Thank you for Drs. Stephen Eklund’s and James Pittman’s article concerning third-molar removal patterns ("Third-Molar Removal Patterns in an Insured Population," April JADA). I am a practicing dentist of 34 years, and I was somewhat surprised to see such a disparity of opinion between general practitioners.
I am an advocate of early removal of unerupted third molars at an appropriate time. My rationale for this is mainly, but not exclusively, that the periodontal status of erupted third molars in middle-aged adults is seldom ideal. Further, I think that these teeth may compromise the health of adjacent teeth.
As a practical matter in my office, we find that it is much easier to motivate a parent to have an adolescent’s third molars removed than to persuade a middle-ager to do the same. Also, I don’t think that the difference in cost to the insurance companies should be a factor in this decision.
I don’t know how much time the authors are able to spend dealing with patients directly. I am willing to bet that if they would ask the people in their school’s hygiene department to take a look at the recall patients who have erupted third molars—and if they would do this for a year or so—they possibly would come away with a changed attitude.
Thank you for the well-balanced Discussion section. I heartily agree that a set of guidelines could be a benefit to us all (although I wouldn’t want to be on the committee drafting them!).
There is an adage in football that there are many possible outcomes for a forward pass, and only one of them is good. This has been my experience with third molars.
