An interesting article titled “Recommendations for Third Molar Removal: A Practice-Based Cohort Study,” appears in the April 2014, issue of the American Journal of Public Health (Vol. 104, No. 4, pp. 728-734), by Joana Cunha-Cruz and et. al. In the article a dental practice based research network Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) is used. A total of 50 general dentists enrolled patients from May 2009 to September 2010. In the study a total of 797 patients who had wisdom teeth (third molar) recommendations from their general dentist were used who were aged 16 to 22. However, the patients were asked to take a survey every 8 months and then a clinical visit 24 months later. From this sample of 797 patients only 516 completed at least one follow up questionnaire.
In the study the general dentists reported that their philosophy for wisdom teeth management fell into 3 categories:
1) in most cases, for preventive reasons (22%),
2) if they were asymptomatic but had poor eruption path or insufficient space (72%),
3) only if pathology or symptoms were present (6%).
A total of 1683 wisdom teeth were recommended for extraction from 469 patients. The main reasons for recommending wisdom teeth extraction were to prevent future problems (79%) and an unfavorable orientation or unlikely to erupt wisdom tooth (57%). A total of 200 patients had 720 wisdom teeth extracted with the main reasons for doing so being dental insurance availability and the tooth not likely to erupt. Of 300 patients with follow up data whose dentist recommended removal, 55% adhered to this recommendation. Of the 214 patients with follow up data whose general dentist recommended to retain a third molar, a total of 84% adhered to this recommendation.
In the discussion the study states that the great majority of wisdom teeth extracted in the study were asymptomatic. The authors state that their study agrees with other studies in which removing wisdom teeth due to pericoronitis, cysts, dental caries, or pain accounted for less than 15% of the cases.
Near the end of the study the authors state
“Although evidence on the benefits of asymptomatic third molar removal is conflicting, the dentists in our study frequently recommended dental extraction. The primary reasons for this recommendation were not symptoms or pathologies associated with the third molars, but to prevent future problems or the judgment that the tooth would never erupt. Monitoring of asymptomatic third molars would have been a more cost-effective strategy for the management of third molars.”
Additional details and information of the study are in the original article.