What Is the Effect of Timing of Removal on the Incidence and Severity of Complications?

Purpose: The purpose of this article is to summarize the literature that addresses the following question: Among patients undergoing third molar removal, do patients who are younger, eg, <25 years, when compared with older patients, have a decreased risk for postoperative complications and more rapid recovery? Materials and Methods: For the purposes of this study, relevant articles were identified through a search of PubMed, Scopus, and the Cochrane Database, using the Medical Subject Headings search terms third molars or wisdom teeth, complications and age, linked to recovery, infections, periodontal conditions, temporomandibular joint problems, nerve involvement, sinus communication, and mandibular fracture. Results: Relevant studies have been identified and are reported for the following complications and their relationship to the patient's age: 1) time to recovery; 2) incidence of fractures; 3) rates of infection; 4) periodontal complications; 5) nerve involvement; 6) temporomandibular joint complications; 7) nerve injury; and 8) sinus-related complications. Conclusions: Studies indicate that as one becomes older, third molars (M3s) become more difficult to remove, may take longer to remove, and may result in an increased risk for complications associated with removal. The age of 25 years appears in many studies to be a critical time after which complications increase more rapidly. Conversely, there are no studies indicating a decrease in complications with increasing age. It also appears that recovery from complications is more prolonged and is less predictable and less complete with increasing age. As such, many clinicians recommend removal of M3s in patients as young adults. Advocates of M3 retention need to review carefully with their patients the risks of delaying M3 removal with the same degree of emphasis as the risks associated with operative treatment. (c) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:37-40, 2012, Suppl 1