Management of Wisdom Teeth without Symptoms

An article by Raymond P. White and William R. Proffit titled “Evaluation and management of asymptomatic third molars: Lack of symptoms does not equate to lack of pathology” appeared in the July 2011 issue of the American Journal of Orthodontics and Dentofacial Orthopedics (Vol 140, Issue 1).

The article states

“Some patients have third molars that are “symptom free and pathology free.” More often, however, third molars are “symptom free, and pathology exists,” requiring a clinical or radiographic examination for confirmation.”

The authors state that a recent report suggests that limited periodontal examination in the United States in the National Health and Nutrition Estimates Survey…”underestimated the prevalence of periodontal disease.”

A study carried out at the University of North Carolina and the University of Kentucky is mentioned which included 409 healthy young adults who averaged 25 years old and had 4 retained asymptomatic third molars.

Mention is made of 106 of these patients were periodontally healthy in the wisdom tooth region at baseline and after a median of 4.1 years, 40 (37.7%) had at least 1 periodonal probing depth in the wisdom tooth region of greater than or equal to 4 mm. Other studies using this data sample are mentioned and the results which are touched on over here

The authors later talk about the biolfim gingivial interface and state

“Deeper [probing depths], which tend to be detected around third molars as soon as the teeth are exposed, are associated with colonization of subgingival anaerobic pathogens at the [biolfim gingivial interface – BGI]. The magnitude and quality of the local inflammatory response at the BGI to the pathogens colonized adjacent to a single gingival epithelial cell layer are reflected in the production of gingival crevicular fluid inflammatory mediators, chiefly from immune-system cells: neutrophils, lymphocytes, and monocytes. The resulting chronic inflammatory process is the source of tissue destruction with time. Once established, the bacteria around third molars are difficult to eradicate with mechanical debridement alone, and pathogens in deeper third molar probing sites can serve as a potential reservoir for pathogens colonizing in other sites on teeth more anterior in the mouth, particularly the adjacent second molars.”

The authors then go on to address how third molars are rarely affected without first or second molars being involved so caries experience is a possible predictor. The authors also address how third molars can change position as they age.  They also suggest how experienced clinicians feel that the difficulty of surgery and recovery period increases as one gets past their 30s.

The authors state

“The clinician involved in the consultation about third molar management should frame the odds of possible options in both positive and negative fashions. It is appropriate to tell adolescents and young adults that, based on recent data, at least 70 of 100 young adults with third molars that are “symptom free” already have pathology or will experience pathology with time. Conversely then, 30 or possibly fewer of 100 young adults will not experience pathology with retained asymptomatic third molars.”

I personally thought the article was well written and informative. However, I disagree a bit about the positive and negative odds descriptions. If this was actually represented of what the clinician you are seeing saw this might be okay but this is based on a study that didn’t have that large of a sample size so I would like to know more information about where these numbers came from.

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