We very much appreciate Dr. Knapp’s interest in our article and the opportunity to discuss further the issues that he raises.
It was not the intent of the article to suggest which approach to third-molar removal is best, but rather to let dentists see the differences in their practice patterns so that a more thorough discussion of the topic can take place within the profession.
While a profession never can unilaterally decide what is best for the public, we nevertheless firmly believe that the focus of these kinds of discussions must be within the profession.
Our principal focus was on the early prophylactic removal of asymptomatic, unerupted third molars. Dr. Knapp’s point about oral hygiene problems around erupted third molars as a rationale for extraction—and the difficulty in motivating middle-aged adults to have these teeth extracted—is a somewhat different issue.
The removal of teeth because of oral hygiene difficulties is perhaps best done on a patient-by-patient, tooth-by-tooth basis, with those patients who can be motivated to adequate oral hygiene having the option to retain these teeth. It is difficult to see how judgments on ability to maintain adequate oral hygiene can be made for an adolescent before the tooth has erupted.
Finally, we agree with Dr. Knapp that insurance should not determine how patients are treated. Treatment decisions should be tailored to the needs and wants of each patient. If a needed and desired procedure happens not to be covered by insurance, the patient surely can decide to purchase it anyway. Also, if patients would not otherwise want a procedure, insurance should not dictate that they have it.
Insurance is best seen as a means to help people to buy what they need and want, not something that dictates those needs and wants.
