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Department of Oral and Maxillofacial Surgery and Hospital Dentistry, Christiana Care Health System, 3512 Silverside Road, Suite 12, Wilmington, DE 19810, USA
Given the prevalence of third molars, high incidence of associated pathology, and
cost of care (surgical or active surveillance), decision-making and management strategies
for third molars have received a great deal of attention. Understandably, there are
controversies that surround wisdom teeth, including the optimal time for treatment,
if and when to prescribe medications such as antibiotics, steroids, and analgesics,
the actual costs (financial and otherwise) of treatment and retention, and what constitutes
monitoring of retained teeth. The “gorilla in the room,” however, involves what are
appropriate indications for the removal of third molars, particularly those that are
asymptomatic. The debate has intensified as proponents of retaining asymptomatic third
molars have focused their concerns on cost containment (Fig. 1).
Fig. 1A 16-year-old girl with 4 unerupted and asymptomatic third molars. Clinical examination
is necessary to help ascertain physiologic space for eruption and maintenance of these
teeth, including quantity and quality of available space. Informed discussion should
include possible consequences of surgical management as well as retention, and the
impact of age on risks of treatment.
National Institute of Clinical Excellence (N.I.C.E.) on the indications for the removal of third molars. Online: issued March 27, 2000. Available at: www.nice.org.uk. Accessed March, 2000.
Mettes DT, Nienhuijs MM, van der Sanden WJ, et al. Interventions for treating asymptomatic impacted wisdom teeth in adolescents and adults. Published online: issued October 8, 2008. Available at: www.cochrane.org. Accessed June 13, 2012.
Opposition to prophylactic removal of third molars (wisdom teeth). Policy Date: 10/28/2008, Policy Number: 20085, Online: Issued February 2008. Available at: www.apha.org. Accessed October, 2008.
