Does caries in the adjacent tooth justify prophylactic odontectomy of impacted tooth?

Abstract

Purpose: To ascertain the influence of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified. Materials and Methods: A retrospective study was conducted based on the records of the patients who underwent surgical removal of lower wisdom tooth in 3 dental clinics of the different cities during December 2015 to August 2019. The orthopantomogram and intraoral periapical radiograph images of 470 patients were considered to evaluate the impact of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified. In order to achieve this, parameters evaluated on the radiographs are the presence of dental caries in relation to lower second molar, angulation of the lower wisdom tooth, depth of impaction, presence of pericoronitis, and patient characteristics like age and gender. The results were analyzed to ascertain whether prophylactic removal of lower wisdom tooth is justified to preserve the long term health of the lower second molar. Results: The results of this study reveal that 28% of the patients developed dental caries in relation to lower second molar in the presence of a wisdom tooth. The mandibular third molars were impacted unilaterally in 63% of cases and bilaterally in 37% of cases. Caries in lower second molars was noticed when the wisdom tooth was in Class I position in 53.8% of the cases and 69% in position A. This finding is commonly encountered in the presence of a mesioangular impacted third molar. It was observed that when a wisdom tooth was in Class I relationship for any kind of angulation it increased the chances for the initiation and progression of caries in lower second molars. Conclusion: It can be concluded that to preserve the lower second molars, it is advisable to prophylactically remove an impacted third molar that have a mesial angulation and Class I and Level A position.