The third molar is the last tooth to erupt in the oral cavity and it is also the most retained/impacted tooth of the jaws. Even though this tooth can remain asymptomatic causing no problems whatsoever to the patient, a series of disorders can be directly related with its presence. Throughout Dentistry history there have always been some doubts concerning the real need for asymptomatic impacted third molar removal and the best time to do it if indicated. This present article, Part I, has the objective to review the literature on the topic. A future to be published article, Part II, will discuss the still controversial issue and propose a conclusion. There is unanimity among oral and maxillofacial surgeons for impacted third molars removal when involved with pathological conditions. The concept of prophylactic extraction of third molars when the indications are not obvious, surgical extraction recommendation must be based on clinical experience and in adequate professional judgment, always taking into account the relation cost/benefits and if patient´s systemic condition is adequate for totally recover from surgical trauma.
Keywords:Impacted tooth; Retained third molar; Impacted third molar; Third molar removal
Do you cringe every time someone mentions the word dentist? Do you break out in a sweat days before you call your dentist for an appointment? Do you develop a case of insomnia the night or two before your dental appointment? Does going into a dental office feel like you are entering a haunted house and you want to shake and scream?
You are one of the millions of people that feel the same way you do even if they may not share it with you. I know because I used to be one of them. I have spent my entire dental career trying to change that and make a difference for the estimated 35-40% of people who have some degree of dental anxiety or Dentophobia.
I have worked with hundreds of patients with various degrees of dental anxiety and assorted fears related to the dental profession. I have researched the causes and the available solutions and have come up with some ideas and suggestions to help you.
Here is a basic list of what you can do once you have decided to seek dental care:
Ask a trusted friend, your primary care doctor or nurse, your optometrist or local pharmacist for a referral. Then go online and research specifically what you are interested in and check out the dentist suggested.
A”Interview” the dentist and staff. This can be done by calling the dental office and talking to the receptionist, by scheduling a consult with the dentist or by scheduling a “cleaning” with the dental hygienist and talking with the dentist once you are there.
Once you have selected one or two possible dental offices, see how you feel when you actually meet them and ask yourself these questions:
“Do they seem kind? Are they empathetic, friendly, and caring? Do they seem gentle?”
“Did they listen to me and act interested when I spoke to them?”
“Do they treat anxious patients?”
“What does their staff say about them?”
“How do they treat their staff?”
“Do they act calm and like they will treat me with
patience or do they act rushed, harried and like they are
running a marathon?”
Ask the receptionist, hygienist or the dental assistant
the following questions- Does the dentist give painless
injections? Does the dentist use topical anesthetic before
giving the shot? Does the dentist understand what it is like
to have dental anxiety? And most importantly- How does the
dentist handle their patients that have dental fears?
Does the dental office have headphones or laughing gas
or some aids to help calm fearful patients and what specific
techniques does the dentist offer?
Find out what the office does for infection control. I
have found that many patients have hidden fears concerning
if they could be contaminated or “catch” something at the
dental office. Let me reassure you that infection control
is highly regulated and most dental offices work hard to
comply. It is easy to verify this either by asking when you
call or checking it out at your appointment to see if all the
instruments used are “bagged, tagged and sterilized” for
Find out what kind of dental materials the office uses.
Some patients are very concerned about what is “hidden” in
the filling materials used, specifically what is in the silver
fillings (amalgam). They worry that the mercury used to
make it will be released into their bodies as a toxin.
There have been many studies done on the safety of amalgam
fillings. In 2009, the US Food and Drug Administration evaluated
the research and found no reason to limit the use of amalgam,
saying it was safe for adults and children over 6. However, some
groups were not convinced and felt they had seen some harmful
side effects and detrimental medical consequences as a direct
result of the amalgam in patient’s mouths. They asked the FDA to
reconsider and that review is under way.
If you are concerned and do not want any silver fillings or
amalgam placed in your mouth, preferring white or composite
(plastic) fillings, then it is up to you to be proactive. Always
remember that patients have the choice of what material gets
placed in their mouths. I suggest that you research the potential
dental office beforehand or interview the dentist BEFORE starting
any dental work. Inform them that you do NOT want any kind
of silver fillings (amalgam) placed in your teeth. If you already
have these silver fillings in your mouth and are concerned they
may be causing problems for you of any kind, locate a dentist
who understands your concerns and will remove them. It is very
important to be sure the dentist has a safe system in their office
to suction away all the silver, including the fumes during drilling
to keep you safe and protected.
Once you know the answers to these questions, you can
decide if you are ready to schedule your next appointment.
If you truly feel comfortable and like you can trust what you
learned, then go ahead. Stop obsessing and fretting and make an
appointment. I strongly suggest you make it a “test” appointment.
Ask a close friend or family member to accompany you for
moral support and for an objective second opinion. See how you
are treated and if your choice was the right one for you. If it was a
positive experience, then go ahead, pat yourself on the back and
make another appointment.
However, if it was not a particularly good experience or
you felt uncomfortable at any time, decide if you can talk about
it honestly with the dentist and work things out. If not choose
another one that suits you better.
Remember that you are in charge and fortunately there are
lots of dentists ready and willing to treat you the way you need
to be treated.
You NEVER need to be afraid of going to the dentist again.
Just find the dentist who offers the method and temperament
that gives you the feeling of safety, comfort, trust and of course
Dr. Susan R. Cushing is a practicing General Dentist who
specializes in Treating Fearful and Phobic Dental patients.
Dr.Cushing graduated Cum Laude from Boston College and went
on to earn her DMD degree from Tufts University Dental. She is
a Fellow in the International College of Dentists, a Master in the
Academy of General Dentistry, a Certified Clinical Hypnotherapist
and a Master Practitioner of Neuro‐Linguistic Programming,
where she helps others re‐program their own thoughts, actions
and behaviors, in order to enhance the quality and effectiveness
of their lives.