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Letter to the Editor, ''Retained Asymptomatic Third Molars and Risk of Second Molar Pathology'' J.W. Friedman J DENT RES 2014 93: 319 DOI: 10.1177/0022034513520326 The online version of this article can be found at: http://jdr.sagepub.com/content/93/3/319
Published by: http://www.sagepublications.com
On behalf of: International and American Associations for Dental Research
Additional services and information for Journal of Dental Research can be found at: Email Alerts: http://jdr.sagepub.com/cgi/alerts Subscriptions: http://jdr.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Feb 19, 2014 What is This?
Downloaded from jdr.sagepub.com at Queen Mary, University of London on July 1, 2014 For personal use only. No other uses without permission. © International & American Associations for Dental Research
research-article2014
JDR
93310.1177/0022034513520326
Letter to the Editor
J.W. Friedman 3057 Queensbury Drive, Los Angeles, CA 90064, USA; drjfriedman@ sbcglobal.net
J Dent Res 93(3):319, 2014
T
hat there is risk of increased periodontal pocket depth and caries on distal surfaces of second molars in the presence of retained third molars is well known (Garaas et al., 2011; Falci et al., 2012). The study by Nunn et al. (2013) attempts to quantify the risk by means of statistical projection and estimates of “relative risk”. However, relative risk unrelated to incidence can be misleading. The greatest relative risk (4.88-fold) of damage observed in this study occurs with retained soft-tissue–impacted third molars. However, the prevalence of soft-tissue impaction is low (3% of 804 quadrants under analysis), putting few second molars at risk from this condition. Risk of damage is even lower for retained erupted and fully bony-impacted teeth. Thus, the overall risk of losing a second molar because of a retained third molar is small. Arbitrarily designating a > 4 mm periodontal probing depth as “pathology” exaggerates both the condition and the risk (Kandasamy, 2011). Not every 4-mm pocket is diseased. There are also “pseudopockets” with no periodontal attachment loss. Considering that the average age of this cohort is 46 yr, it is likely that some individuals had probing depths of > 4 mm between their first and second molars. Should we consider removal of second molars to protect first molars? The authors conclude: “The retention of third molars is associated with increased risk of second molar pathology in middle-aged
Letter to the Editor, “Retained Asymptomatic Third Molars and Risk of Second Molar Pathology” and older adult men.” Perhaps so, but the increased risk and the degree of pathology are too small to suggest possible benefit from the prophylactic removal of third molars.
ACKNOWLEDGMENT The author received no financial support and declares no potential conflicts of interest with respect to the authorship and/or publication of this article.
References Falci SG, de Castro CR, Santos RC, de Souza Lima LD, Ramos-Jorge ML, Botelho AM, et al. (2012). Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg 41:1270-1274. Garaas R, Moss KL, Fisher EL, Wilson G, Offenbacher S, Beck JD, et al. (2011). Prevalence of visible third molars with caries experience or periodontal pathology in middle-aged and older Americans. J Oral Maxillofac Surg 69:463-470. Kandasamy S (2011). Evaluation and management of asymptomatic third molars: watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 140:11-17. Nunn ME, Fish MD, Garcia RI, Kaye EK, Figueroa R, Gohel A, et al. (2013). Retained asymptomatic third molars and risk of second molar pathology. J Dent Res 92:1095-1099.
DOI: 10.1177/0022034513520326 Received October 25, 2013; Last revision November 13, 2013; Accepted November 23, 2013 © International & American Associations for Dental Research
319 Downloaded from jdr.sagepub.com at Queen Mary, University of London on July 1, 2014 For personal use only. No other uses without permission. © International & American Associations for Dental Research
Letter to the Editor, ''Retained Asymptomatic Third Molars and Risk of Second Molar Pathology'' J.W. Friedman J DENT RES 2014 93: 319 DOI: 10.1177/0022034513520326 The online version of this article can be found at: http://jdr.sagepub.com/content/93/3/319
Published by: http://www.sagepublications.com
On behalf of: International and American Associations for Dental Research
Additional services and information for Journal of Dental Research can be found at: Email Alerts: http://jdr.sagepub.com/cgi/alerts Subscriptions: http://jdr.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Feb 19, 2014 What is This?
Downloaded from jdr.sagepub.com at Queen Mary, University of London on July 1, 2014 For personal use only. No other uses without permission. © International & American Associations for Dental Research
research-article2014
JDR
93310.1177/0022034513520326
Letter to the Editor
J.W. Friedman 3057 Queensbury Drive, Los Angeles, CA 90064, USA; drjfriedman@ sbcglobal.net
J Dent Res 93(3):319, 2014
T
hat there is risk of increased periodontal pocket depth and caries on distal surfaces of second molars in the presence of retained third molars is well known (Garaas et al., 2011; Falci et al., 2012). The study by Nunn et al. (2013) attempts to quantify the risk by means of statistical projection and estimates of “relative risk”. However, relative risk unrelated to incidence can be misleading. The greatest relative risk (4.88-fold) of damage observed in this study occurs with retained soft-tissue–impacted third molars. However, the prevalence of soft-tissue impaction is low (3% of 804 quadrants under analysis), putting few second molars at risk from this condition. Risk of damage is even lower for retained erupted and fully bony-impacted teeth. Thus, the overall risk of losing a second molar because of a retained third molar is small. Arbitrarily designating a > 4 mm periodontal probing depth as “pathology” exaggerates both the condition and the risk (Kandasamy, 2011). Not every 4-mm pocket is diseased. There are also “pseudopockets” with no periodontal attachment loss. Considering that the average age of this cohort is 46 yr, it is likely that some individuals had probing depths of > 4 mm between their first and second molars. Should we consider removal of second molars to protect first molars? The authors conclude: “The retention of third molars is associated with increased risk of second molar pathology in middle-aged
Letter to the Editor, “Retained Asymptomatic Third Molars and Risk of Second Molar Pathology” and older adult men.” Perhaps so, but the increased risk and the degree of pathology are too small to suggest possible benefit from the prophylactic removal of third molars.
ACKNOWLEDGMENT The author received no financial support and declares no potential conflicts of interest with respect to the authorship and/or publication of this article.
References Falci SG, de Castro CR, Santos RC, de Souza Lima LD, Ramos-Jorge ML, Botelho AM, et al. (2012). Association between the presence of a partially erupted mandibular third molar and the existence of caries in the distal of the second molars. Int J Oral Maxillofac Surg 41:1270-1274. Garaas R, Moss KL, Fisher EL, Wilson G, Offenbacher S, Beck JD, et al. (2011). Prevalence of visible third molars with caries experience or periodontal pathology in middle-aged and older Americans. J Oral Maxillofac Surg 69:463-470. Kandasamy S (2011). Evaluation and management of asymptomatic third molars: watchful monitoring is a low-risk alternative to extraction. Am J Orthod Dentofacial Orthop 140:11-17. Nunn ME, Fish MD, Garcia RI, Kaye EK, Figueroa R, Gohel A, et al. (2013). Retained asymptomatic third molars and risk of second molar pathology. J Dent Res 92:1095-1099.
DOI: 10.1177/0022034513520326 Received October 25, 2013; Last revision November 13, 2013; Accepted November 23, 2013 © International & American Associations for Dental Research
319 Downloaded from jdr.sagepub.com at Queen Mary, University of London on July 1, 2014 For personal use only. No other uses without permission. © International & American Associations for Dental Research
