لخّصلي

Description of health problem
The four hindmost molars, known as third molars (3Ms) or wisdom teeth, are the last teeth to
erupt in the upper (maxillary) and lower (mandibular) jaws, and this usually happens during
young adulthood between the ages of 18 and 24. Third molars can be either impacted or nonimpacted, and an impacted 3M (I3M) can be classed as erupted, partially erupted or
unerupted. Impaction occurs when the eruption of the tooth is blocked either by soft tissue
(gum) or bone.
For some patients, 3Ms erupt fully, while for others 3Ms could remain unerupted and impacted
throughout the life of the tooth. Third molars can be potentially problematic to the individual by
causing pain and disease; however, many 3Ms are asymptomatic (trouble-free) or diseasefree/pathology-free. There has been significant debate over the past few decades surrounding
the management of 3Ms, and historically, the practice has been to surgically extract 3Ms
prophylactically to avoid potential problems in the future. However, 3M surgery is not without
risk to the patient. Despite the substantial amount of literature dedicated to the debate on
whether or not to prophylactically remove 3Ms, there is still disagreement and controversy
among dentists and oral surgeons as to what constitutes best practice.1 Current National
Institute for Health and Care Excellence (NICE) guidance
2 advises against the routine
prophylactic removal of 3M teeth.
Kandasamy et al 20093 assert that “the literature pertaining to the extraction of third molars is
extensive. There is a large individual variation and a multitude of practitioners’ beliefs and
biases relating to the extraction of especially asymptomatic and pathology-free third molars.
With the current emphasis in dentistry being placed on clinicians to make evidence-based
decisions, the routine removal of third molars has been re-assessed and questioned.”(page
284)3
There is disagreement on the operational definition of what constitutes an asymptomatic or
pathology-/trouble-/disease-free 3M. In part, this is due to some inconsistent and misleading
use of vague terminology.1,4 In some studies “asymptomatic” denotes teeth that have no
associated pathology, in others it denotes an absence of symptoms.4 There is a significant
difference between disease-free and asymptomatic – asymptomatic does not equal diseasefree. It is argued that pathology always precedes symptoms, so it is therefore prudent for
decision makers to assume the development of pathology if teeth are symptomatic.1 The
terminology that is used in clinical research studies needs to convey the precise condition