From the Guidelines
In most cases, it is recommended to leave molars in, as they are crucial for proper chewing and grinding food, which aids digestion and maintains facial structure. According to a recent study published in 2023 in the journal Periodontology 2000 1, individuals who are missing the second molars, having four chewing units (i.e., two premolars and one molar) instead of six, do not exhibit a significant reduction in their chewing capacity. This suggests that having at least one molar is sufficient to provide patients with adequate chewing capacity.
Factors to Consider
When deciding whether to leave molars in or extract them, several factors should be considered, including:
- The occlusal scheme and restorative status of the opposing jaw
- The smile and size of the buccal corridor
- The number of occlusion units required
- The presence of any dental or periodontal disease that may affect the molar
Treatment Alternatives
The study also discusses the use of distal cantilever units in the posterior maxilla as an additional prosthetic resource to extend implant- or tooth-supported fixed dental prostheses and give patients additional chewing units, while avoiding the need for implant placement and ancillary bone augmentation 1. This approach can reduce morbidity, cost, and total treatment time compared to maxillary sinus floor augmentation and placement of standard dental implants.
Importance of Professional Evaluation
If you're experiencing pain, swelling, or other symptoms with your molars, it's essential to consult a dentist for evaluation. They may recommend treatments to save the tooth, such as root canal therapy, crowns, or periodontal treatment, before considering extraction. Removing molars can lead to shifting of remaining teeth, difficulty chewing, and potential bone loss in the jaw over time, which can negatively impact morbidity, mortality, and quality of life. The decision should be made on a case-by-case basis after thorough examination and discussion with your dental professional about the long-term implications for your oral health.
From the Research
Factors to Consider When Deciding to Leave or Remove Molars
- The decision to leave or remove molars depends on various factors, including the presence of underlying malocclusion, the necessity for a general anaesthetic, and potential cooperation with restorative or orthodontic treatment 2.
- Elective extraction of first permanent molars with a questionable long-term prognosis should be considered when planning enforced extractions, as it can be followed by successful eruption of the second permanent molar and ultimately, third molar eruption to complete the molar dentition 2.
- General dentists often recommend removal of third molars to prevent future problems, such as unfavorable orientation or unlikely eruption, rather than due to symptoms or pathology 3.
Complications Associated with Molar Removal
- The timing of removal can affect the incidence and severity of complications, with younger patients (less than 25 years old) having a decreased risk for postoperative complications and more rapid recovery 4.
- As patients get older, third molars become more difficult to remove and may result in an increased risk for complications associated with removal, such as fractures, infections, and nerve involvement 4.
- Tooth-related factors, such as bleeding on probing, probing depth, and furcation involvement, can also influence the prognosis of molars during supportive periodontal care 5.
Patient-Related Factors
- Patient-related factors, such as age, gender, diabetes, smoking, and non-compliance, can also impact the longevity of molar teeth and increase the risk of loss during supportive periodontal care 5.
- Male patients over 50 years old with diabetes and smoking habits are at a higher risk of losing molars during supportive periodontal care 5.