The prophylactic extraction of third molars: a public health hazard

Abstract

Ten million third molars (wisdom teeth) are extracted from approximately 5 million people in the United States each year at an annual cost of over $3 billion. In addition, more than 11 million patient days of "standard discomfort or disability"--pain, swelling, bruising, and malaise--result postoperatively, and more than 11000 people suffer permanent paresthesia--numbness of the lip, tongue, and cheek--as a consequence of nerve injury during the surgery. At least two thirds of these extractions, associated costs, and injuries are unnecessary, constituting a silent epidemic of iatrogenic injury that afflicts tens of thousands of people with lifelong discomfort and disability. Avoidance of prophylactic extraction of third molars can prevent this public health hazard.

Figures

FIGURE 1—

A mesioangular impaction, with the roots in close proximity to or saddling the mandibular canal containing the mandibular nerve.

FIGURE 2—

Panographic radiograph of 4 normally developing wisdom teeth, classified as full bony impactions at the time of extraction.