The removal of “wisdom teeth” (third molars) is one of the most common procedures performed by oral and maxillofacial surgeons. While it is common, it is considered surgery. The questions of whether this is a safe surgical option and should be considered in a person living with Duchenne, comes up frequently. Recently, we asked our good friend (and orthodontist) Elizabeth Vroom, DDS, from UPPMD in the Netherlands to comment.
As stressed by Elizabeth, routinely removing wisdom teeth (prophylactically – done to prevent future problems), should not be considered for every person. “Too many wisdom teeth are removed without evidence” that the procedure is necessary. Stories about the crowding of the other teeth by the wisdom teeth were not substantiated in a recent Cochrane Review1 (link).
How is the decision made?
Third molars may become “impacted.” This occurs when the second molars block the path of eruption of the third molars, creating a barrier and preventing eruption. This impaction may cause no pain or discomfort, and therefore is asymptomatic. In asymptomatic impaction, no intervention is necessary. The Cochrane Review above found no evidence to support, or refute, routine prophylactic removal of asymptomatic impacted third molars. A 30-year longitudinal study performed by the National Institutes for Health (NIH), as well as UK based National Health Service and the National Institute for Clinical Excellence (NICE), all indicate that there is a lack of evidence for the prophylactic removal of third molars.
A recent article discussed the indications for third molar extraction.2 Dodson developed the “Dodson classification system,” defining when third molars do need to be removed.3 This system is based on both patient symptoms (pain, periodic swelling and pain in the area of the third molar, occasional and temporary “foul taste” in the mouth) and the presence of disease (pericoronitis – inflammation of the soft tissues around the tooth), dental caries (tooth decay), or infection.
There are four scenarios when considering the management of third molars:
There are inherent risks with the surgical removal of wisdom teeth. These may include: pain following surgery, significant swelling of the jaw, the risk of infection to the surgical site, damage to the jaw resulting in the inability to open the jaw fully (trismus), damage to the nerves supplying sensation to the tongue and skin of the lower lip and chin (lingual or inferior alveolar nerve damage), and fracture of the jaw.
In summary, if you are trying to make a decision regarding the removal of third molars, you may want to consider the following points: