Background: Defining the indications for third-molar extraction continues to be a topic of controversy.
Methods: The dentist's management of third molars commonly hinges on identifying the presence of symptoms or disease that clearly is attributable to the third molar. Use of a guide that serves as a systematic and unambiguous way to classify third molars has been advocated.
Results: Patients' symptoms are designated as present and attributable to the third molar (Sx+) or as absent (Sx-). In addition, clinical or radiographic evidence of disease is evaluated and designated as present (D+) or absent (D-).
Conclusions: Evidence-based clinical data developed from prospective investigations have shown that an asymptomatic third molar does not necessarily reflect the absence of disease.
Practical implications: Current data are not sufficient to refute or support prophylactic extraction versus active surveillance for the routine management of third molars that are asymptomatic and free of disease (group D). Although decisions regarding third-molar management usually are straightforward, the evidence supporting extraction versus retention of asymptomatic disease-free (group D) third molars is lacking. Active surveillance, a prescribed program of follow-up and reassessment at regular intervals are recommended for retained third molars rather than waiting for the onset of symptoms.
Keywords: Tooth extraction; evidence-based dentistry; literature review; oral and maxillofacial surgery; oral surgical procedures; practice guidelines; third molars.