THIRD MOLAR REMOVAL: RISK AND BENEFITS. The decision to remove impacted molars should only be made when the patient has been made aware of the risks and benefits of removal. Any surgical procedure is subject to possible complications and in the words of Professor Harry Seftel “ a patient must earn the right to have an operation” . Impacted wisdom teeth are most commonly removed when pain or recurrent infection occurs at the impacted site or when the impacted tooth causes damage to adjacent teeth (resorption). There is a risk that impacted teeth may cause pressure on other teeth and affect orthodontic treatment. This would be another reason for wisdom tooth removal. There is debate about whether asymptomatic impacted teeth should be removed. Research shows that 29% of tissue from impacted wisdom teeth demonstrates pathology (cysts or tumor formation) and only 6% of these cases showed radiographic findings of pathology pre operatively. (American Journal of OMFS. May 2002). On the other hand the removal of symptomless wisdom teeth must be approached cautiously with regard to potential complications especially of nerve injury. It is normal to have pain, swelling and bruising post-operatively and the extent varies from patient to patient. Every patient undergoing the surgical removal of a third molar should be warned of the possibility of temporary or permanent nerve damage. There are two nerves in the vicinity of impacted teeth and the possibility of nerve damage must be considered. The possibility of inferior alveolar nerve damage can usually be assessed from pre-operative radiographs. The greater the potential risk, the more crucial it is to balance this against the necessity to remove the impacted tooth. The risk of lingual nerve damage is less tangible and almost impossible to assess preoperatively. There is a weight of evidence that lingual nerve damage can occur irrespective of the surgical approach. Fortunately the incidence of permanent nerve damage is low. The surgeon will assess the site of the operation as well as the radiographs to determine the risks and benefits of the operation.