Extremes of Age
The third molar tooth bud can be radiographically visualized by age 6. Some surgeons think that removal of the tooth bud at age 7 to 9 can be accomplished with minimal surgical morbidity and therefore should be per- ‘formed at this age. However, most surgeons believe that
it is ot possible to predict accurately if the forming third molar will be impacted. The consensus is that very early removal of third molars should be deferred until an accurate diagnosis of impaction can be made. The most common contraindication for the removal of impacted teeth is advanced age. As a patient ages the bone becomes highly calcified, therefore less flexible and less likely to bend under the forces of tooth extraction. The result is that more bone must be surgically removed to displace the tooth from its socket. Similarly, as patients age, they respon Jess favorably
and with more p stoperative sequelae. An I8-year-old patient may have 1 or 2 days of discomfort and swelling after the removal of an impacted tooth, whereas a similar procedure may result in a -i- or S-day recovery period for 50-year-old patient. Finally, if atooth’ has been retained in the alveolar process for many years without periodontal disease,
caries, or cystic degeneration, it is unlikely that these unfavorable sequelae will occur. Therefore in an older patient uisually over age 35) with an impacted tooth that shows no signs of disease and that has a radiographically detectable layer of overlying bone, the ooth should not
be removed (Fig. 9-15). The dentist caring for the patient should check the impacted tooth radiographically every 1 or 2 years to ensure that “no adverse sequela occurs If the impacted tooth shows signs of cystic formation or periodontal disease involving either the adjacent toothor the impacted tooth, if it is a single impacted tooth underneath a prosthesis with thin overlying bone. or ii it becomes symptomatic as the result of infection, the tooth must be removed.