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What are the indications for third molar extraction?

Third MolarsThis summary is based on the article published in the Journal of the American Dental Association: The indications for third molar extractions (June 2014)

Martin B. Steed, DDS

Context

Defining the indications for thirdmolar extraction continues to be a topic of controversy.

The dentist’s management of third molars commonly hinges on identifying the presence of symptoms or disease that clearly is attributable to the third molar. Use of a guide that serves as a systematic and unambiguous way to classify third molars has been advocated.

Investigators in numerous studies have discussed the epidemiology and management of so-called asymptomatic third molars. The term “asymptomatic” is an insufficient description of the clinical status of the third molar. Just as in many other disease courses, such as diabetes and cardiovascular disease, the absence of symptoms in a third molar does not always reflect true absence of disease.

Group A third molars: Patients with third molars in group A have symptoms such as severe pain, edema or trismus. Physical and radiographic examination findings may reveal acute pericoronitis, dental caries or localized or spreading fascial space infection or a combination of the preceding.

Group B third molars: seen less often and placement into this group is more difficult. Clinical examples include vague posteriorquadrant pain from impending eruption in the setting of adequate space for the third molar to erupt into a useful, functional position. Other third molars classified
into group B are located in quadrants in which there is referred myofascial or deafferentiated (atypical) pain.

Group C third molars: Patients with third molars in group C do not have symptoms associated with the third molar, yet disease is present: periodontitis, caaies and Cyst or tumor associated with the tooth.

Group D third Molars: Symptoms and Disease Absent. Clinical decision making for patients with third molars in group D remains challenging. Patients with four asymptomatic disease-free third molars are not common.

Key Messages

  • Evidence-based clinical data collected from prospective investigations show that an asymptomatic third molar does not necessarily reflect an absence of disease.
  • Practitioners typically should consider removing erupted and impacted third molars when they:
    • Cause considerable pain,
    • Are infected,
    • Are associated with bonedestroying pathology, and
    • Are carious or adversely affect the health of adjacent teeth.
  • Practitioners should remove third molars that are expected to be problematic under dentures, are located at sites of planned osteotomies or interfere with planned orthodontic movements.
  • Current data are not sufficient to refute or support prophylactic removal of third molars in group D versus active surveillance. Although third-molar management usually is straightforward, the evidence supporting extraction versus retention of asymptomatic, disease-free (group D) third molars is lacking.

 

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1 Comment

  1. Victor Jacob June 17, 2014

    In my practice I see many adolescents with asymptomatic, un-erupted third molars. In many of these cases, there is insufficient space in the arch to accommodate them or they are so poorly positioned that they are unlikely to erupt, usually mesio-angular or horizontal impactions. These are far more common in my practice than the symptomatic third molars.

    Reply

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