Research background

Wisdom teeth are the last of all teeth to erupt in the mouth. This usually happens between the age of 18 to 24. Because of lack of space or aberrant orientation, the third molars are likely to be impacted and often fail to erupt into a healthy and functional position. (Partially) impacted third molars are associated with many complications. They can cause problems with oral hygiene and symptoms can be painful. In many cases, wisdom teeth are removed to prevent or cure these problems. Wisdom teeth are preferably removed at a younger age, when the roots are not fully developed yet. This makes the extraction easier and results in less complications in comparison to third molar removal in  older patients. Also, pain and swelling are often less pronounced in young people and work or school can be resumed earlier.

At this moment, there are no clear data available in Belgium about the risk of complications and discomfort one can experience after this type of surgery. In this study, we investigate which patients are more prone to these discomforts and complications, in order to optimize the treatment of wisdom teeth to each individual patient. The main goals  of the study are to investigate whether symptomatic third molar extractions are associated with longer/more difficult surgeries and with more complications, compared to asymptomatic third molars and whether surgical difficulty, incidence of complications and postoperative morbidity rise with increasing age.

Currently, there is no consensus on whether or not preventive intervention should be used for asymptomatic impacted wisdom teeth. Some physicians opt for preventive removal to avoid future problems and pathology. Others believe that the benefits of preventive removal do not outweigh the risk of intraoperative and postoperative complications associated with the procedure. For example, pain, swelling and trismus may occur or the inferior alveolar nerve or the lingual nerve may be damaged, causing the patient to experience - temporarily or permanently - sensory disturbances in the lower lip or tongue. The subject has been widely described in the scientific literature. Nevertheless, the quality of most studies is substandard, the patient groups are too small or the follow-up period is too limited. Thus, to date, there is insufficient evidence to conclude that the benefits of preventive removal of wisdom teeth outweigh the associated risks. Some evidence does exist that preservation of wisdom teeth is rarely disease-free. Thus, a proper risk-benefit analysis is imperative.

This study investigated which patients are prone to impaction or incomplete breakthrough, how patients recover after removal of their wisdom teeth, and who is prone to long-term discomfort and (nerve) complications so that in the future, treatment can be better tailored to this.

Collaborating hospitals

The study was set up from the OMFS-IMPATH research group attached to the Department of Oral, Maxillofacial and Maxillofacial Surgery at UZ/KU Leuven and was extended to five Belgian hospitals.

Chair

Donated by the Belgian Professional Society of Physicians-Specialists in Stomatology, Oral, Maxillofacial and Facial Surgery (VBS-MKA) and the Royal Belgian Society for Stomatology and Maxillofacial Surgery (KBVSMFH).

The results were compiled in a doctoral thesis:

Third molar management: eruption, removal and associated risks

Peer-reviewed publications:

Limo