Treatment Planning for Mandibular Third Molars.

NICE guidance for mandibular third molars has been available since 2000. This was set up to limit the surgical treatment of these teeth to symptomatic patients. There are numerous risks involved with surgical treatment of mandibular third molars and these should be explained in detail to the patient. Common and serious complications of mandibular third molar surgery are damage to the inferior alveolar and lingual nerve. Predicting the risk of inferior alveolar nerve injury is useful for treatment planning. The orthopantomogram (OPT) is the baseline special test for assessing this and numerous signs on an OPT can predict an increased risk of injury to the nerve. Cone beam computed tomography (CBCT) is being more frequently used to assess this relationship further and can influence treatment planning. Coronectomy is a technique whereby the crown of the tooth is sectioned and removed leaving the roots in situ. This has proven to be a useful technique in high risk cases, but is not without its own complications. The increase in availability of CBCT imaging and the recent resurgence of coronectomy as a treatment modality can increase the number of treatment options available to patients. We have proposed an algorithm to aid the treatment planning and informed consent processes associated with mandibular third molar surgery. Clinical relevance: This article is relevant to primary and secondary care dental practitioners as it will aid the investigation, treatment planning, correct referral and management of patients with problematic mandibular third molars.

What's new in... the management of post-operative pain in dentistry.

Post-operative pain is a common occurrence within dentistry. The causative factors are not solely dependent on the procedure but a part is also played by the patient's ability to self-cope as well as their level of anxiety. This article discusses the effectiveness of analgesia available for prescription by general dental practitioners based on systematic reviews in the literature, with particular reference to third molar removal. In addition, other methods that can help reduce pain in the post-operative period are addressed, including the types of local anaesthetic used for the procedure and psychological aspects of patient care. The main aim is to update and aid dentists' decision making processes in choosing ways to lessen the pain experienced by patients following dental procedures.