Consensus for the proper management of asymptomatic third molars
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At an annual cost of over three billion dollars, surgical extraction of third molars is by far the most performed surgical procedure in the United States; however, there is and has been much controversy in the literature over the last several decades about the practicality of this procedure. Presently, professionals are divided on the issue of whether or not surgical extraction is necessary for asymptomatic disease free third molars. This comprehensive literature review was performed to investigate the current evidence concerning the prophylactic removal of third molars. It was discovered that many several journals, particularly those pertaining to oral and maxillofacial surgery has been hugely instrumental in marketing this procedure to the public through research articles. Close analysis of the literature revealed a significant level of inconsistency relating to study design, sample size, and methodology. In conclusion, for the typical prophylactic third molar extraction, the risk of complications are often underestimated while the potential gains in quality of life may be exaggerated which will impede the decision making process for the clinician and patient. For an elected surgery that is performed at such a grand scale, there are too many variables still unclear in the literature, many of which present as a public health hazard. There are also many other factors, both physically and ethically, that need to be considered before a responsible decision can be made. It was also found that the imaging technology currently being used as the standard of care for the diagnosis and treatment planning of third molars does not give a clear enough picture to ensure a complication-free surgery. Furthermore, there are other non-invasive options for the management of asymptomatic third molars that are not being applied enough, which do not require sacrificing the third molars. Complications resulting from third molar surgery are one of the most common reasons responsible for lawsuits facing dentists today and can also result in a lifetime of pain and disability for the patient. Taken together, the high cost of surgery along with the risk of complications following an otherwise disease-free third molar doesn't seem to be representative of responsible dentistry. More conservative approaches along with a general shift towards evidence-based dentistry may be the answer for the proper management of third molars. Discouraging the practice of prophylactic removal of third molars could result in billions of dollars in saving, elimination of millions of days of discomfort, and prevention of permanent injury to tens of thousands of people.