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Mythbusters and Wisdom Teeth

Thomas B. Dodson, DMD, MPH

Thomas 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.

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. 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.

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.

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.In addition, following third molar removal, periodontal health of the retained, adjacent teeth remained stable or improved 90% of the time.

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.

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.Patients choosing to monitor their third molars are committed to a lifetime of follow-up. Third molars are dynamic anatomical structures.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.

This article is courtesy of The American Journal of Public Health

T. B. Dodson MYTHBUSTERS AND WISDOM TEETH Am J Public Health, April 1, 2008; 98(4): 581 - 582.

hxxp://www.ajph.org/cgi/content/full/98/4/581

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