After reading Friedman’s article in the Journal ’s Health Policy and Ethics section, casual readers could characterize oral and maxillofacial surgeons as greedy clinicians performing unnecessary procedures with callous disregard for their patients’ pain and risk for complications.1 As a board-certified oral and maxillofacial surgeon in academic practice and with a background in health policy and management, dental public health, and clinical epidemiology, I would like to respond by addressing each of Friedman’s myths.

Myth 1 is that third molars have a high incidence of pathology. This is not a myth: in an observational cohort study, 25% of participants (aged 14 to 45 years) with 4 asymptomatic, impacted third molars had periodontal disease.2

Myth 2 is that early removal of third molars is less traumatic. This is not a myth: with increasing age, removal of third molars becomes a more technically challenging, difficult operation, resulting in prolonged recovery after removal.3

I agree that pressure of erupting third molars causes crowding of anterior teeth—myth 3—is a myth: extracting third molars to prevent or alleviate crowding of the dentition is not usually justified.

Myth 4 is that the risk of pathology in impacted third molars increases with age. This is not a myth. In the cohort described in myth 1 above, 24% of the participants who retained their third molars manifested clinically significant evidence of progression of periodontal disease.4 In addition, following third molar removal, periodontal health of the retained, adjacent teeth remained stable or improved 90% of the time.5

Myth 5 is that there is little risk of harm associated with third molar removal. This is not a myth. Oral and maxillofacial surgeons are cognizant of the complications following third molar removal and do not consider it a trivial operation to be undertaken lightly.68

Most clinicians would agree that all third molars need treatment. One common treatment option is to remove the third molars. The alternative treatment choice, however, is medical management. Patients electing to retain their third molars should be monitored by history, physical examination, and radiographic examination on a regular basis.9 Patients choosing to monitor their third molars are committed to a lifetime of follow-up. Third molars are dynamic anatomical structures.10 Never is it “safe” for patients with retained third molars to be discharged from the oral surgeon’s care. In reviewing these treatment alternatives, the informed patient commonly elects to remove asymptomatic third molars rather than pursue a lifetime of medical management.

References

1. Friedman JW. The prophylactic extraction of third molars: a public health hazard. Am J Pub Health. 2007;97:1554–1559. LinkGoogle Scholar
2. Blakey GH, Marciani RD, Haug RH, et al. Periodontal pathology associated with asymptomatic third molars. J Oral Maxillofac Surg. 2002;60:1227–1233. Crossref, MedlineGoogle Scholar
3. Phillips C, White RP Jr, Shugars D, et al. Risk factors associated with prolonged recovery and delayed clinical healing after third molar surgery. J Oral Maxillofac Surg. 2003;61:1436–1448. Crossref, MedlineGoogle Scholar
4. White RP Jr, Offenbacher S, Blakey GH, et al. Chronic oral inflammation and progression of periodontal pathology in the third molar region. J Oral Maxillofac Surg. 2006;64:880–885. Crossref, MedlineGoogle Scholar
5. Richardson DT, Dodson TB. Risk of periodontal defects after third molar surgery: an exercise in evidence-based clinical decision-making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100:133–137. Crossref, MedlineGoogle Scholar
6. Bui CH, Seldin EB, Dodson TB. Types, frequencies, and risk factors for complications after third molar extraction. J Oral Maxillofac Surg. 2003;61:1379–1389. Crossref, MedlineGoogle Scholar
7. Haug RH, Perrott DH, Gonzalez ML, Talwar RM. The American Association of Oral and Maxillofacial Surgeons Age-Related Third Molar Study. J Oral Maxillofac Surg 63:1106–1114. Crossref, MedlineGoogle Scholar
8. Chuang S-K, Perrott DH, Susarla SM, Dodson TB. Age as a risk factor for third molar surgery complications. J Oral Maxillofac Surg. 2007;65:1685–1692. Crossref, MedlineGoogle Scholar
9. Dodson TB. Management of asymptomatic wisdom teeth. J Mass Dent Soc. 2007;55:30–32. MedlineGoogle Scholar
10. Phillips C, Norman J, Jaskolka M, et al. Changes over time in position and periodontal probing status of retained third molars. J Oral Maxillofac Surg. 2007; 65:2011–2017. Crossref, MedlineGoogle Scholar

Related

No related items

TOOLS

SHARE

ARTICLE CITATION

Thomas B. Dodson, DMD, MPHThomas B. Dodson is with the Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Mass, and the Center for Applied Clinical Investigation, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston. “MYTHBUSTERS AND WISDOM TEETH”, American Journal of Public Health 98, no. 4 (April 1, 2008): pp. 581-582.

https://doi.org/10.2105/AJPH.2007.129577

PMID: 18309118