Revolution vs status quo? Non-intervention strategy of asymptomatic third molars causes harm

Abstract

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

Distal caries of the second molar in the presence of a mandibular third molar – a prevention protocol

“…[4][5][6][7][8] The caries process usually affects the distal aspect of the second molar ( Figure 1) and this has been strongly associated with impacted mandibular third molars especially mesioangular impactions. [8][9][10] Frequently the development of decay remains unnoticed and this is thought to be partly due to the difficulty in detecting caries via visual examination and lack of detailed recommendations or guidance dentists currently receive on screening for this issue. 11 The incidence of impacted wisdom tooth retention causing an influence on the dental arches in such a fashion is well documented in the literature and has been classed as a dental public health concern.…”

Does Retaining Third Molars Result in the Development of Pathology Over Time? A Systematic Review

“…This can be aggravated when the third molar has only partially erupted, because this position will undermine the second molar's gingival seal. 46 However, prospective longitudinal studies are lacking on the topics of second molar ERR and pathologic widening of the pericoronal space. The studies that investigated these pathologies were all cross-sectional in design, compromising the opportunity to inquire into the development of these pathologies over time.…”