Abstract
Objective To critically evaluate reviews about the appropriateness of prophylactic removal of impacted third molars.
Data sources Electronic searches of MEDLINE, Embase, Bids. Hand searches of Index to Dental Literature and references cited in relevant papers.
Study selection Reviews of research literature, addressing pathology and/or symptoms associated with impacted third molars or outcomes of surgical removal published after 1985. Editorials, letters news and comment together with papers where the literature review was not the main element were excluded. Relevance was checked independently by two reviewers. Quality of search method of each review included was assessed as were the inclusion criteria and presentation.
Results 12 reviews fitted the entry criteria, 9 covered general issues while 3 focussed on crowding associated with impaction. A further 5 reviews were excluded. Only one review outlined the search method and criteria for inclusion of the studies.
Third molars and crowding: Association not significant enough to warrant removal.
Pericoronitis: No standard definition used, best estimate of prevalence 10%
Cysts and tumours: Range of incidence quoted 0–11% however difficult to judge reliability of these estimates due to lack of detail in reviews identified.
Caries and periodontal disease: Stated to be common but little objective evidence presented. One review giving an incidence of periodontitis ranging from 1–4.5%. However because of different definitions of periodontitis comparisons difficult.
Complications and risks: Sensory nerve damage 1–6%; alveolar osteitis (dry socket) 1–3.5%; Serious post operative infection was estimated as 25 per 100,000 operations.
Conclusion In the absence of good evidence to support prophylactic removal there appears to be little justification for the removal of pathology-free impacted third molars.
Song F, Landes D P, Glenny A M, Sheldon T A. Prophylactic removal of impacted third molars: an assessment of published reviews. Br Dent J 1997; 182: 339–346
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Address: F Song, NHS Centre for Reviews and Dissemination, University of York, UK
Sources of funding: Based on a report commissioned by the Royal College of Surgeons o England. The Department of Health funds the NHS Centre for Reviews and Dissemination, York
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Shepherd, J. Little justification for the removal of pathology-free third molars. Evid Based Dent 1, 11 (1998). https://doi.org/10.1038/sj.ebd.6490005
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DOI: https://doi.org/10.1038/sj.ebd.6490005
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