Containing the cost of third-molar extractions: a dilemma for health insurance.

No known scientific studies support the extraction of third molars (wisdom teeth) to prevent future disease. Yet, third-molar surgery for this purpose has become so common that in at least one major U.S. health insurance plan, the cumulative cost exceeds that for every other kind of major surgery. Many third molars that are developing normally in adolescents are classified as impacted and removed before they erupt, a practice that results in large expenditures for unnecessary surgery. In addition, the difficulty of the extractions is frequently exaggerated, so that patients and insurance plans are overcharged. Third molar surgery is not without risk of iatrogenic injury. Fracture of the jaw, permanent numbness of the lip (paresthesia), and injury to other teeth may occur. This paper presents a mechanism for containing the cost of third-molar surgery by elimination of payment for nonessential extractions and of the related overcharges. Adoption of this policy by administrators of dental insurance plans would save millions of dollars each year, money that could be better used in providing care for more people with real dental disease.