摘要：Objectives. We investigated general dentists’ reasons for recommending removal or retention of third molars and whether patients adhered to dentists’ recommendations. Methods. In a 2-year prospective cohort study (2009–2011) in the Pacific Northwest, we followed 801 patients aged 16 to 22 years from 50 general dental practices. Generalized estimating equations logistic regressions related patient and dentist characteristics to dentists' recommendations to remove third molars and to patient adherence. Results. General dentists recommended removal of 1683 third molars from 469 (59%) participants, mainly to prevent future problems (79%) or because a third molar had an unfavorable orientation or was unlikely to erupt (57%). Dentists recommended retention and monitoring of 1244 third molars from 366 (46%) participants, because it was too early to decide (73%), eruption path was favorable (39%), or space for eruption was sufficient (26%). When dentists recommended removal, 55% of participants adhered to this recommendation during follow-up, and the main reason was availability of insurance (88%). Conclusions. General dentists frequently recommended removal of third molars for reasons not related to symptoms or pathology, but rather to prevent future problems. Removal of third molars, known as wisdom teeth, is one of the most common dental surgical procedures in the United States, representing 95% of all extractions among persons with insurance aged 16 to 21 years. 1 It has been estimated that 10 million wisdom teeth are removed from 5 million individuals in the United States each year, at a cost of more than $3 billion. 2 Dentists recommend early prophylactic removal of asymptomatic third molars to prevent risk of future pathology and to minimize operative and postoperative risks. 3–6 However, most third molars will erupt without symptoms. 7,8 In addition, third molar removal is associated with morbidity, such as pain, swelling, bleeding, infection, and paresthesia; the overall rate of complications varies from 4.6% 9 to 21%. 4 Thus, recommendations to retain and monitor asymptomatic third molars may be considered an appropriate strategy. 10–13 Several studies have explored the reasons or indications for third molar removal, mainly among patients presenting to oral surgery offices. 3,4,14,15 These studies do not provide information from patients referred for third molar removal but not presenting to oral surgery offices, or the actual indication given by the referring dentist. Recommendations from general dentists and oral surgeons differ, with surgeons recommending significantly more third molar removal. 16,17 Although studies have investigated reasons for third molar removal at the time of surgery, little is known about factors that general dentists consider when making referral decisions. Another interesting aspect of third molar management is patient adherence to recommendations. Although many patients are referred for third molar removal by their general dentist or orthodontist, studies usually only focus on patients who present to oral surgery offices. 15,18 Thus, these samples may self-select for various reasons. Patient referral patterns and adherence to recommendations for third molar removal in general dental offices are not well known. 19,20 Adolescent patients and their parents may or may not follow their dentist’s recommendation to retain or remove third molars. We enrolled patients aged 16 to 22 years with both symptomatic and asymptomatic third molars from the practices of general dentists to examine the decision-making process regarding management of third molars employed by general dentists and patients. Our main objectives were to investigate (1) the reasons given by general dentists for third molar removal or retention, (2) patient adherence to recommendations for third molar removal during follow-up, and (3) factors associated with these decisions, such as current symptoms, socioeconomic factors, and patient preferences. A companion article in this issue reports on the clinical outcomes of third molar retention and removal after the initial 2-year period. 21
