ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Asymptomatic Impacted Third Molars In The Middle Aged Patient
Clinical Question In a healthy adult patient with asymptomatic impacted third molars, how does extraction compare to no treatment in the patient’s long term medical and dental health?
Clinical Bottom Line There is no consensus in the literature on the prophylactic removal of 3rd molars. Each patient must be evaluated individually and the risks/benefits explained. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 18940492Bagain/2008149 patients with impacted third molarsProspective cohort study
Key resultsPostoperative morbidity increases with older age, deeper impaction, M3 side differing from the handedness of the operator, and longer procedures.
#2) 19730432Fernandes/2009613 patients with impacted third molarsProspective cohort study
Key resultsClinical characteristics such as the angulation, degree of impaction, and the patient’s age can be useful in predicting the likelihood of future symptomatology, but whether an impacted 3td molar will develop future symptoms is difficult to predict.
#3) 15846686Mettes/2005Adolescent and adult patients with impacted third molarsMeta-Analysis
Key resultsNo evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults.
Evidence Search MeSH terms: impacted; molar third, pathology; age factors
Comments on
The Evidence
Only three randomized controlled trials met the criteria for the meta-analysis. The cohort studies provide valuable information to consider but are not as reliable as randomized trials, systematic reviews or meta-analysis.
Applicability The factors identified in the cohort studies can help predict patients that are at higher risk for post-operative complications or developing pathology. In particular, increased age is a risk factor for post operative complications, but there is no strong evidence in favor or against prophylactic removal.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Third molar, Impactions, Third molar extraction, Pathology
ID# 892
Date of submission: 07/07/2011spacer
E-mail PatelNK@livemail.uthscssa.edu
Author Niraj Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Erica Teixeira, DDS
Faculty mentor/Co-author e-mail TeixeiraE@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by James Womack (San Antonio, TX) on 11/20/2014
A PubMed search on the prophylactic removal of asymptomatic third molars in a healthy adult patients was performed on September 30, 2014. It was noted that the meta-analysis (Cochrane review) by Mettes 2005 had been revised updated in 2012 PMID: 22696337. The article supports maintains the stance that there is not enough evidence to support or refute the prophylactic removal of asymptomatic impacted wisdom teeth in adults.
by Benjamin Vuong (San Antonio, TX) on 10/03/2014
An additional article related to this topic by Nunn 2013. (PMID 24132082) indicated that certain types of third molar impactions posed a relatively higher risk for second molar pathology. This longitudinal and cross sectional study compared the absence of third molars, soft tissue impaction, and bony impacted third molars as it relates to 2nd molar caries, bone loss, and probing depths: soft tissue impaction presenting the higher relative risk across the board. This article does agree with the Mettes 2012 meta-analysis that more research is needed and that there is insufficient evidence to support or refute the prophylactic removal of impacted third molars.
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