Historical aspects about third molar removal versus retention and distal surface caries in the second mandibular molar adjacent to impacted third molars

This paper provides an insight into the historical recommendations regarding removal of mandibular third molars, as set out by the Royal College of Surgeons of England and the National Institutes of Health in the USA, as well as regional guidance from the National Institute for Health and Care Excellence and the controversy that surrounds surgical removal of third molars. The influences of third molar management as it developed in the UK, the historical economic evaluations, and the available evidence base on third-molar removal versus retention are described. This article seeks to address the growing concerns regarding the increasing frequency of distal surface caries (DSC) in mandibular second molar teeth when the decay is associated with asymptomatic, partially erupted, mandibular third molars, especially when they are mesially or horizontally impacted. Lastly, we illustrate radiographs of patients affected by DSC and how guidance that has been issued by a guideline institution regarding third molar surgery, even though it is based on insufficient evidence, is perceived as a strictly compulsory clinical strategy, and has been used in clinical practice in the UK for more than 20 years.

Automated summary

This paper discusses the historical recommendations on mandibular third molar removal from various authoritative institutions and the controversy surrounding this surgical procedure. It also explores the influences of third molar management in the UK, economic evaluations, and the available evidence on tooth removal versus retention. The article highlights the concerns regarding increasing distal surface caries in mandibular second molars associated with asymptomatic, partially erupted third molars and how guidelines based on insufficient evidence have been applied in clinical practice for over 20 years.