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Historical aspects about third molar removal versus retention and distal surface caries in the second mandibular molar adjacent to impacted third molars


This paper provides an insight into the historical recommendations regarding removal of mandibular third molars, as set out by the Royal College of Surgeons of England and the National Institutes of Health in the USA, as well as regional guidance from the National Institute for Health and Care Excellence and the controversy that surrounds surgical removal of third molars. The influences of third molar management as it developed in the UK, the historical economic evaluations, and the available evidence base on third-molar removal versus retention are described. This article seeks to address the growing concerns regarding the increasing frequency of distal surface caries (DSC) in mandibular second molar teeth when the decay is associated with asymptomatic, partially erupted, mandibular third molars, especially when they are mesially or horizontally impacted. Lastly, we illustrate radiographs of patients affected by DSC and how guidance that has been issued by a guideline institution regarding third molar surgery, even though it is based on insufficient evidence, is perceived as a strictly compulsory clinical strategy, and has been used in clinical practice in the UK for more than 20 years.

Key points

  • Considers the global controversy about asymptomatic third molar management, chiefly related to distal surface caries in the adjacent second molar.

  • Highlights the influences of third molar management in the UK.

  • Emphasises the growing concern related to the increasing prevalence of distal surface caries in the lower second molar that is adjacent to an impacted mandibular third molar.

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Verena Toedtling, Tim Forouzanfar and Henk S. Brand were responsible for the conception, design, drafting and critical appraisal of the manuscript. All authors gave their final approval and agree to be accountable for all aspects of the work.

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Correspondence to Verena Toedtling.

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This article did not require ethical approval as the content is freely available in the public domain and the analysis and data has been obtained from other published research with anonymised data.

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Toedtling, V., Forouzanfar, T. & Brand, H. Historical aspects about third molar removal versus retention and distal surface caries in the second mandibular molar adjacent to impacted third molars. Br Dent J 234, 268–273 (2023).

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