Insufficient evidence is available to determine whether or not asymptomatic disease-free impacted wisdom teeth should be removed. Although asymptomatic disease-free impacted wisdom teeth may be associated with increased risk of periodontitis affecting adjacent second molars in the long term, the evidence is of very low quality. Well-designed RCTs investigating long-term and rare effects of retention and removal of asymptomatic disease-free impacted wisdom teeth, in a representative group of individuals, are unlikely to be feasible. In their continuing absence, high quality, long-term prospective cohort studies may provide valuable evidence in the future. Given the lack of available evidence, patient values should be considered and clinical expertise used to guide shared decision making with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals to prevent undesirable outcomes is advisable.

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BackgroundProphylactic removal of asymptomatic disease-free impacted wisdom teeth is surgical removal of wisdom teeth in the absence of symptoms and with no evidence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as pericoronitis, root resorption, gum and alveolar bone disease (periodontitis), caries and the development of cysts and tumours. When surgical removal is carried out in older people, the risk of postoperative complications, pain and discomfort is increased. Other reasons to justify prophylactic removal of asymptomatic disease-free impacted third molars have included preventing late lower incisor crowding, preventing damage to adjacent structures such as the second molar or the inferior alveolar nerve, in preparation for orthognathic surgery, in preparation for radiotherapy or during procedures to treat people with trauma to the a ected area. Removal of asymptomatic diseasefree wisdom teeth is a common procedure, and researchers must determine whether evidence supports this practice. This review is an update of an existing review published in 2012. ObjectivesTo evaluate the e ects of removal compared with retention (conservative management) of asymptomatic disease-free impacted wisdom teeth in adolescents and adults.

This follow-up survey supports the findings of the original survey. Future longitudinal studies would allow institutions to identify possible weaknesses in their curriculum and to track the career development of their graduates and facilitate robust data collection.

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Background To determine the risk factors for the development of radiographic distal surface caries (rDSC) in patients who attend routine dental check-ups during an era of National Institute for Health Care Excellence third molar surgery guidelines. Methods Radiographs taken during routine dental examinations involving 1012 patients from Manchester, UK were accessed. Clinical parameters, oral health, patient demographics, and socioeconomic factors were assessed. Risk factors were identified by multivariate logistic regression analysis. Results The detected rate of rDSC was 63.9% and rDSC was distributed homogenously across all five socioeconomic groups (p = 0.425). Risk factors associated with rDSC (p < 0.001) were identified as partially erupted mesio-angularly impacted mandibular third molars, third molars with compromised molar to molar contact points, loss of lamina dura of ≥ 2 mm, male gender, increasing age, and a higher modified Decayed Missing Filled Tooth score. Conclusion rDSC was significantly associated with the angulation of third molars, the compromised contact position of the adjacent third molar, the periodontal status of the distal aspect of the second molar and the cumulative history of oral health in a population governed by specific third molar guidelines. An active approach to third molar surgical management could reduce rDSC and serve this population, irrespective of patients’ socioeconomic or deprivation status.

The existing guidelines are based on evidence from an assessment report published by Song et al. 1 in 1999 which refers to research evidence from almost three decades ago, during which time a large number of third molars were prophylactically removed. Moreover, the assessment report documented a very low rate of distal-cervical caries in lower second molars and identified the incidence within a range of 1-4.5%. 2 It is now evident that the removal of wisdom teeth in this era could not provide the data or analysis required to truly highlight the incidence of harm that clinicians see today -some 15 years after the recommendation for a non-intervention strategy. Conflict between research evidence and clinical opinionIn the UK we have little hope of enhancing our evidence in relation to third molar research with large trials as research funders for the NHS (England) and other UK based research councils have funding priorities that lay elsewhere. 3 Furthermore, the current clinical reporting systems in place are not sensitive enough to show an accurate