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
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.