Surveillance as a management strategy for retained third molars: is it desirable?
The purpose of the present report was to define and advocate active surveillance compared with follow-up as needed (prn follow-up), as the preferred management strategy for patients who elect to retain their third molars (M3s). Active surveillance, a nonoperative management strategy for retained M3s, is characterized as a prescribed, regularly scheduled set of follow-up visits that include both clinical and radiographic examinations. Given that the risk of complications with M3 removal are age related, the rationale for recommending active surveillance instead of "prn follow-up" is that the frequency of future disease among retained M3s is sufficiently high to warrant routine scheduled follow-up visits to detect and treat disease before it becomes symptomatic. Symptomatic disease is a late finding. Patients electing active surveillance as their preferred management strategy might not avoid operative treatment in the future, but it should increase their chances of being diagnosed at the youngest age possible, thus minimizing the age-related operative complications. The author recommends that the frequency of follow-up visits be approximately every 24 months and the examination be completed by a specialist or general dentist. Active surveillance as a management strategy is based on level 5 evidence (ie, expert opinion).
Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA 02114, USA. tbdodson@partners.org
Thomas B
TB
Dodson
D058070:Asymptomatic Diseases; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005500:Follow-Up Studies; D006801:Humans; D008964:Molar, Third / Q000473:pathology*; D010510:Periodontal Diseases / Q000175:diagnosis; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D014078:Tooth Eruption; D014081:Tooth Extraction / Q000191:economics; D014095:Tooth, Impacted / Q000145:classification*; D057832:Watchful Waiting / Q000191:economics