Abstract
AbstractAimsTo investigate the reasons for extraction of third molars (3Ms) at Tufts University School of Dental Medicine (TUSDM) and compare this to the UK’s NICE guidelines.MethodsData were collected at TUSDM retrospectively from 99 patients who underwent surgery in 2019 under American Dental Association (ADA) codes D7220, D7230, D7240 and D7241 (removal of impacted tooth in soft tissue, partially bony, completely bony and with unusual surgical complications). Patient details of age, location of 3M, Winter's classification of impaction, reason for extraction, need for bony removal, type of anaesthesia or sedation, prescribed medications and complications were recorded.ResultsA total of 274 surgical extractions of teeth were recorded. Ages ranged from 15 to 39, with an average age of 24. Intravenous sedation (IVS) was used in 80% of patients with an average of 3.6 3Ms extracted in each of these patients, when local anaesthetic was used alone an average of two 3Ms were extracted. Ninety per cent and 78.7% of maxillary and mandibular 3Ms, respectively, were extracted with no pathology. Thirteen per cent of mandibular 3Ms were extracted due to pericoronitis (usually a single episode), 4% due to caries and 2.3% due to distal second molar (2M) caries. There were five instances of post‐operative complications, the worst being hypoesthesia of the right inferior dental (ID) nerve for 3 months.ConclusionWisdom teeth are removed earlier at Tufts for prophylactic reasons with the intention of preventing future problems and caries in the adjacent tooth. More evidence is required to decide which patients would benefit from prophylactic extractions.
Highlights
Funding of a healthcare system, whether its state funded or private/insurance based, has a bearing on how patients are managed
Third molars (3Ms) are the final teeth to erupt between the ages of 17 and 21; due to lack of space they are the most frequently impacted teeth. 3Ms were historically subject to prophylactic removal in the United Kingdom at a young age due to their common association with pathology in the form of pericoronitis, periodontal disease, unrestorable caries, pulpal or periapical pathology, abscesses and cysts, root resorption, crowding, temporomandibular pain and destruction of adjacent teeth via caries or external root resorption.[1]
Most surgical extractions of 3Ms undertaken at Tufts would not be justified in the United Kingdom due to National Institute of Clinical Excellence (NICE) guidelines
Summary
Funding of a healthcare system, whether its state funded or private/insurance based, has a bearing on how patients are managed. In the United Kingdom, wisdom teeth are removed at an older age once pathology has developed to comply with the NICE criteria. In many cases, this involves caries in the second molar and a more intimate relationship between the roots and inferior dental nerve.
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