Naeem Adam, Prof. PJ Sandler
Mounting evidence has found the retention of asymptomatic, impacted third molars has potentially placed a generation of patients at risk of distal surface caries (DSC) in the second molar. DSC is frequently identified late, and consequently has a poor prognosis. We provide an overview of the ongoing debate, discuss the potential for DSC, and present a typical situation where asymptomatic third molar retention led to the preventable loss of a second molar.
To explain and illustrate how the retention of asymptomatic, impacted third molars, as a result of following NICE guidance, has potentially left a generation of patients at risk of future disease and tooth loss.
Methods and Results
A critical review of the most pertinent literature and guidance to date followed by a case report illustrating the possible consequences of apparently ill-conceived NICE guidance.
NICE guidance on the extraction of wisdom teeth has had little, long-term, impact on the number of patients requiring third molar removal. In favouring the retention of asymptomatic, partially erupted, mesioangular impacted third molars this guidance has placed a generation of patients at risk of DSC in the second molar. DSC is frequently identified late, it often has a poor prognosis, and overall caries risk does not appear to accurately capture the risk of DSC.