Prophylactic removal of impacted third molars: an assessment of published reviews.
OBJECTIVE
To evaluate published reviews of the appropriateness of prophylactic removal of impacted third molars.


METHODS
Systematic review and critical appraisal of relevant reviews.


METHODS
Computerised databases (Medline and Embase), the Index to Dental Literature, and the references of articles were searched to identify relevant reviews.


METHODS
Pathologies associated with impacted third molars and outcomes following surgical removal of third molars.


RESULTS
Twelve published reviews were assessed. Major methodological problems in these include that authors did not describe review methods such as literature search strategy and criteria for inclusion of primary studies. Reviews with similar aims included different sets of primary studies as evidence. Details of primary studies quoted were seldom sufficient for readers to judge the reliability of the evidence. With the exception of two reviews with poorer quality, the reviews concluded that there is a lack of evidence to support the prophylactic removal of impacted third molars. Two decision analyses also concluded that, on average, patients' long-term wellbeing is maximised if extraction is confined to those impacted third molars with pathology.


CONCLUSIONS
In the absence of good evidence to support prophylactic removal, there appears to be little justification for the removal of pathology-free impacted third molars.
Song
F
F
NHS Centre for Reviews and Dissemination, University of York.
Landes
D P
DP
Glenny
A M
AM
Sheldon
T A
TA
D000075202:Contraindications; D016206:Databases, Bibliographic; D003661:Decision Support Techniques; D003731:Dental Caries / Q000209:etiology; D004368:Dry Socket / Q000209:etiology; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D007570:Jaw Cysts / Q000209:etiology; D008964:Molar, Third / Q000601:surgery*; D010497:Pericoronitis / Q000209:etiology; D010510:Periodontal Diseases / Q000209:etiology; D012391:Root Resorption / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D014081:Tooth Extraction / Q000009:adverse effects / Q000706:statistics & numerical data; D014095:Tooth, Impacted / Q000150:complications / Q000601:surgery