Active Surveillance For Managing Retained Wisdom Teeth

An interesting expert opinion by Thomas B. Dodson appears in the Journal of Oral and Maxillofacial Surgery vol. 70, issue 9, supplement 1, pages 20-24, 2012, titled ” Surveillance as a Management Strategy for Retained Third Molars: Is It Desirable?”  The author opens by describing in the third paragraph that the treatment of symptomatic disease-free wisdom teeth can be challenging. The author states in the third paragraph

“Absent good evidence, management decisions should incorporate the clinician’s experience and expertise, and after a careful, balanced review of the risks and benefits of both treatment options, weigh heavily the patient’s wishes and desires regarding extraction versus retention. The opinions in this chapter reflect the author’s personal decision-making process based on a careful literature review and clinical experience/expertise.”

The author opens by describing his clinical classification of wisdom teeth rationale. He states that the clinician needs to determine if the wisdom teeth are causing symptoms or not. Patients can complain of pain near wisdom teeth but this may not mean the wisdom teeth are the source of the pain as other things could be going on such as normal teething pain. From this, the clinician can determine if the patient is symptomatic or asymptomatic. The author then suggests the clinician moves on to probing the wisdom teeth to determine if the probing depths are greater than 4 mm or not. In addition, a radiological examination can be conducted to determine if disease such as caries or resorption are present and assess the location of nerves and second molars. The clinician then can group the wisdom teeth into 1 of 4 categories. These categories were discussed in another article by the author which I have discussed in What is the Prevalence of Patients with Asymptomatic, Disease-Free Third Molars (Wisdom Teeth).

For those patients with who have symptomatic and disease present wisdom teeth and asymptomatic and disease present wisdom the author says the management strategy is usually straightforward. The author states

“Treatment depends on the diagnosis and can range from the full scope of restorative and hygiene care to periodontal therapy to coronectomy to extraction. The treatment choice should be individualized according to factors such as hygiene, eruption status, functionality, anatomic location, risk to local anatomic structures, and patient preference.”

For those patients who are symptomatic but have no disease present in the wisdom teeth the clinician should attempt to find a cause of the pain/problems but this can take time. For those patients with asymptomatic and disease free wisdom teeth the author states

“…the clinician needs to review in detail the risks and benefits of operative treatment versus retention and weigh heavily in the decision the patient’s preferences, wishes, desires, and perceived risks and benefits.”

The author states numerous complications can occur from removing wisdom teeth (of which I have discussed many more over at and also mentions a patient consider the indirect costs of removal such of lost productivity at work or school. Further the author notes that wisdom teeth that are retained “…frequently and unpredictably change position, eruption status, and periodontal status.”

The author then gets into a discussion between active surveillance when managing asymptomatic disease free wisdom teeth and a follow up when symptomatic approach. The first approach requires the patient to regularly follow up with a clinician on a scheduled basis which includes physical and radiological examinations. The second approach is described as poor by the author. The author states his rationale for active surveillance versus following up when symptomatic

“…active surveillance should result in the diagnosis and treatment of disease at a younger age thus decreasing the risk or morbidity of age-related complications after…removal.”

The author recommends that he suggests that patients following an active surveillance plan be seen every 2 years or sooner if symptoms develop. He also mentions that it is not clear if the follow up should be done with a primary care dentist or an oral and maxillofacial surgeon. He does however state that the clinician should be competent in wisdom teeth assessment and management.

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