World Journal of Dentistry

Register      Login

VOLUME 10 , ISSUE 1 ( January-February, 2019 ) > List of Articles


Prophylactic Extraction of Third Molars: Justified or Not?

T Srinivasa Prasad

Keywords : Impacted, Prophylactic removal, Third molar

Citation Information : Prasad TS. Prophylactic Extraction of Third Molars: Justified or Not?. World J Dent 2019; 10 (1):72-77.

DOI: 10.5005/jp-journals-10015-1606

License: CC BY-NC 4.0

Published Online: 01-02-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: Removal of the third molars is the most common minor oral surgical procedure being performed. Though controversy is minimal when there is a pathology involved with the third molar, prophylactic removal of impacted third molars has always been debated. This review focuses on the prophylactic removal of the third molar Background: Many a time an impacted third molar can remain asymptomatic throughout life. What is to be considered is the risk of just retaining an asymptomatic third molar against overt problems that arise if it becomes pathological. Review results: Quite a number of systematic reviews have been compiled by various authors on this topic. However, still, there is no decision with a black and white certainty when it comes to prophylactic removal of impacted third molars. Conclusion: This article highlights the review on surgical removal of impacted molars, the associated complications during removal and the complications associated with retention.

PDF Share
  1. Kruger E, Thomson WM, Konthasinghe P. Third molar outcomes from age 18 to 26: findings from a population based New Zealand longitudinal study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 2001; 92(2):150-155.
  2. Bergman J. Are wisdom teeth (third molars) vestiges of human evolution? Journal of Creation. 1998; 12(3):297-304.
  3. Brokaw WC. The third molar question: when and why should we recommend removal? Virginia Dental Journal 1991; 68(4):18-21.
  4. Stordeur S, Eyssen M. Prophylactic removal of pathologyfree wisdom teeth: rapid assessment. Good Clinical Practice (GCP). Brussels: Belgian Health Care Knowledge Centre (KCE). 2012. KCE Report 182C. D/2012/10.273/49.
  5. Purkait SK. Developmental anomalies of oral and para-oral structures. 3rd Ed. Essentials of oral pathology. New Delhi, Jaypee Brothers medical publishers. 2011; p. 39.
  6. Peterson LJ. Principles of Management of Impacted Teeth. In: Peterson, Ellis, Hupp, Tucker, editors; Contemporary Oral and Maxillofacial Surgery Missouri: Mosby: 2003. pp. 184-213.
  7. Syed KB, Kota Z, Ibrahim M, Bagi MA, Assiri MA. “Prevalence of Impacted Molar Teeth among Saudi Population in Asir Region, Saudi Arabia – A Retrospective Study of 3 Years”. J Int Oral Health 2013;5(1):43-47.
  8. Godfrey K, Dent KK. Prophylactic removal of asymptomatic third molars: a review. Australian dental journal. 1999; 44(4): 233-237.
  9. Alling CC, Alling RD. Indications for management of impacted teeth. In: Alling CC, Helfrick JF, Alling RD, eds. Impacted teeth. Philadelphia: WB Saunders; 1993.
  10. Friedman JW. Containing the cost of third-molar extractions: a dilemma for health insurance. Public Health Reports. 1983; 98(4):376.
  11. Faculty of Dental Surgery of the Royal College of Surgeons of England. Report of a working party convened by the Faculty of Dental Surgery. Current clinical practice and parameters of care. The management of patients with third molar (syn: wisdom) teeth. London: Faculty of Dental Surgery RCS (Eng), 1997.
  12. Song F, O'meara S, Wilson P, Golder S, Kleijnen J. The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth. Health Technology Assessment (Winchester, England). 2000;4(15):1-55.
  13. Daley TD. Third molar prophylactic extraction: a review and analysis of the literature. Gen Dent 1996; 44: 310-320.
  14. Mercier P, Precious D. Risks and benefits of removal of impacted third molars. A critical review of the literature. J Oral Maxillofac Surg 1992;21:17-27.
  15. Von-Wowern N, Nielsen HO. The fate of impacted lower third molars after the age of 20. Int J Oral Maxillofac Surg 1989;18: 277-280.
  16. Lindqvist B, Thilander B. Extraction of third molars in cases of anticipated crowding in the lower jaw. Am J Orthod 1982; 81:130-139.
  17. Shafer WG, Hine MK, Levy BM. A Textbook of Oral Pathology. 4th ed., Philadelphia, W.B. Saunders Company, 1983, p. 260.
  18. Mourshed F. A roentgenographic study of dentigerous cyst. Oral Surg 1964;18:47-53.
  19. Keith DA. The detection of abnormalities in the jaws-a survey. Br Dent J 1973;134:129-135.
  20. Alattar MM, Baughman RA, Collett WK. A survey of panoramic radiographs for evaluation of normal and pathologic findings. Oral Surg 1980;50:472-478.
  21. Rakprasitkul S. Pathologic changes in the pericoronal tissues of unerupted third molars. Quintessence Int 2001;32: 633-638.
  22. Baykul T, Saglam AA, Aydin U, Basak K. Incidence of cystic changes in radiologically normal impacted lower third molar follicles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:542-545.
