Objective: Removal of third molars (3Ms) is one of the most
common surgical procedures performed by dental surgeons.
3Ms that are associated with pathologic changes such as infection,
nonrestorable caries lesions, cysts, tumors, and destruction
of adjacent teeth and bone are under consensus for their
removal. However, debate exists regarding the prophylactic
removal of asymptomatic impacted 3Ms. This review attempts
to establish indications for prophylactic extraction of 3Ms.
Method and Materials: Clinical experience and a summary
of the literature are presented concerning the effects of
retained 3Ms in relation to caries and periodontal disease, dental
arch changes and anterior crowding, cysts and other etiologies,
mandibular fractures, temporomandibular pain, and aging of bone. Results: Nearly half of impacted 3Ms are associated
with some form of pathology, most frequently caries
(20%) and periodontal disease (17%). They increase the probability
of fractures and their presence results in difficult fracture
reduction and a higher rate of complication. The number of
3Ms decreases rapidly with age, with only 31% remaining at
38 years of age. Conclusion: Preventive removal of 3Ms at a
young age is justified because retained 3Ms are at high risk of
developing various pathologies. In addition, at older ages
extraction of 3Ms becomes more complex, with an increased
rate of complication due to deteriorated systemic physiologic
conditions and changes in bone physiology.