain age by default.

Presumably flu shots are good business for the manufacturers, though I'm not sure about the science. After having the flu as a healthy late-twenty-something a while ago, which was...intensely horrible, I've chosen to get it ever since.

This guy infamously has a problem with each and every HN user and chooses to display an NSFW image saying such if your request's referrer header has news.ycombinator.com. Don't click.

Mine recommends the same, but it’s not because I need them out now, but because by the time I’m elderly I might be more likely to need them out, but by that time the surgery might be very difficult for me. As he pitched it to me, “get them out now while you’re young and it’s no big deal”.

I haven’t decided yet since they cause me no problems now and so far I’m to keep them relatively clean, but I have known several elderly family members who eventually needed molars removed because they hadn’t/couldn’t clean them well enough and it was a very difficult surgery for them.

It can be true for some people. Look at the lower right one on the xray here: https://www.jwz.org/gruntle/wisdom-teeth.html

>>>I can only assume it's dogma or an opportunity to bill insurance for costly unnecessary surgery.

This may be specific to location, but would it be the same dentist recommending the treatment as performing the surgery? Here (BC, Canada) everyone I've known who's had wisdom teeth removed had it done by a specialist, not the dentist that suggested it (which presumably cuts down on self-serving recommendations).

I mean not if the dentist refers them to a specialist. Usually that involves a kickback; there's a whole slew of problems with that in the US with lactation specialists referring parents to dentists over a tongue tie problem without actually viewing the baby.

Sorry, I thought he disabled that.

They're not a problem until they are. I recently had a molar out likely due to damage from an impacted wisdom tooth I had out years ago. The rear of the molar was compromised on the back, and there was no way to save the tooth. If I had my molars out earlier when I was young, it probably wouldn't have been an issue.

Unless you wanna see an adviceanimals take on a hairy ballsack, you've gotta open that incognito.

I don't think Jamie wants HN traffic on his blog.

Yeah, I didn't go to the dentist for a few years when I was in grad school and had no insurance. My first visit with a new dentist he informs me I had three cavities. I had no pain but just thought it was prudent to get checked out. I went ahead with the fillings and he nicked a nerve. For days I was in horrible pain and just assumed that was what happened when you had a filling. A few years later I started experiencing extreme shooting pains in the side of my mouth. Then an abscess formed. It turned out the tooth was dying and I had go get a root canal (which actually wasn't that bad).

The root canal was eight years ago. I brush and floss twice a day (brushing without flossing feels weird to me now). I haven't been to the dentist since before the pandemic and my teeth feel completely fine.

It's so odd how experiences vary on this. I'm in my 40s (in the US) and still have all four of my wisdom teeth. When I was a young adult, my dentist told me that they were all intact, and (over time) not moving, so there was no reason to do anything with them. I've gone through a few other dentists in other places since then, and no dentist (including a recent one I had that annoyed me by recommending harmless but unnecessary procedures so they could pad their bill for my insurance) has ever pushed me to get my wisdom teeth removed. When I've started as a new patient at a new practice, they've noted I still have them, and after I say "yup, they've been stable since I was a kid, and cause me no pain", they immediately move on and don't bring it up again.

Flu may not be too dangerous in people who aren't elderly but it still sucks. Can a non-elderly, not in any other high risk group, person get seasonal flu vaccination in Europe if they ask for it, and is it covered by European health care systems?

You just copy and paste the url, so that the referrer is unset.

It's not always true though. My dentist in Europe pushed me to get my wisdom teeth removed early "because you're going to need to get them removed eventually anyway" at a government clinic with no profit incentive.

My wisdom teeth came in like you describe. They meet my back molars at a 90 degree angle. They never bothered me, though - I have had two removed because they got infected, but otherwise they never caused any issues.

Definitely not all wisdom teeth come in like that: it's possible to have all 4 aligned normally and have have enough room (I do).

But coming in towards other teeth and hitting them, or other forms of impaction, are pretty common. You probably saw (or could have seen) the situation pretty clearly on an x-ray.

That being said, there is/was definitely an air of "this is just what we do, it's easier this way" for removing wisdom teeth, akin to say, what removing tonsils once was.

I believe he did? At least I didn't run into that n a long time.

Not covered, but I can get the shot at nearby pharmacy for 15€.

They're not only covered by the gesetzliche Krankenkassen (German public health insurance providers, mandatory if you don't meet the criteria for private insurance), mine gives me a little bonus if I prove I've gotten various vaccines, including annual COVID booster and flu.

Not sure which country you're talking about, but in Germany, the public health insurances cheerfully pay for annual flu and COVID boosters for everyone.

"Some people, when confronted with a problem, think 'I know, I'll quote Jamie Zawinski.' Now they have two problems."

Ah, that explains the downvotes. Sorry. My browser just doesn't send a referrer for clicked links, so I didn't notice.

sounds like the dentist was on the level. lotta things it could be, and those may be easy to address without dental surgery.

did you ever figure out what the root cause of the migraines was?

Unfortunately, no. And they've been getting worse over the years. I have, however, found Excedrin Migraine is really good at dealing with them, so it's not as big a deal as it was, since I hadn't found anything back then.