Abstract
The prophylactic extraction of asymptomatic impacted mandibular third molar is a contentious issue in dental practice. To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar. This was a prospective clinical study over a three-year period. The diagnosis of impacted mandibular third molar and their associated pathology was made by clinical and radiological examination. The data obtained were age, sex, type of impaction, reason for surgical extraction, and the clinical condition of the adjacent second molar. Patients 50 years and above were 33.4%, and those with impaction 22.8%, while the symptomatic cases were in 18.4% patients. The age of the patients ranged from 52 to 84 years with male: female ratio, 2.3:1. In all the asymptomatic impactions, the adjacent second molars were disease-free, whereas 73.6% of the adjacent second molar related to symptomatic cases were asymptomatic (P=0.001). This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical extraction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments.
Highlights
Patients who had impacted mandibular third molars were 287/1261 (22.8%) with 333 impactions, while those that were symptomatic were seen in 53/287(18.4%) patients
The symptomatic third molars that required surgical extraction were unilateral in all cases (n=53/333, 15.9%)
This study showed that 15.9% of impacted mandibular third molars in 18.4% of patients were symptomatic, and were surgically removed while the rest 84.1% in 81.6% patients were asymptomatic
Summary
Impaction of mandibular third molars is common among the general population with frequency ranging from 22.0% to 66.0%.1-3 When diagnosed in adolescent or young adult, the prognosis of such impacted mandibular wisdom teeth cannot be determined immediately because over time, it is influenced by many confounding variables which may be local, systemic or both.[4,5,6] When afflicted by disease, researchers and clini-African Health Sciences cians generally agree that it should be extracted to relieve patients’ pain and discomfort.[7,8] On the contrary, others have suggested that this dentition plays no significant role in the oral cavity except to cause disease and recommended extraction even in the absence of an obvious pathological condition.[9,10,11] This practice is controversial among researchers and clinicians in dental surgery and oral and maxillofacial surgery across the globe, as there is no consensus agreement in this regard.[9,10,11,12] The question has always been whether early surgical intervention in adolescents and young adults is justified or not in asymptomatic cases? The debate centres on whether the health needs of the patient justify the cost of the extraction in terms of the discomfort experienced post-operatively, surgical cost, and the economic burden on government and other non-governmental organizations in some countries that may partly bear the surgical bills. The extraction of impacted mandibular third molar in the absence of any pathology is common in Europe and America.[10,12] In the study environment, this practice is not common and the patients affected live their normal life with it, except when it is involved in disease that make them present in hospitals or dental clinics for treatment.[13,14] adequate statistics is required to identify and address the peculiar needs of the patients afflicted by this condition, those with limited access to oral health as reported earlier in our environment.[15] This study evaluates symptomatic impacted mandibular third molars in patients 50 years and above, and determines the burden of the impaction on the adjacent second molar. Objective: To evaluate symptomatic impacted mandibular third molars in patients 50 years and above, and determine the burden of the impaction on the adjacent second molar. Conclusion: This study showed that 15.9% of impactions in 18.4% of patients were symptomatic and required surgical extraction, whereas the burden of impaction on the adjacent second molar was 26.4%, and these required only preventive and restorative treatments. Afri Health Sci. 2019;19(1). 1789-1794. https:// dx.doi. org/10.4314/ ahs. v19i1.55
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