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Surgical removal of third molars problems in middle age

BMJ 1994; 309 doi: (Published 12 November 1994) Cite this as: BMJ 1994;309:1301
  1. R Hopkins

    Third molars may cause severe

    EDITOR, - Jonathan P Shepherd and Mark Brickley suggest that the prophylactic removal of third molars should be abandoned.1 In my clinical experience some patients carry their asymptomatic unerupted third molars with them to the grave, as suggested by Shepherd and Brickley, while others present with acute surgical and medical problems at any age up to that event. Unpublished data of the British United Provident Association (BUPA) show that a significant number of patients present in middle age and beyond with acute problems arising from their third molars; at this time not only their bone but also their cardiovascular system is brittle. Their reduced powers of recovery are such that what is an unpleasant experience in the late teens and early 20s can become a major surgical problem with hazards of mandibular fracture, nerve damage, and anaesthetic and medical complications.

    Few surgeons will disagree with the statement that the prophylactic removal of third molars should be abandoned, but prophylaxis requires definition. Take, for example, a patient who presents with an acute or chronic peritonitis arising from a non-functional impacted third molar and becomes asymptomatic after antibiotic treatment. Should the tooth be removed before reinfection develops? The patient may be referred to hospital and refuse surgery with local anaesthesia. Should other impacted but asymptomatic third molars be removed under the same general anaesthesia? There is little difference in cost unless admission is required later for their surgical removal, again under general anaesthesia. Social convenience and recuperative powers are usually never better than in a young adult.

    Shepherd and Brickley are ideally suited to set up a long term study into the morbidity produced by symptomatic third molars presenting in middle age and later. Postponing the surgical and medical morbidity of impacted teeth until then may be a high price to …

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