It is baffling to consider that even though genetically, we have to have 32 sets of teeth inorder to function properly, our third molars are always left without a space in the bone to grow. This is probably due to the fact that (our primitive diet consists of mostly meat and the evolution of our diet has shifted to a more vegetarian diet. This causes less provocation for our muscles to pull and guide the direction of bone growth forward. ) Other than the usual factors of mismatch between dental arch and alveolar bone, there are also factors than would hinder normal growth such as adjacent tooth structure, thick soft tissue and dense overlying bone. But in any kind of impacted tooth, it is always recommended to be removed. These are the following reasons:


1. Prevention of Periodontal Disease


Periodontal disease ranges from simple gingivitis to periodontitis which is the loss of bone. Tooth adjacent to the impacted teeth is at risk to developing periodontal disease. This is due to (1) its position decreases the amount of bone on the distal aspect of the adjacent tooth and (2) It is a hard to reach zone on the back part of the 2nd molar which is harder to maintain. On the back part of the 2nd molar, there could exist a thick gingiva and deep pocket. If not maintained, Gingival inflammation might develop and the normal flora thrives to more virulent ones. This causes progression of periodontal disease. On some areas of the mouth, it could lead to more serious effects especially on upper third molars.



If we remove the third molars, progression of periodontal disease can be prevented. If this is removed before any resorption of bone can occur, then the area could heal and bone can fillup the space occupied by the third molar.


2. Prevention of Dental Caries


Dental Caries develops with the niche, bacteria and food source. The back side of the 2nd molar is the perfect place to culture this. This place/part is almost always goes unnoticed until it is already too late and the caries is too deep – already warranting extraction.


3. Prevention of Pericoronitis


Pericoronitis is the inflammation of the surrounding soft tissue of the partially erupted tooth. This happens when there is a thick soft tissue covering the area of the crown of the third molars. This part can be traumatized by the upper erupted tooth. This part can also have food debris and bacteria be stagnant for a long time. The number and virulence of bacteria may increase because of the perfect environment.

If the immune system of the host is normal, this condition can be maintained normally, but if the body cannot eliminate the bacteria, then this becomes acutely infected and therefore cause discomfort such as fever, dysphagia (difficulty in swallowing) and to some lenghts, dyspnea (difficulty in breathing).

Depending on the degree of pericoronitis, it could present with swelling and pain. Some can also cause fever, fascial space infection which extends to the muscles of mastication. Even though the molar is partially erupted, sometimes it is better to just take it out to prevent other negative sequelae.

Some patients have undergone removal of this soft tissue (operculectomy) but it geos to have the same episodes so unless the cause is removed, there will always be a risk of pericoronitis to go back

The third molars are then removed but in premise that the inflammation has already resolved.


4. Prevention of Root Resorption



When the impacted tooth grows, it causes pressure on the adjacent tooth and this causes resorption.  Removal of the cause prevents this to fully take in effect.


5. Impacted Teeth Under a Dental Prosthesis


If there is a need for a prosthesis (denture) that would be supported by soft tissue, then the impacted tooth inside this area should be taken out. As the base of the denture rests on the bone, this becomes thinned out and therefore exposes the impacted tooth. This may then result to ulcerations which can lead to odontogenic infection.


Other than its effect on the tissue, it should be considered that fabricating a denture before extraction may not consider future boone resorption. This will result in a bad fit. It is worse if extraction is done after the inflammation has already begun.


6. Prevention of Odontogenic Cysts and Tumors



Impacted teeth should be removed due to its tendency to be associated with odontogenic cysts and tumors. When impacted teeth are completely submerged in the bone, the follicular cyst is also left with it. The dental follicle does not usually transform into a cyst or tumor. But if it does, the follicular cells covering the crown may undergo cystic degeneration and become  dentigerous cyst or even to an odontogenic keraticyst


Based on statistics though, the statistics of cysts relating to a tooth is not that high, in cases that is did, it is mostcommonlycaused by a mandibular third molars.


7. Treatment of Pain of Unexplained Origin


Sometimes, there are pain of unknown origin on the jaw. If all the other symptoms are excluded, then the impacted tooth should be removed


8. Prevention of Jaw Fractures


Impacted third molars in the mandible usually grows in the angle. They occupy a space and this space makes the bone thin on this area. This thinned portion makes the mandible prone to fracture.


9. Facilitation of Orthodontic Treatment


There are cases that would require distalization of first and second molars. Retaining an impacted tooth could hinder movement towards the favored direction. It is best to have all the impacted teeth removed, if possible before orthodontic treatment.


10. Optimal Periodontal Healing


Before any destruction takes place in the distal sideof the second molar, it is highly favorable to take out the third molars. Besides the fact that no local destruction has taken place yet, patients that are also younger have faster and better healing.


Author: Dr. Keneshia Tingson