Diagnostic and Therapeutic Considerations: Third Molar Teeth

Abstract

Numerous non-controversial indications for removal of third molar teeth exist. Nevertheless, recent costcontainment efforts by third party payers and government agencies have focused on the asymptomatic third molar as a public health policy issue. These efforts have led, in turn, to current research aimed at establishing specific treatment criteria. Ongoing studies on the bacteriology of the periodontium surrounding the partially erupted third molar have found microorganisms characteristic of periodontal disease. Non-intervention outcome studies, while in their infancy, have provided some data regarding the longterm fate of third molars that are not extracted. Economic analyses and statistical modeling to assess costeffectiveness of extraction versus non-extraction are themselves controversial. Although the data are not yet conclusive, this lecture will attempt to present the available evidence, both pro and con, regarding specific conditions affecting third molars, with emphasis on periodontal disease, orthodontic requirements, and the truly non-pathologic third molar. Implicit in the decision in favor of extraction is knowledge of the potential complications of this surgical procedure. The discussion of complications will provide in-depth information on postoperative infection, alveolar osteitis, nerve injury, and mandibular fracture.