Retrospective analysis of malpositioned mandibular third molars in elderly patients

Abstract

Objective: To determine the frequency of symptomatic malpositioned mandibular third molars in elderly patients. Method: An analytic study of hospital records of elderly patients with symptomatic impacted mandibular third molars over 17 years was undertaken. Information on demographics, types of impaction, reasons for surgical extraction, and complications after treatment were obtained. Those who were asymptomatic would be excluded from analysis. Results: Altogether, 6214 impacted mandibular third molars were isolated in 5, 431 patients. However, 436 (7.0%) symptomatic impacted teeth were recorded in 436 (8.0%) patients and these were extracted, while the rest, 5778 (93.0%) were asymptomatic.  Males were greater than females in the ratio of 1.1:1. The frequency of occurrence of mesio-angular and vertical impactions were significant (P= 0.001) compared with disto-angular and horizontal. Periodontal disease was 211 (48.4%) of the case in addition to dental caries and its clinical sequelae 203 (46.6%) were significant reasons for extractions (P=0.000). The common postoperative complications were alveolar osteitis and hypersensitivity of the adjacent molar 22(68.7%) which related to surgical extraction of disto-angular impactions (P= 0.001). Conclusions: This study showed the older the patient the less likely malpositioned mandibular third molar suggesting that majority of such impactions do not cause pathology after many years of their presence in the oral cavity. Prophylactic extraction of malpositioned mandibular third molars in all patients should be discouraged, but each case should be treated on merit or when symptomatic.