InquiryThird molar removal
Section snippets
Background
Third molar removal is an extremely common dental surgical procedure in the United States, accounting for 95% of all extractions in persons age 16 to 21 years. Although most third molars will erupt without symptoms, many dentists recommend early prophylactic removal of asymptomatic third molars to lower the risk of future pathologic conditions. Third molar removal is accompanied by pain, swelling, bleeding, infection, and paresthesia, among other complications, in 4.6% to 21% of cases.
Methods
A 2-year study followed 801 patients age 16 to 21 years from 50 general dental practices. All had at least one third molar present and had not had any removed. Radiographs of the third molars taken in the past 12 months or at the baseline appointment were also available. Patients completed a questionnaire at baseline and underwent a clinical examination. Dental caries, pericoronitis, clinical attachment loss, temporomandibular signs and symptoms, and paresthesia of the lip and tongue were
Results
Of the 797 patients who received a recommendation concerning third molars, 516 (65%) completed at least one follow-up questionnaire. Dentists recommended the removal of 1638 third molars in 469 patients. The principal reasons for removal were to prevent future problems (79% of cases) and to address unfavorable third molar orientation or the dentist’s opinion that the third molar would not erupt (57%). The reasons cited least often were pericoronitis, periodontal concerns, or dental caries (all
Discussion
Most of the teeth whose removal was recommended were asymptomatic and the recommendation was given to prevent future problems. Over half of the patients followed the recommendation. Pathologic conditions were not a major reason for having a tooth removed. Many patients with pain or discomfort decided against removing a tooth when symptoms resolved. However, soft tissue impaction often prompted patients to have the tooth removed, whereas bony impaction did not, reflecting the impact soft tissue
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Cunha-Cruz J, Rothen M, Spiekerman C, et al: Recommendations for third molar removal: A practice-based cohort study. Am J Public Health 104:735-743, 2014
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