The “current thinking” Pollan and Pogrel refer to is almost exclusively that of the American Association of Oral and Maxillofacial Surgeons (AAOMS), reflecting studies sponsored by AAOMS and published almost exclusively in its own journal. It is particularly noteworthy that periodontists, specialists in the treatment of gum disease, have not singled out third molars for extraction.
The unpredictability of morbidity stressed by Pollan and Pogrel is not limited to wisdom teeth. It applies to the appendix, gall bladder, tonsils, uterus, prostate, and female breasts. No responsible person would suggest removing these structures in adolescence, or at any age, to prevent future disease in a small percentage of the population, as AAOMS recommends for third molars. Their conjectural suggestion that “periodontal disease may originate around third molars and spread forward” will come as a surprise to those who develop periodontal disease after removal of their third molars.
Dodson refers to a study in which 25% of participants had periodontal pathology around third molars, consisting of 1 or more pockets with depths of 5 mm or greater. Is that reason to extract all third molars? By logical extension, all teeth with 5 mm or greater pockets should be extracted, and we wouldn’t need periodontists or dental hygienists, whose specialty is to treat and save those teeth in the event of disease.
I wrote that “early removal of third molars is actually more traumatic than leaving asymptomatic, nonpathologic teeth in situ.”1(p1555) The total trauma to millions of young people having unnecessary extractions far exceeds any possible increase in trauma suffered by the few older people requiring third molar extraction for a real disease condition.
According to Dodson, few oral and maxillofacial surgeons would agree that “there is little risk of harm in the removal of third molars,” and they do not consider it “a trivial operation to be undertaken lightly.” If, then, it is a serious operation, why did AAOMS place a 4-page advertising supplement in USA Today2 urging the extraction of wisdom teeth with no mention of risk of potential injury or negative outcome? Is that truth in advertising?
Dodson writes that, following third molar extraction, “ . . . periodontal health of . . . adjacent teeth remained stable or improved 90% of the time.” However, his own journal article states, “Given healthy periodontal status preoperatively, 48% [of adjacent second molars] had worsening of their periodontal measures.”3(p133)
Dodson recommends lifetime monitoring by an oral surgeon of everyone with retained third molars. It would be much safer to have an examination every 12 to 18 months by a general dentist who is less likely to subject patients to unnecessary extractions and the corollary risk of iatrogenic injury.
References
- 1.Friedman JW. The prophylactic extraction of third molars: a public health hazard. Am J Public Health. 2007;97:1554–1559. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.American Association of Oral and Maxillofacial Surgeons. Special advertising section: advertising supplement. USA Today. September 28, 2007:1–4.
- 3.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;100:133–137. [DOI] [PubMed] [Google Scholar]