At an annual cost of over three billion dollars, surgical extraction of third molars is by far the most performed surgical procedure in the United States; however, there is and has been much controversy in the literature over the last several decades about the practicality of this procedure. Presently, professionals are divided on the issue of whether or not surgical extraction is necessary for asymptomatic disease free third molars. This comprehensive literature review was performed to investigate the current evidence concerning the prophylactic removal of third molars. It was discovered that many several journals, particularly those pertaining to oral and maxillofacial surgery has been hugely instrumental in marketing this procedure to the public through research articles. Close analysis of the literature revealed a significant level of inconsistency relating to study design, sample size, and methodology. In conclusion, for the typical prophylactic third molar extraction, the risk of complications are often underestimated while the potential gains in quality of life may be exaggerated which will impede the decision making process for the clinician and patient. For an elected surgery that is performed at such a grand scale, there are too many variables still unclear in the literature, many of which present as a public health hazard. There are also many other factors, both physically and ethically, that need to be considered before a responsible decision can be made. It was also found that the imaging technology currently being used as the standard of care for the diagnosis and treatment planning of third molars does not give a clear enough picture to ensure a complication-free surgery. Furthermore, there are other non-invasive options for the management of asymptomatic third molars that are not being applied enough, which do not require sacrificing the third molars. Complications resulting from third molar surgery are one of the most common reasons responsible for lawsuits facing dentists today and can also result in a lifetime of pain and disability for the patient. Taken together, the high cost of surgery along with the risk of complications following an otherwise disease-free third molar doesn't seem to be representative of responsible dentistry. More conservative approaches along with a general shift towards evidence-based dentistry may be the answer for the proper management of third molars. Discouraging the practice of prophylactic removal of third molars could result in billions of dollars in saving, elimination of millions of days of discomfort, and prevention of permanent injury to tens of thousands of people.

Magister Chirurgiae Dentium - MChD / Aim: To assess the change in the quality of life of patients while on the third molar surgery waiting list. Introduction: A large number of patients routinely present at the Tygerberg Oral Health Centre for removal of symptomatic impacted third molars. This results in many patients being placed on a surgical waiting list. In addition, many patients who have been placed on this waiting list return for adjunctive interventions, indicating a possible decrease in Quality of Life (QoL) over the waiting period. Numerous studies document post-surgery changes in QoL in patients that have had third molars removed. Many other studies detail QoL changes in patients awaiting orthopaedic and general surgery procedures. However, no study could be found that dealt with changes in QoL while awaiting third molar surgery. Materials and Methods: This is a prospective questionnaire-based study. It compares QoL at the beginning and the end of the waiting period for the removal of impacted third molars in order to determine whether a change in QoL occurs during the waiting period. The study sample was made up of 48 patients who met the inclusion criteria. Results: The present study shows that patients presenting with symptomatic impacted third molars have a decreased QoL at baseline, which further deteriorates over the waiting period. Although the overall change is negative, it is not statistically significant. This suggests that the null hypothesis cannot be excluded, and that it is therefore acceptable for patients to be managed on a waiting list. Conclusion: Third molar surgery results in a greater decrease in mental than physical wellbeing. The results in this study regarding a negative change in QoL was found not to be statistically significant. Only three out of 48 patients required emergency intervention. It can thus be concluded that placing patients on a waiting list for third molar surgery is acceptable.

Magister Scientiae Dentium - MSc(Dent) / Aim: A clinical trial to determine the post-operative outcomes of a PRF-treated socket versus a conventionally treated socket following surgical removal of third molar teeth. Introduction: Third molar surgery is a procedure many have to endure and which often results in prolonged healing time with consequential absence from work and school. This has motivated clinicians to seek methods to enhance the healing process and in effect, reduce the healing time. Research on the use of PRF in enhancing wound healing in maxillofacial and oral surgery have shown varying results. Therefore, this study was conceived to ascertain the effect PRF has on the post-operative sequelae of third molar teeth. Materials and Methods: This was a split mouth, prospective, single blinded, randomized control trial. The study sample was made up of 26 patients (N=26) who met the inclusion criteria. Four of the patients experienced neurosensory fallout of an associated nerve and were subsequently excluded from the sample. This resulted in the total sample size of twenty-two patients (n=22). Symmetrically impacted maxillary and mandibular third molars were removed under general anaesthesia. Patients were treated in a within subject design: when one side of a patient was treated with PRF, the other side was conventionally treated and acted as a control. The allocation of the side treated with PRF was 'random'. Patients were followed-up on Day 2 and Day 7, respectively. Pain scores were recorded on a visual analogue scale (VAS) using 0 to 10 pain score. Swelling, wound dehiscence, development of alveolar osteitis, wound infection and post-operative bleeding were compared between the intervention and control side. Results: Twenty-two patients (females = 13 and males = nine) b

SammanfattningMineralisering och utveckling av visdomständer kan användas som åldersindikator i övre tonåren och används för asylsökande utan identifikation eller födelseattest. Utvärderingen görs med hjälp av dentala röntgenbilder och olika tolkningsmodeller.Målet med den aktuella studien var att undersöka åldersbedömningsmetoder på röntgenbilder av visdomständers tillförlitlighet och överensstämmelse med fokus på populationsgrupper och etnicitet. Detta är av vikt då resultat från en sådan bedömning ligger till grund för juridiska beslut huruvida en individ är vuxen eller ett barn (över eller under 18 år).En systematisk sökning genomfördes i PubMed, Embase och Cochrane enligt PRISMA-modellen, och 23 artiklar som uppfyllde inklusionskriterierna granskades av två observatörer enligt en modifierad QUADAS 2 och tio artiklar bedömdes ha låg risk för bias.Populationsbeskrivningarna var bristande. Detta leder till svårigheter att utföra bedömningar av artiklars resultat och precision, därmed också jämförelser mellan olika studier. Problemet ligger på en generell nivå då definitioner är osäkra, men samtidigt i de separata artiklarna då de inte redovisat någon definition.Det var svårt att jämföra de inkluderade artiklarna då deras syften och metoder varierade. Huvudfyndet var att de flesta artiklarna konkluderade att användningen av visdomstanden som en åldersindikator i de övre tonåren är en otillräcklig metod. Användning och betydelse av dess resultat bör därför ifrågasättas. / AbstractThe mineralization and development of the third molars can be used as an indicator of age in the upper teens and is used in purpose of assessing age in asylum seekers without identification or birth certificates. The evaluation is determined with dental radiographs and different methods of interpretation.The aim of the study was to investigate the accuracy and precision of different age estimation models of radiographs of third molars, focusing on population groups and ethnicity. This is of great importance since the results of an age assessment constitute the basis in a juridical outcome, deciding whether an individual is an adult or a child (over or under 18 years of age). A systematic search of PubMed, Embase and Cochrane was made according to the PRISMA-statement, and 23 articles which met the inclusion criteria were assessed using a modified QUADAS 2 by two observers, ten of these were graded as having low risk of bias.Population groups were poorly described, leading to difficulties in evaluating results and precision, thereby also comparisons between different studies. The problem both lay at a general level where definitions are ambivalent, but also in the separate articles where definitions are missing.It was hard to compare the included papers since their aims and methods varied. The main finding was that most of the articles concluded that the use of the third molar as an age indicator in the upper teens is an insufficient system. The use and impact of the results should thereby be questioned.