Decision making in third molar surgery: a survey of Brazilian oral and maxillofacial surgeons

Abstract

This study was designed to evaluate the variations in decision making among Brazilian oral and maxillofacial surgeons (OMFS) and trainees in relation to third molar surgery. A survey on 18 diverse clinical situations related to the assessment and treatment of the third molar surgeries was conducted during the 20th Brazilian National OMFS meeting. Participants were divided into three groups according to their level of training. Another variable studied was length of experience. Correlation between the question answers and the variables was analysed using the chi-square test and the f test. The mean age of participants was 32.68 years, and their mean length of experience was 5.24 years. There were no statistical differences between the level of training and number of years of experience and the responses to 15 of the 18 questions on clinical situations. However, differences were found in responses to prophylactic extraction of asymptomatic third molars, use of non-steriodal anti-inflammatory drugs (NSAIDs) during the preoperative surgical period and the use of additional imaging to plan extractions. The group with shorter time of experience (3.8 ± 3.94 years) tended to recommend extractions of asymptomatic third molars more frequently compared with the more experienced surgeons (P = 0.041). More experienced surgeons used NSAIDs in the preoperative surgical period, whereas the majority of the youngest surgeons (4.1 ± 5.96 years of experience) did not (P = 0.0042). The certificated trained and in practice group tended to treat deep lower third molar impactions based on the findings of a panoramic radiograph, without obtaining additional imaging [cone beam computed tomography (CBCT)] before treatment (P = 0.0132). Decision making regarding third molar treatment differs according to the level of training and is influenced by the number of years of experience. Therefore, further continuous education programmes in this area are warranted to make recommendations regarding third molars consistent with the current literature.

Prophylactic Extraction of Third Molars: Evidence-Based Dentistry

“…Although a substantial number of clinical studies have been published on this topic, the conflicting results still hinder the decisionmaking process in the clinical setting (18,22). These controversial findings are the product of differences among the studies, regarding to diverse methodological issues, such as study design, sample size or monitoring (follow-up) time (6,18). Additionally, Friedman (7) expresses that, even currently, five "historical" myths regarding third molars prevail among the dental community: (i) third molars have a high incidence of pathology; (ii) early removal of third molars is less traumatic; (iii) pressure of erupting third molars causes crowding of anterior teeth; (iv) the risk of pathology in ITM increases with age; and (v) there is little risk of harm in the removal of third molars.…”

“…However, diverse studies have demonstrated considerable intra-and inter-dentist variability -including wrong diagnosis-concerning to decisions to extract or not asymptomatic impacted third molars (9,24). Regarding this, the criteria defining the indications for the surgical extraction of these molars are still the origin of considerable debate among dental practitioners (6,8,9,19). Due to these reasons, diverse clinical practice guidelines have been developed in an attempt to increase the professional performance, and to assist the clinicians, patients and parents in making decisions about the appropriate management of ITM (22).…”

“…Impacted third molars (ITM) are the most common developmental disorder of the human being (3). Removal of third molars is the most commonly performed oral surgery worldwide (1,(4)(5)(6). According to Friedman, ten million third molars are extracted in the US each year, with an annual cost of over $3 billion (7); while in England and Wales, expenditures for the same reason amounted to around £ 5.2 million between 1995 and 1996 (4).…”

“…Therefore, little controversy exists about their surgical removal when they are properly diagnosed. However, the justification for prophylactic extraction of disease-free ITM has remained less clear for many years (4,6,9,11,12).…”

Tomografia computadorizada de feixe cônico como exame complementar norteador em exodontia de terceiro molar semi-incluso e impactado próximo ao canal mandibular: relato de caso

“…No contexto da cirurgia bucomaxilofacial, a exodontia de terceiros molares é um dos procedimentos mais comuns, apresentando diversas indicações [1][2][3][4][5][6] . É um procedimento delicado, podendo causar diversas complicações pós-operatórias 7,8 .…”