From the Guidelines
Routine extraction of asymptomatic impacted third molars is generally not recommended. These teeth should be monitored rather than automatically removed if they are not causing problems. Extraction should be considered only when there are specific indications such as recurrent pericoronitis (infection around the crown), untreatable caries, cysts or tumors, damage to adjacent teeth, or when the tooth interferes with orthognathic surgery or orthodontic treatment 1.
Key Considerations
- The prevalence of dental impaction is strongly related to age, gender, ethnicity, and anatomical localization, with third molars being the most commonly impacted teeth 1.
- Possible causes of dental impaction include lack of space, position anomalies, supernumerary teeth, persistence of primary teeth, odontogenic cysts/tumors, trauma, and systemic diseases, with the first two being the most frequent 1.
- Regular dental check-ups with radiographic monitoring every 1-2 years are sufficient for asymptomatic impacted third molars.
Management
- For patients who do require extraction, perioperative management typically includes preoperative antibiotics and postoperative pain control with ibuprofen and/or acetaminophen.
- Chlorhexidine 0.12% mouthwash twice daily for one week can help prevent infection.
- Patients should apply ice packs intermittently for the first 24 hours, maintain a soft diet for several days, and avoid smoking and using straws to prevent dry socket. The rationale for conservative management is that many impacted third molars remain asymptomatic throughout life, and extraction carries risks including nerve damage, dry socket, infection, and bleeding 1.
From the Research
Guidance for Extraction of Asymptomatic Impacted Third Molars
The decision to extract asymptomatic impacted third molars is complex and requires careful consideration of various factors. Some key points to consider include:
- The presence of disease or potential for disease is a key factor in deciding whether to extract asymptomatic third molars 2
- Extraction is indicated in the presence of disease associated with an impacted third molar, whether symptomatic or not 2
- In the absence of infection or other associated disease conditions, extraction is not indicated 2
- The removal of asymptomatic third molars should be based on individual clinical and radiographic assessment of each patient 3
- Patients should be educated on the indications, contraindications, risks, and benefits of removal of third molars, and a mutual decision should be made with the dentist 3
Considerations for Extraction
Some studies suggest that the decision to remove asymptomatic third molars is sometimes less clear and requires clinical experience 4. Additionally, data is accumulating from third molar studies to provide evidence-based guidelines for elective third molar surgery 4. However, there is no clear consensus on the guidance for extraction of asymptomatic impacted third molars, and more research is needed to establish definitive clinical practice guidelines.
Indications for Extraction
Some common indications for extraction of impacted third molars include: