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Mounting evidence has found the retention of asymptomatic, impacted third molars has potentially placed a generation of patients at risk of distal surface caries (DSC) in the second molar. DSC is frequently identified late, and consequently has a poor prognosis. We provide an overview of the ongoing debate, discuss the potential for DSC, and present a typical situation where asymptomatic third molar retention led to the preventable loss of a second molar, and significantly compromised subsequent orthodontic management.
CPD/Clinical Relevance: Appropriate consideration of the risk posed by impacted wisdom teeth, which do not necessarily meet the present NICE indications for removal, could prevent future second molar loss and the need for the prolonged and complex orthodontic treatment required to align a third molar.
Article
The removal of asymptomatic third molars remains a contentious issue in dentistry.1,2 Some evidence-based guidance suggests prophylactic removal may, in some instances, prevent the possible pathology associated with retaining these teeth,3,4 but a more conservative approach was recommended in guidelines from the National institute for Health and Care Excellence (NICE), first published in March 2000.5 This guidance emphasized the risks associated with the extraction of third molars, and called for an end to their prophylactic removal in the National Health Service (NHS).
We offer an overview of the ongoing debate, discuss the potential for third molar retention to give rise to distal surface caries (DSC) in the second molar, and present a typical clinical scenario where the conservative approach has led to the preventable loss of a second molar and the requirement for prolonged and extremely complex orthodontic treatment.
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