We would like to thank Dr. Goldberg for his kind words, clinical insights and opinions. We also feel technological advances in dentistry over the last century, both in restorative dentistry and preventive dentistry, have decreased the value of the third molar in modern man. We believe this trend will likely continue with time, as tooth loss from disease decreases and successful replacement with implant prosthesis increases.
We would like to submit, however, that, in our opinion, a universally applied, safe, non-injurious, atraumatic, noninvasive or minimally invasive therapeutic procedure designed to prevent the development of the third molar is a desirable therapeutic goal. We believe the benefits that would be gained to patients from not developing this tooth far outweigh the risks that would be posed to them if this tooth were allowed to develop.
While we agree such a preventive procedure may not be available in the near future, we believe there is value in beginning research efforts to attain this goal. Children, who do not develop this tooth for "natural" reasons, never suffer the health consequences it imposes. Why not afford every child the opportunity of this benefit?
We do not favor the elimination of this tooth just because it may be a vestigial organ. A vestigial organ that causes only infrequent or even occasional disease, pain and morbidity is quite different from one that a majority of the population suffers from at one time or another in their lifetimes.
Also, we do not believe an analogy between the appendix and the presence of the third molar in modern man is valid. There appears to be growing evidence in the medical literature that suggests the appendix serves an important immunological purpose.1 Until the function and value of the appendix are established, it is impossible to determine its true benefit/risk ratio. And, unlike the appendix that develops in utero and in an area that is nearly inaccessible to therapy, the timing and the location of the development of the third molar make the possibility of its therapeutic agenesis entirely within reason.
The specialty of oral and maxillofacial surgery has significantly decreased the risks and morbidity associated with third-molar extraction over the years. It has sought answers to questions relating to the disease and morbidity associated with this tooth, and it has led the profession in setting reasonable guidelines for third-molar extraction. We applaud its efforts in decreasing the morbidity from surgery and applying rationality to the decision of when to and when not to extract these teeth, eliminating much unnecessary surgery.
Yet, we feel that any surgery that can be avoided should be avoided, and a procedure to prevent the development of the third molar could totally eliminate surgery of any kind that results from its development. It is our hope that the dental research community seeks to develop a preventive procedure that renders all patients free of the pain, suffering and anxiety caused by this tooth.
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