In reference to Drs. Silvestri and Singh’s April JADA article, "The Unresolved Problem of the Third Molar," I agree that the value of third molars in modern people is questionable, but I wonder about the practicality of the authors’ novel methodology of intentional agenesis of these teeth.
Cryogenics, sclerosing agents, retinoic acid derivatives, citral and teratogens such as alcohol delivered a few millimeters below the mucosa in the maxillary and mandibular posterior ridge area of children from birth up to five years? Humm! No doubt these children would require referral to an oral surgeon or pedodontist, followed by sedation or general anesthesia with subsequent introduction of these substances into their ridges.
Hopefully, intravenous access is straightforward (or the surgical/anesthesia room is soundproof), the anesthesia goes well, good imaging of the surgical site is acquired, dosage of the agenesis substance(s) is correct, placement is accurate, systemic uptake is minimal, postoperative recovery is uneventful, allergy or toxicity is avoided, the parents don’t miss much work, and the fee is reasonable.
Finally, we hope the adjacent tooth buds develop normally and the third molars don’t show up later! Who is going to suggest this treatment to the mothers of these kids? Not I.
