Removing Wisdom Teeth May Improve The Periodontal Health of Remaining Teeth

An interesting article titled “Removal of Symptomatic Third Molars May Improve Periodontal Status of Remaining Dentition,” by Carolyn Dicus-Brookes and et al. appears in the Journal of Oral and Maxillofacial Surgery (vol. 71, pp. 1639-1646, 2013). The article seeks to explore the impact of removing wisdom teeth on the periodontal status of adjacent second molars and other teeth located in the mouth specifically for patients who have mild symptoms of pericoronitis.

As discussed recently over at Upcoming Changes to JOMS and AAOMS in 2014, select articles in JOMS will have press releases written by AAOMS staff to accompany them. This is one of those articles so that feature appears to have already been rolled out. To get an idea of what the press release entails I will briefly describe it. It is very short (less than 10 sentences) and fits on 1 page. It was released on October 1, 2013. The press release states 69 patients were followed with mild symptoms of pericoronitis. All patients had wisdom teeth prior to the study start and had an average age of 21.

The main conclusion of the study as stated in the press release, is that at the beginning of the study 88% had probing depths of about 4 mm around the distal side of at least one of their second molars and 61% had probing depths of 4 mm on the anterior side. See the risks of keeping wisdom teeth removal page for more discussion on probing depths.  After wisdom teeth were surgically extracted, patients who had probing depths of about 4 mm around the distal side of at least one of their second molars decreased to 46% and patients who had probing of about 4 mm on the anterior side decreased to 29%. Hence the authors conclude that the extraction of wisdom teeth in patients with mild pericoronitis improves the periodontal status of adjacent second molars and anterior teeth.

Reading over the press release, it really leaves out a lot of important details in the study. For example, in the study a discussion is made of the controversy over removing wisdom teeth due to pericoronitis. Another detail is left out that, 4 of 8 patients who had all probing depths less than 4 mm on the distal molars prior to extraction developed at least 1 probing depth greater than 4 mm on the distal molars after extraction. Further, a lot of discussion occurs in the article on periodontal disease and the biofilm-gingival interface.

The authors state

“The present data are compatible with current biological models of periodontal inflammatory disease focusing on the biofilm-gingival interface (BGI)…  As known from prior studies, patients with deeper [pocket depths] in the third molar region, all third molars, and the [distal of the second molar] periodontal probing sites have increased levels of red and orange complex periodontal pathogens in the biofilm and higher levels of inflammatory mediators detected in the gingival crevicular fluid at the BGI….[data from studies cited] suggested that removal of third molars may be beneficial in symptomatic patients by decreasing the surface area of the BGI and the associated elevated numbers of subgingival red and orange complex bacteria that are known risk factors associated with periodontal inflammatory disease and its progression.”

In the discussion the authors mention the result that 4 patients had probing depths increase on distal molars after wisdom teeth extraction but say they have no explanation for this and recommend additional studies be carried out to find those patients who are at risk for this to occur.

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