Looking at the Timing of Removal of Wisdom Teeth and It’s Effect on Complications

An interesting study by M. Anthony Pogrel titled “What Is the Effect of Timing of Removal on the Incidence and Severity of Complications?” appears in the Journal of Oral and Maxillofacial Surgery, vol. 70, issue 9, supplement 1, pages S37-S40, 2012. The author sets out to explore if younger patients (less than 25 years) have a decreased risk for postoperative complications than older patients.  The author begins by describing three studies in the literature that have shown that complications associated with wisdom teeth removal increase after 25 years of age. I have also mentioned several of these studies over at http://www.teethremoval.com/wisdomteeth.html.

The author then goes on to discuss that recovery for patients of wisdom teeth surgery older than 21 may be delayed after extraction (by two studies).

The author then discusses that mandibular fracture and tuberosity fracture may occur after wisdom teeth removal and the incidence (based on 6 cases) may increase with age.

The author then discusses 4 studies which demonstrate that infections can occur more frequently in older patients after wisdom teeth removal. An additional study suggests that infections can occur more often when surgical time increases.

The author later discusses periodontal complications after wisdom teeth removal and the effect on age. He states:

“A number of well-controlled trials have indicated that for older patients (often aged 25 years), the periodontal condition on the distal aspect of the second molar (M2) may not predictably recover after [third molar – wisdom teeth] M3 removal, and it has been shown that in some older patients, postoperative periodontal problems may actually be created after M3 removal when they did not exist preoperatively.”

The author then discusses nerve damage that can occur after wisdom teeth removal (specifically the inferior alveolar nerve) and the effect on age. Two studies are identified which suggest that older patients are more likely to have incomplete recovery of the nerve and permanent damage.

The author then describes a study which shows that temporomandibular joint (TMJ) problems may be more likely to occur after wisdom teeth removal in patients 21 and older.

The author finally discusses a study which shows that potential sinus complications (associated with upper wisdom teeth) after wisdom teeth removal are more likely to occur and lead to chronic sinus problems in older patients.

The author states in his conclusion

“Studies indicate that as one becomes older, [wisdom teeth] become more difficult to remove and may take longer to remove, leading to an increase in the incidence of complications associated with removal. The age of 25 years appears in many studies to be a critical time after which complications increase more rapidly. Conversely, there are no studies indicating a decrease in complications with increasing age.”

I take a bit of an issue with the age of 25 years remark and that no studies have indicated a decrease in complications with increasing age. See http://www.teethremoval.com/wisdomteeth.html.

I cite two studies here which actually showed that 25 to 35 years old patients were associated with the highest risk of complications (there was a younger and older group in these). Further, the 25 year old cutoff often selected may be arbitrary selected by some practitioners skilled in the art to make the statistics appear to cause older patients to always have more complications.  Nonetheless, I do agree that the majority of studies do indicate that as one becomes older an increase in complications occurs.

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