Potential Risks of Surgery for Wisdom Teeth (Third Molars)

M. Anthony Pogrel in his article “What Are the Risks of Operative Intervention?” in the Journal of Oral and Maxilofacial Surgery vol. 70, pp. 33-36, 2012, suppl. 1, goes into complications associated with removing impacted wisdom teeth (third molars). I have previously explored this topic in detail over at http://www.teethremoval.com/complications.html. Although I did a poor job of distinguishing actual complications from negligence.

In the article, Pogrel describes how studies have indicated that around 10% (1 in 10) of people undergoing removal of third molars may suffer from a complication. However, most of these complications are mild and will completely resolve in time. Pogrel states

“Complications from M3 removal can be divided into 2 groups: those that are short-lived and self limiting, including bleeding, inflammatory complications such as surgical site infection and alveolar osteitis, or “dry socket,” drug reactions, displaced crowns from adjacent teeth, and short-term anesthetic complications; and those with potential long-term or permanent complications.”

Pogrel attempted to find high level evidence and searched PubMed, Scopus, and the Cochrane Database but no randomized controlled trials were found. He attempted to look at case studies used at least 100 patients and did not look at individual case reports and anecdotal reports.

  1. Periodontal Complications – removing wisdom teeth can exacerbate periodontal problems on the distal aspect of the lower second molars. Several studies that have explored this issue are described.
  2. TemporomandibularJoint (TMJ) Problems – removing wisdom teeth can cause TMJ disorders although some patients may have pre-existing TMJ dysfunction. A few studies exploring this issue with conflicting conclusions are described.
  3. Nerve Involvement – the inferior alveolvar nerve and lingual nerves potentially being damaged are described. Pogrel describes the lingual nerve being damaged between 0.2% and 2% of all cases and the inferior alveolar nerve being damaged between 0.5% to 5% of all cases. A mention is made of a study showing permanent nerve damage of less than 1 in 1,000 for both nerves.
  4. Sinus Complications – the incidence of a communication to the sinus when removing an upper wisdom tooth is not clear. Several studies are mentioned.
  5. Other Complications

In addition, a few other complications are mentioned but as pointed out by Pogrel they usually only appear in case reports since they are uncommon.

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