Update on Third Molars

Third molars have been characterized by the American Association of Oral and Maxillofacial Surgeons as a "Ticking Time Bomb". 90% of people with impacted 3rd molars will have complications that arise from them.  

Reasons to Remove Third Molars

• Prevent the presence of perio disease, carries, infection,cysts and tumors.
• Facilitate ortho treatment.
• Impacted teeth under dental prosthesis.

 

Third Molar Clinical Trials

Started in the late 90's in response to the healthcare delivery system's demand for evidence-based medicine. Sponsored by AAOMS, the Oral and Maxillofacial Surgery foundation, and the NIH. 11 years total. 3600 patients, Institutional review board approved longitudinal clinical trial. This research challenges two pervasive and long-held beliefs: 1. Third molars which have broken through the tissue and erupted into the mouth in a normal, upright position have minimal problems. 2. The absence of symptoms from retained third molars indicates the teeth are free from problems. These beliefs would be found to be incorrect.  

Study Findings

Periodontal Issues: Patients with visible third molars are more likely to have progression of periodontal disease (or gum disease) than patients without third molars. Blakey,G;et al. JOMS 64:189-193,2006 Data suggests that asymptomatic patients with a pocket depth around third molars greater than 5mm, have significantly increased levels of infammatory mediators vs patients with pocket depths less thatn 5 mm. These findings take on even greater significance in light of recent sudies that suggest periodontal infections such as those observed in this study have the potential for a negative impact on general health, affecting the  progression of cardiovascular disease, diabetes mellitus and pregnancy outcomes.

 

Gum Disease in Young Adults

Many studies have previously linked periodontal disease with systemic effects, usually in older populations. AAOMS/OMSF data is unique in that it affects "young adults" ages 20 to 35. Periodontal disease is rare in patients under 30 years of age; those who have periodontal pockets of 3mm or more generally exhibit them only in the third molar region. If untreated, the periodontal bacteria will encompass second molars and other teeth. It has been discovered that for young adults ages 20 to 35 enrolled in a longitudinal clinical trial, retained third molars, even those that exhibit no outward signs or symptoms of disease, may pose serious health risks that include chronic oral inflammation from periodontal disease which also increases the risk for increased inflammation throughtout the body.  

Conclusion

Gum disease around third molars can not be cured. Periodontal pathology in the third molar region is difficult to treat successfully. Eliminating the pathogenic bacteria, once established in periodontal pockets may not be possible, even with repetitive treatments.   Featured Image: LIVESTRONG