Third molar: attitude and conduct

Abstract

Introduction: Pathology ot the third molar (3M) is a current topic of stomatology because it causes frequent complications. In the medical literature there are many contradictions regarding the treatment conduct. Purpose: Improving the rehabilitation of patients with 3M pathology by establishing attitudes and treatment conduct. Material and methods: Incidence of complications of 3M pathology was evaluated depending on various factors. The medical records and radiological examination data were statistically processed. The first study group comprised 486 patients with complications caused by 3M, treated in the in-patient department, the second group-167 patients treated in the out-patient department. I assisted in the treatment and check-up of 34 patients with complications caused by 3M. Results: Of 486 patients with complications caused by 3M, 436 (89.7%) had inflammatory complications (30.0% of the total number of inflammatory processes in the oro-maxillo-facial region). Abscesses and phlegmons were recorded in 333 patients (68,4%). The phlegmon caused by 3M was complicated by severe sepsis in 12 patients (2.5%). Most patients presented on 3rd day of onset of the disease (30.0%) and the phlegmons' frequency increased with the number of days. The highest incidence of 3M complications was in patients between 20-27 years (43%). Complications caused by the lower 3M developed in 89% cases. A frequent cause of severe post-extractional inflammatory complications was immediate 3M extraction at patient's presentation with an inflammatory process. The second group included 167 patients with 3M pathology treated in the out-patient department (56.0% of the whole lot). Pericoronitis was found in 94 patients (56.3%), simple and complicated caries of the II molar caused by 3M-23(13.8%), 3M impaction-53(31.7%), Wassmund crescent sign-20 (12.0%). Post-extractional inflammatory complications were not detected, because the extraction was performed after resolving the phase of acute inflammation. Conclusions: 1. Inflammatory 3M complications have a significant frequency, which argue in favor of expanding indications to extraction; 2. Reduction of the frequency of severe inflammatory complications can be obtained by extraction of 3M only after resolving the acute inflammatory process; 3. 3M eruption is the period of increased risk of complications and patients' late presentation increase their severity, so it is necessary to train young patients to consult the doctor as early as possible; 5. Affection of the II molar caused by 3M is quite common, it being an argument for the expanding indications to extraction; 6. Drawing general dentists' attention expecially those tending to ignore the indication to extraction to 3M problem can help to reduce the complications rate; 7. Improvement of medical records to increase the 3M problem study extent and accuracy by young researchers is recommendable.