Like usual there are often heated exchanges over the management of wisdom teeth (third molars).
Back in November 2011, in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5) there was an exchange regarding two previous articles that had appeared and consequent exchange (White RP Jr, Proffit WR. Evaluation and management of asymptomatic third molars: lack of symptoms does not equate to lack of pathology. Am J Orthod Dentofacial Orthop 2011;140:10-6; and Kandasamy S. Evaluation and management of asymptomatic third molars: watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 2011;140:11-7)
The articles in question I am referring to here are “Third molars” by Raymond P. White, Jr, and William R. Proffit in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5, pages 600-601) and Author’s response by Sanjivan Kandasamy in the American Journal of Orthodontics and Dentofacial Orthopedics (vol. 140, issue 5, pages 601-602) .
In the “Third molars” article the authors provide 5 points which are what they feel are inaccuracies and unsupported opinions which appeared in the prior July 2011 article by Dr. Kandasamy (“Evaluation and management of asymptomatic third molars: watchful monitoring is a low-risk alternative to extraction”).
- The first point is that the third molar conference in Washington D.C. did not recommend routine removal of wisdom teeth. (I previously covered this conference in this post http://blog.teethremoval.com/third-molar-multidisciplinary-press-conference/)
- The second point is that obstetric patients who have periodontal disease have more adverse outcomes.
- The third point is that 2 guidelines have appeared on third molars specifically from the National Institute for Health and Clinical
Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN). This is addressed on the controversy page http://www.teethremoval.com/controversy.html. - The fourth point is it is not clear what the data to refer to the statement that only 30% of third molars have pathology came from.
- The fifth point is that older patients recovering from third molar surgery can have delayed recovery times.
The authors state:
“The bottom line: one can indeed do harm by doing nothing.”
In his response Dr. Kandasamy states:
“Extraction is not the only treatment available. It might be indicated in some patients, but certainly not all. Where and by whom is the line to be drawn? What is the prospective medical disutility of the proposed 4-mm periodontal pocket compared with the well-documented hazards of extraction?”
Dr. Kandasamy goes on to say later:
“I do not want to encourage a frivolous back-and forth banter. …It is about an influential point of view that unfortunately seems to advise and guide clinicians to extract most, if not all, third molars on the basis of the probability of future periodontal disease, resulting systemic implications, and presumed complications when the teeth are extracted later rather than earlier in life. Stated simply, I remain unconvinced.”