The pathological outcomes related to symptomatic impacted third molars and follicles as found in a private practice in South Africa

Doctoral Thesis


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University of Cape Town

The aim of this study primarily was to review pathological reports of all symptomatic third molar teeth removed in a private practice, and to use the data to support or refute routine removal of third molar teeth. All patients who underwent third molar tooth removal for symptoms,either systemic or local ,in a private practice over a twenty year period between 1987 and 2007 were included in the study. Specimens were sent for histological assessment by Oral Pathologists. The patient records were reviewed retrospectively. A total of 3427 third molar teeth were included in the study. There were 68.75% specimens which had some sort of pathology. Only 0.3% of specimens were reported as normal dental follicular tissue. There were 31.25% specimens of hyperplastic follicular tissue which was considered non pathologic as they consisted of normal dental follicular tissue with a mild chronic inflammatory cell infiltrate. However the 68.75% pathologic lesions consisted of 14.44% specimens with early dentigerous cysts, 8.11% with dentigerous cysts, 42.80% of paradental cysts and the remainder with other pathologies. The majority of the patients were in the second and third decades and mostly female. The age distribution of the patients suggested a progression from hyperplastic follicular tissue with a peak occurring at 17 years, to early dentigerous cysts at 19 years, to dentigerous cysts at 21 years. Paradental cyst formation, with a peak incidence at 19 years of age formed a large number of the pathological lesions found, and accounted for a large number of patients seeking treatment, owing to the symptoms associated. This study represents an analysis of the largest number of symptomatic third molar teeth submitted for histological assessment known. The data obtained was used to review the guidelines for the management of third molar teeth. From this study it can be concluded that symptomatic impacted third molar teeth should be removed early in the third decade in order to avoid general or local symptoms suffered by these patients.

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Includes bibliographical references.