What costs are associated with the management of third molars?
OBJECTIVE
The purpose of this study was to estimate the treatment costs directly related to operative and nonoperative management of asymptomatic, disease-free, third molar (M3) teeth.


METHODS
The data reviewed were limited to claims submitted by oral and maxillofacial surgeons. The data collected included charges for consultations, radiographs, surgical removal of bony impacted teeth, and general anesthesia, using the 2009 data extracts from Delta Dental of Virginia. The median charges were used as a proxy for the actual costs attributable to the removal or retention of M3 teeth. Three clinical scenarios were executed using the available claims data to calculate the treatment costs associated with nonoperative and operative M3 management. An assumption made in the computation of expenses was that for subjects who elected to retain their M3s, the recommended management strategy was active surveillance. Active surveillance is a prescribed treatment to monitor the retained M3s characterized by performing a clinical examination and panoramic imaging every 2 years. The author assumed a 3% increase in charges per annum.


RESULTS
The 3 scenarios were as follows: scenario 1 (nonoperative management), retention of asymptomatic, disease-free M3s and monitoring for 20 years from age 18 to 38 years; scenario 2 (operative management), removal of 2 asymptomatic, disease-free, bony impacted M3s for 18-year-old patients using general anesthesia (30 minutes) in an office-based ambulatory setting; and scenario 3 (failure of non-operative management), removal of 1 previously asymptomatic, disease-free, bony impacted M3 after 10 years of follow-up in a now 28-year-old patient using general anesthesia (30 minutes) in an office-based ambulatory setting. The estimated charges for managing M3s were $2,342, $1,184, and $1,997 for scenarios 1, 2, and 3, respectively.


CONCLUSIONS
A simplified financial analysis derived from the dental claims data suggests that during the course of the patient's lifetime, the charges associated with non-operative management of asymptomatic, disease-free M3s will exceed the charges of operative management. The difference in costs might be important to patients when choosing between operative and non-operative management of their M3s.
Delta Dental of Virginia, Roanoke, VA 24018, USA. george.koumaras@deltadentalva.com
George M
GM
Koumaras
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics; D000766:Anesthesia, Dental / Q000191:economics; D000768:Anesthesia, General / Q000191:economics; D058070:Asymptomatic Diseases / Q000191:economics / Q000628:therapy; D005250:Fees, Dental; D017048:Health Care Costs; D006801:Humans; D008964:Molar, Third / Q000601:surgery*; D011862:Radiography, Panoramic / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D014081:Tooth Extraction / Q000191:economics*; D014095:Tooth, Impacted / Q000191:economics / Q000601:surgery*; D057832:Watchful Waiting / Q000191:economics*; D055815:Young Adult