Guideline 43: Management of Unerupted and Impacted Third Molar Teeth

Management of Unerupted and Impacted Third Molar Teeth
Annex 2

Key messages for patients

Note: These key messages are not intended for direct dissemination to patients, but may be incorporated into local patient information materials.

The pros and cons of removing unerupted and impacted third molar teeth:

As a general principle, teeth should not be removed without due cause. This applies to third molars as much as it does to any other teeth.
All forms of surgery carry some risk of complications. Extraction of unerupted and impacted third molar teeth sometimes leads to problems such as pain and swelling, together with the possibility of altered sensation in the lips or tongue. Even in the best of hands, accidents can occur.
Where there is adequate space, unerupted teeth should be left in place to erupt. In childhood, even impacted teeth may change their position. It is not possible to predict accurately whether teeth will erupt and there is little evidence that the teeth become more difficult to remove with age, or that more complications occur by leaving them in place.
However, there are some definite indications for removal of third molars. For example, where there has been recurrent pain and discomfort due to multiple episodes of infection, then removal of third molars may be appropriate to reduce the pain and inconvenience to the patient, time off work, and the risks and costs associated with repeated antibiotic treatment.
Other situations where it may be in the patient's best interests to have early removal of third molars include those whose jobs mean that they may have to work in situations isolated from expert treatment, or when medical conditions may lead to difficulty or risk with their removal.

How will the decision be made?

Your dentist or doctor will carry out a full assessment, including taking your medical and dental history, and a clinical examination to see if removal of the tooth or teeth is indicated and is advisable. He or she will discuss with you the advantages and disadvantages of removal in your particular case, as well as the possible risks of the operation. You will also have one or more x-rays of your teeth taken before any decision to operate is agreed. The clinician should also explain the implications of a decision not to remove the tooth and any possible problems in the future.

The operation itself:

General anaesthesia may be needed for complex and lengthy operations, but local anaesthesia carries less risk of complications.
Bruising and swelling often occur following third molar surgery, but usually go within two weeks
Other common complications of third molar surgery include bleeding, minor infection, and damage to the adjacent teeth. Your doctor or dentist will inform you if any problems arise during surgery and discuss with you if any further treatment is needed.

After the operation:

Your doctor or dentist will advise you how to look after your mouth after the operation, e.g. with hot salty mouthwashes; and what painkillers to take, e.g. paracetamol or ibuprofen.
There is no evidence to suggest that antibiotics should routinely be prescribed following third molar removal, but they may be needed in some cases.
Before leaving, you should know how to contact the surgeon in case of emergency. A review appointment may be arranged, but this is not always necessarily. A letter will also be sent to your own dentist to let him or her know about the operation and any follow up arrangements.