Systematic Review of Prophylactic Extraction of Third Molars: From Brazil

Many reviews have been conducted in recent years to determine if healthy third molars (known as wisdom teeth) should be prophylacticly extracted as in removed before causing problems. A new study by Moacir Guilherme da Costa and four other researchers titled “Is there justification for prophylactic extraction of third molars? A systematic review,” appears in Braz Oral Res., (São Paulo) 2013 Mar-Apr;27(2):183-8. The article discusses how in the United States roughly 10 million wisdom teeth are extracted from around 5 million individuals each year.

The article discuss how several reasons are usually given for extracting wisdom teeth

  1. pericoronitis
  2. periodontal defects in the distal region of the second molar
  3. caries in the third or second molars
  4. different types of odontogenic cysts and tumors
  5. crowding of the lower incisors
  6. indications for orthodontic, prosthetic or restorative purposes

The authors state how the majority of dental surgeons feel when there is clinical, radiological or laboratorial evidence of acute or chronic periodontitis, caries, pericoronitis, harmful effects on second molars or disease the removal of third molars is justified.

The authors mentioned how several controversies arise surrounding removing healthy asymptomatic wisdom teeth including

  1. inadequate study designs
  2. small sample size
  3. insufficient monitoring time
  4. methodological flaws

Hence the authors set up to methodologically look at numerous databases and journal sources to find evidence. The authors found four studies which met their selection criteria. In the discussion section the authors state

“None of the studies fulfilled the eligibility criteria established for the present systematic review. This finding demonstrates the scarcity of consistent papers and inadequate scientific evidence that could otherwise allow surgeon dentists to make decisions regarding reliable indications for the prophylactic extraction of third molars and the determination of which cases should be followed up. Meta-analysis and heterogeneity were not performed due to the small number of studies with different methodologies found.”

The authors go on to say in the conclusion

“The data encountered in the present systematic review demonstrate the lack of studies on which to base adequate clinical decisions regarding indications for the prophylactic extraction of third molars. The only scientific proof points to the non-indiction of prophylactic extraction for the purpose of preventing late crowding of the lower incisors.”

The authors also provide a bit of commentary on some issues regarding third molar extraction.

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