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THIRD MOLARS
L E T T E R S
LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
THIRD MOLARS
Thank you for Drs. Stephen Eklund’s and James Pittman’s article concerning third-molar removal patterns (“Third-Molar Removal Patterns in an Insured Population,” April JADA). I am a practicing dentist of 34 years, and I was somewhat surprised to see such a disparity of opinion between general practitioners. I am an advocate of early removal of unerupted third molars at an appropriate time. My rationale for this is mainly, but not exclusively, that the periodontal status of erupted third molars in middle-aged adults is seldom ideal. Further, I think that these teeth may compromise the health of adjacent teeth. As a practical matter in my office, we find that it is much easier to motivate a parent to have an adolescent’s third molars removed than to persuade a middle-ager to do the same. Also, I don’t think that the difference in cost to the insurance companies should be a factor in this decision. I don’t know how much time the authors are able to spend
dealing with patients directly. I am willing to bet that if they would ask the people in their school’s hygiene department to take a look at the recall patients who have erupted third molars—and if they would do this for a year or so—they possibly would come away with a changed attitude. Thank you for the well-balanced Discussion section. I heartily agree that a set of guidelines could be a benefit to us all (although I wouldn’t want to be on the committee drafting them!). There is an adage in football that there are many possible outcomes for a forward pass, and only one of them is good. This has been my experience with third molars. Fred Knapp, D.D.S. Independence, Mo. Authors’ response: We very much appreciate Dr. Knapp’s interest in our article and the opportunity to discuss further the issues that he raises. It was not the intent of the article to suggest which approach to third-molar removal is best, but rather to let dentists see the differences in their practice patterns so that a more thorough discussion of the topic can take place within the profession. While a profession never can unilaterally decide what is best for the public, we nevertheless firmly believe that the focus of these kinds of discussions must be within the profession. Our principal focus was on the early prophylactic removal of asymptomatic, unerupted third molars. Dr. Knapp’s point about oral hygiene problems around erupted third molars as a rationale for extraction—and
the difficulty in motivating middle-aged adults to have these teeth extracted—is a somewhat different issue. The removal of teeth because of oral hygiene difficulties is perhaps best done on a patientby-patient, tooth-by-tooth basis, with those patients who can be motivated to adequate oral hygiene having the option to retain these teeth. It is difficult to see how judgments on ability to maintain adequate oral hygiene can be made for an adolescent before the tooth has erupted. Finally, we agree with Dr. Knapp that insurance should not determine how patients are treated. Treatment decisions should be tailored to the needs and wants of each patient. If a needed and desired procedure happens not to be covered by insurance, the patient surely can decide to purchase it anyway. Also, if patients would not otherwise want a procedure, insurance should not dictate that they have it. Insurance is best seen as a means to help people to buy what they need and want, not something that dictates those needs and wants. Stephen A. Eklund, D.D.S, M.H.S.A., Dr.P.H., James L. Pittman, D.D.S., M.S. Ann Arbor, Mich. IMPLANT FAILURES
“Implant Failures Associated With Asymptomatic Endodontically Treated Teeth” by Drs. David Brisman, Adam Brisman and Mark Moses (February JADA) is a clinical report about four implant failures that the authors claim resulted from their proximity to asymptomatic endodontically treated teeth.
JADA, Vol. 132, July 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.
853
LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
THIRD MOLARS
Thank you for Drs. Stephen Eklund’s and James Pittman’s article concerning third-molar removal patterns (“Third-Molar Removal Patterns in an Insured Population,” April JADA). I am a practicing dentist of 34 years, and I was somewhat surprised to see such a disparity of opinion between general practitioners. I am an advocate of early removal of unerupted third molars at an appropriate time. My rationale for this is mainly, but not exclusively, that the periodontal status of erupted third molars in middle-aged adults is seldom ideal. Further, I think that these teeth may compromise the health of adjacent teeth. As a practical matter in my office, we find that it is much easier to motivate a parent to have an adolescent’s third molars removed than to persuade a middle-ager to do the same. Also, I don’t think that the difference in cost to the insurance companies should be a factor in this decision. I don’t know how much time the authors are able to spend
dealing with patients directly. I am willing to bet that if they would ask the people in their school’s hygiene department to take a look at the recall patients who have erupted third molars—and if they would do this for a year or so—they possibly would come away with a changed attitude. Thank you for the well-balanced Discussion section. I heartily agree that a set of guidelines could be a benefit to us all (although I wouldn’t want to be on the committee drafting them!). There is an adage in football that there are many possible outcomes for a forward pass, and only one of them is good. This has been my experience with third molars. Fred Knapp, D.D.S. Independence, Mo. Authors’ response: We very much appreciate Dr. Knapp’s interest in our article and the opportunity to discuss further the issues that he raises. It was not the intent of the article to suggest which approach to third-molar removal is best, but rather to let dentists see the differences in their practice patterns so that a more thorough discussion of the topic can take place within the profession. While a profession never can unilaterally decide what is best for the public, we nevertheless firmly believe that the focus of these kinds of discussions must be within the profession. Our principal focus was on the early prophylactic removal of asymptomatic, unerupted third molars. Dr. Knapp’s point about oral hygiene problems around erupted third molars as a rationale for extraction—and
the difficulty in motivating middle-aged adults to have these teeth extracted—is a somewhat different issue. The removal of teeth because of oral hygiene difficulties is perhaps best done on a patientby-patient, tooth-by-tooth basis, with those patients who can be motivated to adequate oral hygiene having the option to retain these teeth. It is difficult to see how judgments on ability to maintain adequate oral hygiene can be made for an adolescent before the tooth has erupted. Finally, we agree with Dr. Knapp that insurance should not determine how patients are treated. Treatment decisions should be tailored to the needs and wants of each patient. If a needed and desired procedure happens not to be covered by insurance, the patient surely can decide to purchase it anyway. Also, if patients would not otherwise want a procedure, insurance should not dictate that they have it. Insurance is best seen as a means to help people to buy what they need and want, not something that dictates those needs and wants. Stephen A. Eklund, D.D.S, M.H.S.A., Dr.P.H., James L. Pittman, D.D.S., M.S. Ann Arbor, Mich. IMPLANT FAILURES
“Implant Failures Associated With Asymptomatic Endodontically Treated Teeth” by Drs. David Brisman, Adam Brisman and Mark Moses (February JADA) is a clinical report about four implant failures that the authors claim resulted from their proximity to asymptomatic endodontically treated teeth.
JADA, Vol. 132, July 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.
853