Prophylactic vs. symptomatic third molar removal: effects on patient postoperative morbidity

Purpose The present study aimed to assess differences in postoperative morbidity be-tween prophylactic and symptomatic third molar removals, and to assess the ef-fect of age on the recovery of the patient. Methods Patients admitted for third molar removal were prospectively followed up four times during treatment in context of the M3BE study. Data were collected through pre-, peri and postoperative surveys (days 3 and 10). Uni-and multi -variable logistic regression was used to assess the probability of postoperative symptoms of discomfort on day 3 and day 10 according to several patient-and surgery-related predictive factors (age, gender, indication for removal, method of extraction, anesthesia and number of extracted maxillary and/or mandibular third molars). Results In total, 6010 patients with a mean age of 25.2 (+/- 11.2) underwent 6347 surgeries to have 15,357 third molars removed. Frequently observed symptoms of post -operative discomfort were pain, trismus and swelling, all of which were transient in nature with steep decreases from postoperative days 3 to 10. Increasing age was associated with an enhanced risk of persistent pain, trismus and swelling and a significantly higher risk of iatrogenic injury to the inferior alveolar nerve. Symptomatic indications for removal were more common in patients over age 25 years, but these pre-existing pathologies did not compromise the postop-erative recovery process. Other factors related to postoperative morbidity were female gender, intraoperative osteotomy and the number of extractions. Conclusion The results of this study suggest that there are convincing patient-and surgery-related factors that favor timely third molar removal, preferably before the age of 25, especially in order to avoid persistent morbidity and nerve complications.