Third molars: not so NICE? risk factors for distal caries in mandibular second molars

Abstract

UK guidelines currently advise against the prophylactic removal of mandibular third molars. However, growing evidence shows that asymptomatic impacted mandibular third molars may contribute to the formation of distal caries in mandibular second molars. Patients should be made aware that these guidelines do not necessarily prevent the potential development of decay or loss of mandibular second molars. A retrospective review, over 6 months, analysed the incidence and evaluated the risk for developing caries on the distal aspect of mandibular second molars, in patients referred for assessment of impacted third molars. Distal caries in the mandibular second molar was present in 24.1% of cases. Of these patients, 9% demonstrated caries bilaterally. In those who developed distal caries in the mandibular second molar, 76% of adjacent third molars demonstrated mesio-angular impaction, 91% of third molars were partially erupted, and 95% of third molars were either touching or in close proximity to the ACJ of the second molar tooth. The prophylactic removal or coronectomy of mesio-angluar or horizontally impacted third molars that are partially erupted and closely related to the ACJ of mandibular second molars may result in improved long-term patient outcomes. CPD/Clinical Relevance: The prophylactic removal or coronectomy of certain third molars may result in improved long-term patient outcomes.