Presence of Asymptomatic Wisdom Teeth and Systemic Disease

All dentists are aware that the presence of pericoronitis around third molar teeth can progress to serious and even life threatening infections, and most would agree that tooth removal is necessary to solve such a problem. It is less obvious, however, that asymptomatic third molars may pose potential infection risks to patients. In 2007, the American Association of Oral and Maxillofacial Surgeons created a task force to conduct an intense literature search concerning third molar topics. The risk of infection around asymptomatic third molar teeth was one of the topics studied.

The following conclusions were made from this effort:

  • Periodontal pathogens are present in the pericoronal tissues of asymptomatic third molars.
  • Inflammatory mediators are found in the pericoronal tissues of asymptomatic third molars.
  • Patients with asymptomatic third molars develop progressing periodontal disease in the second and third molar regions as they age.
  • The presence of third molar teeth appears to put patients at risk for systematic illness such as cardiovascular disease and comprised obstretric outcome.
  • The absent symptoms does not mean the absent of disease in regard to third molar teeth.

Why do Asymptomatic Third Molars Increase a Patient’s Risk of Periodontal Disease?

Though this project did not study why asymptomatic third molars cause increased risk of periodontal disease and inflammation, it is my personal opinion that this risk is due to inadequate access for adequate oral hygiene. These are the most posterior teeth in the mouth. The lower third molar is wedged between the second molar tooth and the ascending ramus of the mandible. The maxillary third molar often contacts the soft tissue over the coronoid process of the mandible. Getting a toothbrush and floss into these areas is often very difficult. Bacteria can easily colonize within the pericoronal tissues, periodontal disease can develop and spread to the adjacent second molar teeth.

Should These Findings Change the Way We Address Asymptomatic Third Molars in Our Practices?

I do not believe that the results of this study suggest that all asymptomatic third molar teeth require removal. What the results do suggest, however, is that dentists should inform patients with asymptomatic third molars that there is conclusive evidence proving that the present of asymptomatic third molar teeth predisposes them to periodontal disease, inflammation, and the oral/systemic risks associated with this disease process. They should be informed that if these teeth are removed later in life, the body’s ability to repair the resulting defect may be compromised, and the health of the second molar tooth is often compromised. These findings also give justification for preventive removal of asymptomatic, erupted third molars. If a patient decides to retain these teeth, it becomes the dentist’s responsibility to recommend monitoring of these areas for signs of periodontal disease and to instruct the patient to perform adequate oral hygiene procedures to help prevent this disease. It is no longer advisable to tell patients “if your wisdom teeth do not bother you, don’t worry about them.”

Reference:

Information for this article was obtainedĀ from the White Paper on Third Molar Data. The entire publication can be obtained from the American Association of Oral and Maxillofacial Surgeons website at aaoms.org

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