Dentaltown May 2023 - 51

We need to remember that 'asymptomatic' does not
mean 'disease-free.' About 25% of patients who deny any
symptoms around their third molars have inflammatory
periodontal disease around those teeth.
BY DR. JAY B. REZNICK
W
henever we do a consultation for
removal of wisdom teeth, we discuss
with the patient the potential risks and
complications of the surgery. We try to
do a thorough job so the patient can make the
best-informed decision about their treatment
course. But how much time do we spend discussing
the risks of not removing third molars,
especially when that patient is younger than
25 years old?
We know the hazards include development
of caries, infection, periodontal problems, bone
loss, development of cysts and other pathology,
fracture of the mandible and damage to adjacent
teeth. But how common are these risks, and how
heavily should they weigh in our recommendations
to our patients?
So, that brings up the age-old question: Should
asymptomatic third molars be prophylactically
removed? As Assael eloquently put it, it depends
on how you ask the question, who is asking the
question, and who is providing the answer.1
Insurance carriers and public health systems
tend to argue against their removal; we clinicians
generally argue in favor of prophylactic surgery
with the goal of preventing disease and minimizing
the surgical morbidity to our patients.
What does the literature say about this question,
and how does our personal clinical experience
influence whether we recommend removal of
asymptomatic third molars or not?
The case against removal
Those who argue against preventive surgery have
two basic arguments. First, the incidence of complications
from retained third molars-including
pain, infection, caries, bone loss, periodontal
issues, development of cysts and tumors, and
mandible fracture-is so low that prophylactic
removal for those reasons is not warranted. The
second relates to the financial cost, recovery
time and risk of significant complications such
as permanent paresthesia.
Stanley et al. evaluated 11,598 cases of
impacted third molars in patients older than
20 using panoramic radiographs. Their study
showed the incidence of cyst development
around third molars to be 0.25%. Internal resorption
was visible in 0.13%, 0.72% had periodontal
bone loss behind the second molar, and caries
were seen in 0.72%.2
Friedman (a retired dentist who is opposed to
prophylactic third-molar removal and frequently
is an advocate for third-party payers) states
that internal resorption is present in 0.85% of
asymptomatic wisdom teeth; 1.65% are associated
with the development of cysts; 4.72% show
periodontal bone loss; and 4.78% show resorption
on the distal of second molars. He equates this
to the incidence of appendicitis and cholecystitis
(10%-12%) in the adult population and
argues that prophylactic appendectomies and
cholecystectomies are not the standard of care.
MAY 2023 | 51 | DENTALTOWN.COM
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Dentaltown May 2023

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