The question of whether or not to prophylactically remove impacted third molars in young patients has been a topic of heated debate for many years. On the one hand, there are those who have argued that such treatment will prevent a number of subsequent problems that are associated with these teeth, ranging from dental caries or periodontal pocket formation endangering the adjacent second molar to even more serious conditions such as a dentigerous cyst or even tumor formation. In support of their position they cite numerous studies from the literature indicating the relatively high incidence of various types of pathology associated with retained impacted third molars. They also reference studies showing that the number of postoperative complications and the temporary reduction in the quality of life are greater when these teeth are removed later in life. On the other hand, those who have supported allowing such teeth to remain until problems occur have argued that not all impacted third molars develop problems and that it is more cost-effective to treat them when they do than to remove all of them prophylactically. However, recent studies on the so-called oral-systemic disease connection have considerably strengthened the evidence supporting the need for early impacted third molar removal.
Although it is important to differentiate between those data that merely indicate an association of an oral condition with a systemic disease and those that show a causal relationship, there is more and more clinical and scientific evidence accumulating to support the latter concept. The earliest studies on an oral-systemic disease connection focused on the role of generalized dental plaque and periodontal disease. They showed that gingivitis and periodontitis may be risk factors for preterm birth, low birth weight and other adverse pregnancy outcomes; atherosclerotic cardiovascular disease; and poor glycemic control in diabetics. Subsequently, there have been studies showing an apparent link between periodontitis and platelet activation, a known contributor to atherosclerosis, as well as with peripheral vascular disease.
Based on such findings, a number of studies have now focused on whether the impacted third molar could also contribute to the systemic chronic inflammatory response and negative health outcomes. These studies have shown that the third molar region is a common site of periodontal pathology, even in asymptomatic persons, and that this may also extend to involve more anterior teeth over time. Thus, it is evident that the impacted third molar can be an important contributor to chronic oral infection as well. Even though there is still a need for further investigation in populations with specific systemic diseases that may have an underlying relationship to such chronic inflammation, there already appears to be sufficient evidence for clinicians to give serious consideration to the removal of impacted third molars in young patients as a prophylactic health measure.
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