Does Retaining Third Molars Result in the Development of Pathology Over Time? A Systematic Review.

PURPOSE: The present systematic review was conducted to assess the available literature on pathologies associated with third molar retention. MATERIALS AND METHODS: A systematic literature search was conducted in MEDLINE (PubMed), Embase, and Cochrane Library and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Relevant reports were selected using predefined inclusion and exclusion criteria. Pathology related to third molar retention included caries, periodontal pathology, second molar external root resorption, and pathologic widening of the third molar pericoronal space. The methodologic quality of each study was reviewed using a pathology-specific tool to assess the risk of bias. RESULTS: A total of 37 studies were included for qualitative analysis. The available data showed that asymptomatic retained third molars frequently become diseased with increasing age of the patient and increased retention time. Caries and periodontal pathology were most frequently observed, especially in partially erupted third molars and mesially inclined mandibular third molars. Overall, the available data were regarded as medium to fair quality evidence. CONCLUSIONS: The available data have revealed that retained asymptomatic third molars rarely remain disease-free over time. Increasing age and, thus, increasing retention time seemed associated with greater disease prevalence. Well-designed, prospective follow-up studies are needed to substantiate the clinical management of asymptomatic disease-free third molars.

Cervicofacial actinomycosis following third molar removal: case-series and review.

Actinomycosis is an opportunistic infection caused by bacteria of the Actinomyces spp., commonly A. israelii. These are non-pathogenic commensals in the mouth, gut, and female genital tract. An infection may arise following trauma or surgery, such as tooth extraction. More than half of cases of actinomycosis occur in the perimandibular area and are termed cervicofacial actinomycosis. Initially, the infection develops as a painful, rapidly progressive swelling. The lesion may then indurate and is often painless while the overlying skin discolors red to purple-blue. Prolonged treatment with antibiotics and surgery are often required for resolution, unless treatment is promptly started. However, diagnosis may be delayed or missed because of difficult bacterial culturing and frequent confusion with malignancy and other infections. This case study describes six patients who developed cervicofacial actinomycosis following third molar extraction. The purpose of this study is to inform clinicians on this stubborn and deceitful disease entity and to highlight the importance of clinical recognition for quick resolution with minimal morbidity.