An interesting article titled “Third Molar Complications in the Elderly—A Matched-Pairs Analysis” appears in the 2017 edition of the Journal of Oral and Maxillofacial Surgery written by Baensch et al. (vol. 75, pp. 680-686). The article explores the perioperative morbidity of wisdom teeth removal in elderly patients to better determine the long-term future burden on waiting until old age to have wisdom teeth extracted.
The article addresses how if there is less early (prophylactic) wisdom teeth surgery in young adult patients this will inevitably lead to an increasing number of elderly patients with persisting problems with wisdom teeth that necessitate their removal and this can lead to potential complications. In the article the authors devised a study to compare patients 65 years old or older to patients between the ages of 15 and 20 after having wisdom teeth removed. A total of 127 patients were included in both groups. At least one wisdom tooth was removed in all patients between 2008 and 2013. To avoid any selection bias since many younger patients had wisdom teeth removed, the authors selected the first and last patient every month until the 127 patients was reached. Of the 127 elderly patients only 38 had isolated wisdom tooth removal and the others had other dentoalveolar surgical procedures.
The authors found that patients in the eldery group had an average of 1.5 wisdom teeth removed while patients in the young group had an average of 3.75 wisdom teeth removed. Looking at the 38 eldery patients with isolated wisdom tooth removal and comparing to 38 matched young patients the mean operation time per tooth was 28.7 minutes versus 14.6 minutes. The entire group of 127 young patients had a mean operation time of 14.5 minutes. The authors noted that the 38 elderly patients with isolated wisdom tooth removal had a lower general morbidity than the young patients likely due to selection bias such as late pericoronitis or cavities. The authors found that those in the eldery group had on average 2.9 +/- 2.01 pre-existing diseases, whereas there was hardly any pre-existing diseases in the young group. In the eldery group 16.1% of all lower wisdom teeth directly contacted the inferior alveolar nerve canal whereas only 1.2% did in the younger group. The complication rate for the eldery group was 22% versus 3.1% in the younger group which was statistically significant. In the eldery group around 9% of patients required re-operation due to causes such as bleeding whereas only 1.6% of patients in the younger group required re-operation.
In the study the authors also looked at panoramic x-rays of 300 patients 65 or older who attended their clinic in Germany from 2008 to 2014 for reasons other than wisdom teeth removal. From these x-rays it was determined only 19 of the 300 patients (6.5%) had retained at least one wisdom tooth. The authors state
“Abandoning [wisdom teeth] 3M removal during adolescence and young adulthood will inevitably lead to a large proportion of elderly patients with retained [wisdom teeth] 3Ms still at risk for secondary complications and late removal.”
The authors feel their study shows that removal of wisdom teeth in elderly patients require additional local and systemic medical risks and is more time consuming with higher complication rates when compared to removing wisdom teeth when a patient is a young adult. Furthermore, the authors point out the experience of stopping prophylactic wisdom teeth removals in the National Health Service in the U.K. and specifically how the median age of patients having wisdom teeth removed has only increased by 6 years and that this resulted in a secondary major increase of wisdom teeth removals and a higher caseload of cavities, periodontal disease, and pericoronitis. Thus the authors feel that a burst of wisdom teeth associated morbidity occurs when the surgery is shifted to later in life.