Extraction of the third molar, also known as the wisdom tooth, is one of the most common surgical procedures today and is usually advised for patients whose third molars cause problems that may lead to further complications like root damage, decay or gum disease.

Should the tooth cause no symptoms, however, there appears to be insufficient evidence to indicate that the benefits of surgery outweigh the risks according to a research published in the Cochrane Database of Systematic Reviews.

To remove, or not to remove; that is the question

“Given the fact that wisdom teeth are removed on a large scale worldwide, it is surprising that high quality research is lacking,” said lead author Hossein Ghaeminia of Radboud University Medical Center in the Netherlands.

“In the USA for instance, the preventive removal of asymptomatic disease-free wisdom teeth is very common,” he said, despite no evident benefit to the extraction of “symptom-free” third molars.

In contrast, the National Institute for Health and Care Excellence (NICE) in the UK advises not to remove asymptomatic disease-free wisdom teeth.

Closer to home in Singapore, consultant Dr Shermin Lee of the Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore (NDCS), advised: “This is a grey area which is debatable even among experts from the UK and the US. Treatment should be tailored to the individual.”

Nip it in the bud – only when symptomatic

Two notable studies were identified in their review – a prospective study in the US, and another randomised controlled trial from a dental hospital in the UK. However, neither provided insights in to a patient’s quality of life after removal or retention of asymptomatic wisdom teeth.

The prospective study of 416 healthy men found that retention of impacted wisdom tooth translated to a higher risk for gum disease around the adjacent tooth in the long run, compared to those who opted for removal or did not have a wisdom tooth to begin with.

Meanwhile, the UK trial involving 164 participants found no notable differences in the participant’s dental health, regardless of the choice to remove or retain their wisdom tooth.

According to Ghaeminia, both studies also found that the most common risks of surgery are infection, inflammation of the tooth socket and temporary nerve injury causing impaired sensation of the lip and chin. However, they did not measure other factors of cost, cyst or tumour formation, bleeding, nerve damage or infection.

“We will likely conduct another prospective cohort study to examine risks from retained asymptomatic third molars” said Martha E. Nunn of Creighton University in Nebraska, who was not involved in the recent study. Her personal stance is against the removal of third molar tooth buds during adolescence as she has seen permanent bone damage from such surgeries.

Ghaeminia, however, reasoned that if wisdom teeth do become symptomatic at an older age, surgery poses more complications for adults than for adolescents.

“On the other hand, preventive removal of all asymptomatic wisdom teeth is also undesirable: if the tooth would stay asymptomatic and disease free during lifetime, the patient might have been exposed to an unnecessary risk of complications and costs,” he said.

“In the absence of evidence, orthodontists, dentists and oral surgeons should discuss the pros and cons of wisdom teeth removal in each case individually.” MIMS

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