  23. Yasuoka T, Yonemoto K, Kato Y, Tatematsu N. Squamous cell carcinoma arising in a dentigerous cyst. J Oral Maxillofac Surg 2000;58:900-905.
  24. Eversole LR, Sabes WR, Rovin S. Aggressive growth and neoplastic potential of odontogenic cysts. Cancer 1975;35: 270-282.
  25. Guven 0, Keskin A, Akal UK. The incidence of cysts and tumors around impacted third molars. Int J Oral Maxillofac Surg 2000;29:131-135.
  26. Shear M, Shigh S. Age-standardized incidence rates of ameloblastoma and dentigerous cyst on the Witwatersrand, South Africa. Comm Dent Oral Epidemiol 1978; 6: 195-199.
  27. National Institute of Health Consensus Development Conference Summaries, Vol. 2. Removal of Third Molars. NIDR, 1979.
  28. Zhu S-J, Choi B-H, Kim H-J, Park W-S, Huh J-il., Jung J-H, Kim B-Y, Lee S-H. Relationship between the presence of unerupted mandibular third molars and fractures of the mandibular condyle. Int J Oral Maxillofac Surg 2005;34:382-385.
  29. Reitzik M, Lownie JF, Cleaton-Jones JP, Austin J. Experimental fractures of monkeys mandibles. Int J Oral Surg 1978;7: 100-103.
  30. Shepherd J, Brickley M. Surgical removal of third molars. Prophylactic surgery should be abandoned. BMJ 1994; 309: 620-621.
  31. Stephens R, Kogon S, Reid J. The unerupted or impacted third molar – a critical appraisal of its pathologic potential. J Can Dent Assoc 1989;55:201-207.
  32. Ahlqwist M, Grondahl HG. Prevalence of impacted teeth and associated pathology in middle-aged and older Swedish women. Community Dent Oral Epidemiol 1991;19:116-119.
  33. Laskin DM. Oral and maxillofacial surgery. St Louis: CV Mosby, 1985;2:30-60.
  34. Kaban LB, Pogrel MA, Perrott DH. Complications in oral and maxillofacial surgery. Philadelphia : WB Saunders, 1997: 60-66.
  35. Ricketts RM. The dilemma of the third molar. In: Schatz JP, Joho JP, eds. Minor surgery in orthodontics. Chicago: Quintessence Publishing; 1992.
  36. Chiapasco M, De Cicco L, Marrone G. Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol 1993;76:412-420.
  37. Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: a west of Scotland Oral Surgery Research Group Study. Br J Oral Maxillofac Surg 1992;30:78-82.
  38. Nunn ME, Fish MD, Garcia RI, Kaye EK, Figuerosa R, Gohel A, et al. Retained asymptomatic third molars and risk for second molar pathology. Journal of Dental Research 2013; 92(12):1095-1099.
  39. Harradine NW, Pearson MH, Toth B. The effect of extraction of third molars on late lower incisor crowding: a randomized controlled trial. British Journal of Orthodontics 1998; 25(2):117-122.
  40. Ghaeminia H, Perry J, Nienhuijs ME, Toedtling V, Tummers M, Hoppenreijs TJ, Van der Sanden WJ, Mettes TG. Surgical removal versus retention for the management of asymptomatic disease-free impacted wisdom teeth. The Cochrane Library; 2016.
  41. Costa MG, Pazzini CA, Pantuzo MC, Jorge ML, Marques LS. Is there justification for prophylactic extraction of third molars? A systematic review. Brazilian Oral Research. 2013;27 (2): 183-188.
  42. Mettes TD, Ghaeminia H, Nienhuijs ME, Perry J, Van der Sanden WJ, Plasschaert A. Surgical removal versus retention for the management of asymptomatic impacted wisdom teeth. Cochrane Database Syst Rev. 2012;6.
  43. Chaparro-Avendano AV, Perez-Garcia S, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Morbidity of third molar extraction in patients between 12 and 18 years of age. Med Oral Patol Oral Cir Bucal. 2005;10(5):422-431.
  44. Wang XL. Correlation study on acute pericoronitis and the position of the mandibular impacted third molar. Shanghai Kou Qiang Yi Xue. 1995;4(2):70-72. Chinese.
  45. Yamalik K, Bozkaya S. The predictivity of mandibular third molar position as a risk indicator for pericoronitis. Clin Oral Investig. 2008;12(1):9-14.
  46. McArdle LW, Renton TF. Distal cervical caries in the mandibular second molar: an indication for the prophylactic removal of the third molar? Br J Oral Maxillofac Surg. 2006; 44(1):42-45.
  47. Kan KW, Liu JK, Lo EC, Corbet EF, Leung WK. Residual periodontal defects distal to the mandibular second molar 6. 36 months after impacted third molar extraction. J Clin Periodontol. 2002;29(11):1004-1011.
  48. Richardson DT, Dodson TB. Risk of periodontal defects after third molar surgery: An exercise in evidence-based clinical decision-making. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):133-137.
  49. Patil S, Halgatti V, Khandelwal S, Santosh BS, Maheshwari S. Prevalence of cysts and tumors around the retained and unerupted third molars in the Indian population. Journal of oral biology and craniofacial research. 2014;4(2):82-87.
  50. Vigneswaran AT, Shilpa S. The incidence of cysts and tumors associated with impacted third molars. Journal of pharmacy & bioallied sciences. 2015;7(Suppl 1):S251.
  51. Adeyemo WL, Ladeinde AL, Olugbemiga MM. Prophylactic surgical removal of impacted third molars: Contemporary views. Pakistan Oral Dent J. 2005;25:11-14.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.