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To Pull or Not to Pull? That is the Question…

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Should you remove or retain the third molars? When patients come to you for advice on what to do with their wisdom teeth, there is no straightforward answer. When is surgery indicated, particularly when the teeth are asymptomatic? What are the risks involved with removal or retention? When is the best time for treatment?

Each decision should be made on a case-by-case basis, and the American Association of Oral and Maxillofacial Surgeons (AAOMS) has clarified their position on how to manage wisdom teeth in a recently-published white paper, “Management of Third Molar Teeth.” 

According to the paper, “evidence based practice” is the key approach to any clinical dilemma, including how to manage third molars. A clinician needs to consider many possible choices, including removal, partial removal (coronectomy), retention with active clinical and radiographic surveillance, surgical exposure, tooth repositioning, transplantation, surgical periodontics, and marsupialization of associated soft tissue pathology with observation and possible secondary treatment. In addition, a dentist needs to consider the likelihood that disease will develop in the future.

Here is the official AAOMS statement on the management of third molars:

Predicated on the best evidence-based data, third molar teeth that are associated with disease, or are at high risk of developing disease, should be surgically managed. In the absence of disease or significant risk of disease, active clinical and radiographic surveillance is indicated. This statement clearly recognizes that while not all third molars require surgical management, given the documented high incidence of problems associated with third molars over time, all patients should be evaluated by someone experienced and expert in third molar management.

Since evidence clearly shows that surgery is more difficult as patients age, the AAOMS recommends that a decision should be made before the middle of the patient’s third decade to remove or continue to observe third molars, with the knowledge that future treatment may be necessary. The AAOMS recognizes the oral and maxillofacial surgeon as the clinician qualified to determine a surgical treatment plan and care for the individual patient.

 

Check out these DPS  “BEST PRODUCT” evaluations of surgical products:

 LM Instruments’ LM Extraction Instruments 

 

 

 DENTSPLY Pharmaceutical’s 4% Citanest Forte with epinephrine anesthetic

 

 

 Septodont’s Septoject XL Dental Needle

 

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