American Association of Oral and Maxillofacial Surgeons

Management of Third Molar Teeth
Management of Third Molar Teeth was developed by theAmerican Association of Oral and Maxillofacial Surgeons(AAOMS) and is supported by the following organizations:

American Association of Orthodontists (AAO)
American College of Oral and Maxillofacial Surgeons(ACOMS)

American Academy of Oral and Maxillofacial Pathology(AAOMP)

British Association of Oral and Maxillofacial Surgeons(BAOMS)

American Academy of Oral and Maxillofacial Radiology(AAOMR)

British Association of Oral Surgeons (BAOS)

American Academy of Pediatric Dentistry (AAPD)
American Academy of Periodontology (AAP)
American Association of Endodontists (AAE)The American Association of Oral and Maxillofacial
Surgeons believes the best approach to any clinicaldilemma is to employ “evidence based practice.”This process merges the best available clinically
relevant evidence with the results of a comprehensive
and focused clinical and imaging examination toformulate recommendations that can be discussedwith the individual patient.
A common clinical dilemma faced by patients today iswhat to do about their third molars. Areas of concern
include determining when surgical management isindicated (particularly in the case of “asymptomatic”
teeth), the risks associated with either removal or retentionof third molars, the optimal timing for treatment, the costof treatment as well as the cost of retention, and how tobest develop a plan for follow-up when a decision is madeto retain a third molar.
There are a variety of recognized management choices
for third molars, including removal, partial removal(coronectomy), retention with active clinical andradiographic surveillance, surgical exposure, tooth
repositioning, transplantation, surgical periodontics,
and marsupialization of associated soft tissue pathology
with observation and possible secondary treatment.
When considering possible management choices,
the clinician should also consider the likelihoodthat disease will develop. Further, evidence clearly
indicates that surgery is more difficult as patients age;
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Canadian Association of Oral and Maxillofacial Surgeons(CAOMS)International Association of Oral and MaxillofacialSurgeons (IAOMS)

therefore given the desire to achieve therapeutic
goals, obtain positive outcomes, and avoid known
risks and complications, a decision should be madebefore the middle of the patient’s third decade toremove or continue to observe third molars, with theknowledge that future treatment may be necessary
based on the clinical situation. Finally, the AAOMS
also recognizes the oral and maxillofacial surgeon as
the clinician qualified to determine a surgical treatment
plan and care for the individual patient.

AAOMS Position Statement on
Third Molar Management
As a means of helping to clarify what is known withrespect to third molar management, the AAOMS offers
the following position statement:
Predicated on the best evidence-based data,
third molar teeth that are associated with disease,or are at high risk of developing disease, shouldbe surgically managed. In the absence of diseaseor significant risk of disease, active clinical andradiographic surveillance is indicated.
This statement clearly recognizes that while not all
third molars require surgical management, given thedocumented high incidence of problems associatedwith third molars over time, all patients should beevaluated by someone experienced and expert inthird molar management.

Approach to the Patient with Third Molars
The approach to third molar management begins with athorough medical and dental history, with attention paid
to any symptoms that may be associated with the patient’s
wisdom teeth. The clinician should ascertain whether
symptoms are present and if so, whether they are related
to the patient’s third molars or another source. Physicalexaminations should include the eruption status andposition of the tooth in the jaws/oral cavity, functionality,and periodontal and caries status. Imaging allows
determination of the presence or absence of the tooth,presence or absence of disease, anatomy of the toothand its root system, as well as the tooth’s relationshipto important structures such as the inferior alveolar
nerve, adjacent second molar, maxillary sinus, etc.
In addition, imaging can detect significant associatedand non-associated disease, such as cysts or tumors.
Where there is evidence of disease, management isgenerally straightforward. When tissue associated witha third molar is suspected to be pathologic in nature, it
should be submitted for histologic examination. Whensymptoms are present, it is important to identify thesource with subsequent management focused on
removal or control of the etiology.
Uncertainty is more explicit in the case of patients whohave asymptomatic, disease-free third molars. Given that
we cannot confidently predict what the future holds for
all patients with asymptomatic, disease-free teeth, wemust rely on the clinician’s experience and expertise inrecognizing the likelihood that pathology will develop
and his or her ability to communicate this in realistic
terms to the patient.

White Paper
In the absence of evidence regarding current associatedsymptoms or disease to support surgical management,
the surgeon should review the likelihood of pathology
developing in the future, functionality, risks of removal,risks of retention, and protocol for active surveillance.
Removal should be favored when the third molar iscurrently or likely to be non-functional, there is an
overlying removable prosthesis, orthodontic removal
is justified (such as when the tooth is preventing theeruption of the second molar) and in the case of planned
orthognathic surgery. Patients should also be informedof the greater difficulty and increased rate of complications
associated with third molar removal as they age. Whenappropriate, patients should be advised that if they retain
their disease-free wisdom teeth, it is possible they could
live their entire lives without problems.
The AAOMS offers the above recommendations basedon the best available clinically relevant literature and iscommitted to a process of constant re-evaluation of newinformation.

For relevant sources and resource material, please see Supporting
Information to the Management of Patients with Third Molar Teeth
available on aaoms.org.

© 2016 American Association of Oral and Maxillofacial Surgeons. No portion of thispublication may be used or reproduced without the express written consent of theAmerican Association of Oral and Maxillofacial Surgeons.

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