Little evidence exists to support removing
impacted wisdom teeth that are not causing pain and swelling, aren’t negatively
affecting other teeth, and are disease-free, finds a new review in The Cochrane
Library.
According
to the review authors, led by Theodorus (Dirk) G. Mettes of the Radboud
University Nijmegen Medical Center in the Netherlands, wisdom teeth—third
molars that typically make an appearance when individuals are between age 17
and 24—often fail to break the gum line, or do so only partially.
These
so-called impacted wisdom teeth have the potential to cause a host of problems,
including swelling or ulceration of the gums around these teeth, cysts or
tumors, and damage, decay, or disease in the second molars. However, many
people can go their entire lives without these teeth causing any problems.
Though
the general consensus among most dentists and oral surgeons is that troublesome
impacted wisdom teeth should be removed, Mettes says, there’s a range of
opinions on what to do with asymptomatic ones. Some dental care professionals
advise patients to have these teeth removed as a matter of course to prevent
future problems.
Though
such prophylactic removal can avoid problems caused by these teeth, extraction
surgery isn’t without risks. At the very least, patients who elect for surgery
will have some pain and swelling that requires time off of work, school, and
other pursuits and will incur the cost of the procedure. More serious risks
include permanent nerve damage, a broken jaw or infections in the bone and
surrounding tissues.
As a
result, Mettes explains, some care providers prefer a “wait and see” approach,
removing impacted wisdom teeth only when problems arise. This approach can have
its own disadvantages, such as allowing problems to advance if patients or
their dentists aren’t vigilant, or requiring time off and expense for
monitoring visits.
To help
develop a consensus, Mettes and his colleagues combed medical databases for
studies that compared those who had asymptomatic wisdom teeth removed to those
who retained them. Their extensive search turned up only a single study. Even
this research, meant to determine whether removing these teeth in adolescents
prevents future crowding of front teeth, was inconclusive.
Though
care providers’ and patients’ decisions on whether to remove asymptomatic
impacted wisdom teeth “should be based on the best available evidence and
combined with extensive clinical experience,” little evidence exists for or
against this procedure at the moment, Mettes says.
Thomas Dodson,
D.M.D., M.P.H., an oral and maxillofacial surgeon at Massachusetts General
Hospital and a member of the American Association of Oral and Maxillofacial
Surgeons (AAOMS), emphasizes that the decision to remove is clear-cut if
there’s disease or dysfunction in impacted wisdom teeth.
However,
he says, it can be a tough call for people in whom these teeth are asymptomatic
and disease-free.
“Those
tend to be the longer conversations,” he says. “I rely on patients to tell me
what they prefer to do.”
He
notes that the study designs necessary to help care providers and their
patients make better decisions—randomizing large groups of patients into two
groups, one which has these teeth removed and one which has teeth retained—are
costly and time-consuming.
“In
systematic review after systematic review, each says that more research is
necessary,” Dodson says. “But so far, no one has had the interest to fund the
necessary research.”
More information: Mettes TDIRKG, et al. Surgical removal versus retention for the
management of asymptomatic impacted wisdom teeth. Cochrane Database of
Systematic Reviews 2012, Issue 6. Art. No.: CD003879. DOI:
10.1002/14651858.CD003879.pub3
Provided
by Health
Behavior News Service
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