Press Conference
October 19, 2010 • Willard Intercontinental Hotel
Washington, DC
Definitions:
Asymptomatic, Disease-free Third Molars (Wisdom Teeth) –
• The patient does not report third molar-related symptoms and the third molars either are not visible, cannot be
probed with a dental probe, probing depths are less than 4 millimeters, and there is no radiographic evidence of
pathology; or
• The tooth is completely erupted, functional, hygienic, and without caries or readily restorable and has probing
depths less than 4 millimeters; or
• The tooth is erupting (with associated symptoms) and there appears to be adequate room for the third molar to
erupt into a functional, hygienic position.
Evidence-based Research
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making
decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual
clinical expertise with the best available external clinical evidence from systematic research. i
Key Findings:
General Health and Wisdom Tooth Extraction
Not all wisdom teeth need to be extracted, but all of them need to be managed.
An absence of symptoms does not equal the absence of disease.
Retained wisdom teeth frequently and unpredictably change position, eruption and periodontal status.
Sixty percent of patients with asymptomatic, disease-free wisdom teeth prefer extraction to retention.
The decision to retain wisdom teeth is a lifetime decision. Further, monitoring retained wisdom teeth may be
more expensive than extraction in the long term.
Epidemiological studies support the concept that the retention of third molars with pocketing increases the
risk for several broader conditions that are associated with increased systemic inflammation, including
preterm birth and cardiovascular disease.
Periodontal Disease
Retained, asymptomatic wisdom teeth are eventually extracted between 25% and almost 70% of the time.
o 25% of patients with asymptomatic retained wisdom teeth have evidence of periodontal disease, and
40% of patients of those patients with periodontal disease at baseline will have clinically significant
progression of their periodontal disease.
Periodontal disease begins with third molar eruption. The microbial biofilm associated with partially erupted
third molars and pericoronitis emulates periodontal disease.
Pocketing around wisdom teeth is an important indicator of periodontal disease, especially when bleeding
occurs on probing, as this is a sign of local inflammation that may have systemic effects. Retaining wisdom
teeth with probing depths greater than 4mm increases the risk for developing increased pocketing anteriorly.
Extraction reduces the risk for periodontal disease in young adults.
i
Sackett, DL; Rosenberg, WMC, Muir Gray, JA, Haynes, RB, Richardson, WS; Evidence based medicine: what it is and
what it isn't. BMJ 312:71-72, 1996