Monitoring the Periodontal Status of Wisdom Teeth

An interesting article titled “Monitoring for Periodontal Inflammatory Disease in the Third Molar Region,” appears in the April 2015, issue of the Journal of Oral and Maxilofacial Surgery written by Brent A. Golden and et. al. (vol. 73, issue 4). The study looked at participants who had asymptomatic wisdom teeth and sought to assess the periodontal status of those wisdom teeth at 2 year intervals for 6 years. The participants in the study were taken to have healthy periodontal status of their wisdom teeth if the probing depths were less than 4 mm. A total of 129 such patients were included in the study. In actuality the study participants were a subsample of another larger study were patients had 4 asymptomatic wisdom teeth. The subsample included all participants with a healthy periodontal status (all probing depths less than 4 mm) in the wisdom teeth region, defined as distal of second molars and around adjacent third molars, with clinical data collected at three 2-year intervals. Eighty-nine percent of those in the study visited a dentist at least occasionally, all of them brushed their teeth at least daily, and 67% used dental floss. After 6 years of the study, one-fourth of the […]

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A Study of 185 Coronectomy Procedures of Wisdom Teeth

An interesting article titled “Coronectomy of the Mandibular Third Molar: A Retrospective Study of 185 Procedures and the Decision to Repeat the Coronectomy in Cases of Failure,” appears in the April 2015 issue of the Journal of Oral and Maxillofacial Surgery written by Boaz Frenkel and et. al. (vol. 73, issue 4). The article seeks to evaluate the success rate of coronectomy and if failure occurs, retreatment. Coronectomy is an alternative extraction technique of wisdom teeth to prevent inferior alveolar nerve (IAN) injury in cases of root proximity to the IAN or complicated root anatomy of the mandibular wisdom teeth. The technique seeks to extract the crown of the mandibular wisdom teeth and leave the roots intact. Coronectomy is not without risks and complications and things such as infection, dry socket, and pain can occur in addition to healing that doesn’t fully resolve and root eruption. Coronectomy failure can be treated with reoperation (removal of the residual roots) or in some cases repeat coronectomy can occur. The study included 173 patients undergoing 185 coronectomy procedures between December, 2008, and October,  2012, at Sheba Medical Center in Israel.  Coronectomy was performed when orthopantographic imaging indicated close proximity of the roots of […]

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The Risk of Future Extraction of Wisdom Teeth

An interesting study titled “What is the Risk of Future Extraction of Asymptomatic Third Molars? A Systematic Review,” written by Gary F. Bouloux and et al., appears in the May 2015 issue of the Journal of Oral and Maxilofacial Surgery (vol. 73, issue 5). The study attempts to determine the annual and cumulative rate of when asymptomatic wisdom teeth become necessary to remove. The authors state that the management of asymptomatic wisdom teeth is controversial and unresolved. They performed a systematic review of past studies using PubMed, Google Scholar, and the Cochrane Central Register of Controlled Trials on retained wisdom teeth. The authors had several criteria necessary for the study to be included in their analysis. The studies were included if they were an English language publication, were a prospective study design, had more than 50 subjects, had recorded the number of subjects or wisdom teeth requiring extraction during the study period, and had a follow-up duration of 1 year or more. Additional criteria were patients aged 18 years old or older, at least 1 wisdom teeth present at enrollment, and only asymptomatic wisdom teeth at enrollment. The authors started with 65 studies and narrowed it down to 7 studies […]

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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 […]

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Does Not Treating Asymptomatic Wisdom Teeth Cause Harm?

An interesting article appears in the July 2015, British Dental Journal, titled “Revolution vs status quo? Non-intervention strategy of asymptomatic third molars causes harm” written by V. Toedtling and J. M. Yates (vol. 219, no. 1, pp. 11-12.) The article addresses how the Faculty of Dental Surgery of the Royal College of Surgeons of England has asked the National Institute for Health Care Excellence (NICE) to re-assess their guidance on wisdom teeth extractions. This is because the group and doctors feel that there is an increasing amount of distal-cervical caries (cavities) in lower second molar teeth (teeth right next to wisdom teeth) when associated with asymptomatic partially erupted mesial or horizontally impacted lower wisdom teeth (mandibular third molars). The authors say that NICE has been reluctant to re-appraise their 2000 guidance and guidelines on wisdom teeth removal. The authors point out that these guidelines were based partially off of a report which refers to research that is 3 decades old (at the time of the guidance). This report showed that there is a very low rate of distal cervical caries in lower second molars (1 to 4.5% incidence). The authors say because so many wisdom teeth were prophylactically extracted during […]

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