The April JADA article "The Unresolved Problem of the Third Molar" by Drs. Silvestri and Singh is an excellent review of the evolutionary changes and dietary shifts that have influenced the third-molar "problem."
I submit that technically advanced and affordable dental care and the use of fluoride in the last half of the twentieth century are major contributors to the problem of the impacted third molar in Western society.
Historically, early loss of first and second molars from rampant or ubiquitous dental caries permits eruption of the most common type of impaction, the mesioangular variety. Conversely, maintaining the first and second molars leaves little space for third-molar eruption. As is so often the case in medical therapy, the solution to problem A creates problem B. Fluoridation had prevented the carious destruction and loss of billions of teeth, the greatest boon to dental health in history. But fluoride does "contribute" to the current problem of impacted teeth. This is the unfortunate truth, not heresy.
As to the possibility of accomplishing early third-molar agenesis, how would the pediatric candidates be selected? Many impacted third molars remain asymptomatic and free of pathology and never require the cost or morbidity of surgical extraction. Universal agenesis procedures would be as unconscionable as is the wholesale removal of impacted teeth, simply because they exist. By the time we have determined how to eliminate that other vestigial organ, the appendix, perhaps we’ll have some resolution of the third-molar problem.
