From the Guidelines
The extraction of asymptomatic impacted third molars (wisdom teeth) is generally not recommended as a routine preventive measure. Current guidelines suggest a conservative approach, recommending observation and monitoring rather than prophylactic removal when these teeth are fully impacted, asymptomatic, and show no pathology 1. Extraction should be considered when there are specific indications such as recurrent pericoronitis (infection around the crown), untreatable caries, non-restorable tooth damage, cysts or tumors, resorption of adjacent teeth, or when the tooth interferes with orthognathic surgery or orthodontic treatment.
Key Considerations
- The decision to extract asymptomatic impacted third molars should be individualized based on the patient's specific clinical situation, considering factors such as age, medical history, and the anatomical position of the tooth 1.
- For patients under regular dental care, periodic clinical and radiographic evaluation (typically panoramic radiographs every 24 months) is sufficient to monitor asymptomatic impacted third molars.
- If extraction becomes necessary, it is ideally performed in young adults (ages 17-25) when root formation is incomplete, as this timing is associated with fewer surgical complications and better healing outcomes.
Guideline Implementation
The implementation of guidelines for the management of impacted and unerupted third molar teeth can be effective through various strategies, including reminders, education, and audit and feedback 1. However, the effectiveness of these strategies may vary depending on the specific context and population.
Outcome Prioritization
In prioritizing outcomes, the focus should be on minimizing morbidity, mortality, and optimizing quality of life. The conservative approach to asymptomatic impacted third molars balances the risks of surgery against the relatively low risk of future complications from retained asymptomatic impacted third molars, thereby prioritizing patient safety and well-being 1.
From the Research
Guidelines for Extraction of Asymptomatic Impacted Third Molars
The extraction of asymptomatic impacted third molars, also known as wisdom teeth, is a common surgical procedure performed by dentists. The decision to extract these teeth should be based on individual clinical and radiographic assessment of each patient 2.
Indications for Extraction
The indications for extraction of impacted third molars include:
- Infections, which accounted for the majority of extractions in one study 3
- Periodontal pocket formation distal to second molars 3
- Caries, cysts, jaw fractures, and neoplasm 3
- Obscure jaw pain, which was the most common reason for removing impacted upper third molars in one study 3
Risk Factors for Complications
The risk factors for complications in impacted third molar surgery include:
- Distance to maxillary sinus, depth score, bone coverage score, operation time, tooth's angulation, and type of surgeon 4
- Minimum distance to inferior alveolar nerve (IAN), bone coverage score, total operation time, and operation by an oral surgeon (DMD) 4
Prophylactic Removal
There is debate regarding the prophylactic removal of asymptomatic impacted third molars. However, nearly half of impacted third molars are associated with some form of pathology, and preventive removal at a young age may be justified to prevent the development of various pathologies 5.
Systematic Review
A systematic review of indications for the extraction of symptomatic impacted third molars found that extraction is indicated in the presence of disease associated with an impacted third molar, whether symptomatic or not. In contrast, extraction is not indicated in the absence of infection or other associated disease conditions 6.
Key Considerations
When considering the extraction of asymptomatic impacted third molars, the following key considerations should be taken into account: