Care Guidelines for Wisdom Teeth: 2014 Finnish Guidelines

An article titled Current Care Guidelines for Third Molar Teeth appears in the May 2015 issue of the Journal of Oral and Maxilofacial Surgery (vol. 73, issue 5), written by Irja Venta. The article describes the 2014 Finnish Care Guidelines on wisdom teeth removal. The guidelines were written in mind for the best possible care to the patient without weighing against the resources of the health system.

The author states

“The updated guidelines for the third molar are based on evidence, with an extensive review of 180 references…Because nerve injuries continue to be the most common reason for malpractice claims submitted to the Finnish Patient Insurance Center, this issue warrants attention. Another important issue is the controversy surrounding the preventive, prophylactic, early, or elective removal of third molars; 4 distinct groups are suggested as candidates for early removal.”

The guidelines have an emphasis on avoiding nerve injuries. Cone-beam computed tomogram can be used to obtain information about the relation between the root end and the mandibular canal. When the risk of nerve injury is high, the guidelines recommend removing only the crown (coronectomy). When the risk of mandibular bone fracture and nerve injury is present, the crown can be exposed and then use orthodontic traction to pull the tooth closer to the occlusal surface before extraction.

The article discusses the four cases when preventive removal of mandibular wisdom teeth is recommended to prevent injury of the inferior alveolar nerve, pericoronitis, postoperative bone defects, and caries.

  1. If the mandibular wisdom teeth is developing in a position in which the root of the tooth and the mandibular canal are superimposed on the radiograph and there is insufficient space for the tooth to erupt or if the direction of eruption is unfavorable, then removal of the tooth is recommended before the growth of the root end is complete to prevent injury to the inferior alveolar nerve.
  2. Acute pericoronitis in 20 to 25 year old patients can be prevented by electively removing the partially erupted third molars in a vertical and disto angular position and close to the occlusal surface.
  3. Postoperative bone defects of partially erupted mandibular third molars that are in a horizontal position or deeply inclined forward can be prevented by removal before 25 years of age.
  4. Partially erupted wisdom teeth as they increase the amount of salivary bacteria that causes plaque.

The author also states that other national guidelines on wisdom teeth management are underway.

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