Prophylactic removal of third molars: a risk-benefit analysis
Tesone, Francesca Marie
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The treatment of impacted third molars that have neither symptoms nor disease is controversial. One school of thought is that these teeth should be extracted before they do become symptomatic and/or diseased. A second school of thought advocates retaining these teeth until such time when they show evidence of developing symptoms or disease. The purpose of this review is to present the reasoning behind the two opposing schools of thought. Studies involving both the risks and the benefits of extracting and retaining asymptomatic, disease-free third molars were examined. There are studies to support the proponents of each school of thought. Proponents of removal are of the belief that many asymptomatic and disease-free impacted third molars eventually do become symptomatic and/or diseased, and do so when the patient is older. The morbidity and incidence of complications common to the procedure increase with age, and therefore proponents of removal prefer that surgery be performed at a younger age when the complications are less likely to be as severe or permanent. Those in support of retaining and monitoring these teeth are of the opinion that the status of these asymptomatic and disease-free impacted third molars may never change and therefore never require surgical intervention. They believe the increased complication rate and morbidity experience by some of the older surgical patients do not justify the routine removal of all asymptomatic, disease-free impacted third molars at an early age. Both groups recognize that when surgical intervention is employed, complications such as pain, swelling, alveolar osteitis, periodontal problems, temporomandibular joint disorders, nerve involvement, sinus communication, and financial stress are not uncommon. Ultimately, the clinician must consider the information presented in this review, and combine it with his/her academic knowledge and personal clinical experience to inform the patient of the risks and benefits of both treatment options. That way, the clinician and the patient together can decide the strategy for management of an asymptomatic, disease-free third molar.