No reliable studies exist to support removal of trouble-free impacted wisdom teeth, according to a systematic review of evidence. Despite this surprising lack of data, extraction of third molars has long been considered appropriate care in most developed countries.
“Watchful monitoring” of asymptomatic wisdom teeth may be a more appropriate strategy, suggest review authors led by Dr. Dirk Mettes of Radboud University Medical Centre Nijmegen in the Netherlands. Furthermore, they add, health risks and cost-effectiveness of surgery deserve greater consideration.
“Prudent decision-making, with adherence to specified indicators for removal, may reduce the number of surgical procedures by 60 percent or more,” the authors say.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Impacted wisdom teeth can cause inflammation of the gum, gum and bone disease, damage to adjacent teeth and development of cysts and tumors. General agreement exists that removal is appropriate when pain or problems occur.
However, the benefits of surgery are much less clear when it comes to removal of disease-free impacted wisdom teeth. Despite of a thorough review of the literature, the reviewers found no data to support this treatment approach.
Mettes and his colleagues could not locate any reliable studies of routine wisdom tooth removal in adults. They found two studies of the practice in adolescents, yet together these included just over 200 participants.
The studies focused only on whether removal of wisdom teeth prevents crowding in the lower jaw within five years, and neither study revealed a significant benefit. “The conclusion drawn from [the larger] study was that the removal of impacted third molars to reduce or prevent late incisor crowding cannot be justified,” say the review authors.
However, crowding is not the problem, according to Dr. Richard Haug, of the American Association of Oral and Maxillofacial Surgeons, and coinvestigator on two current studies on wisdom teeth.