The aim of this study was to evaluate through a systematic review the extraction of third molars as a risk factor for temporomandibular disorders (TMDs).
Types of studies reviewed
Randomized and nonrandomized controlled clinical trials where patients underwent third molar extraction and with qualitative evaluation of TMDs before and after extraction were included.
After applying the inclusion criteria, seven nonrandomized clinical studies were included. QUIPS tool showed that four articles presented a moderate and three a high risk of bias (RoB). Six studies reported that TMDs presented higher level after removal of third molars ranging from OR, 1.81 to 2.15/RR, 2.1. However, one study showed no significant association. GRADE showed heterogeneity in relation to general results, which means that confidence in the estimated effects varied from low to moderate GRADE. The quality of clinical recommendations decreased especially due to the risk of bias in some of the included studies evaluated with the QUIPS tool.
Conclusions and practical implications
Third molar extraction can be associated with the development of TMD signs and symptoms. Furthermore, TMD can be aggravated according to the third molar location, the degree of impaction and surgical difficulty, age, and gender. This systematic review highlights the need to perform randomized clinical trials with diagnostic criteria and standardized surgical procedures.
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Friedman JW (2007) The prophylactic extraction of third molars: a public health hazard. Am J Public Health 97(9):1554–1559
Normando D (2015) Third molars: to extract or not to extract? Dental Press. J Orthod 20(4):17–18
Von Wowern N, Nielson HO (1989) The fate of impacted lower third molars after the age of 20. A four-year clinical follow-up. Int J Oral Maxillofac Surg 18:277–280
Agrawal A, Yadav A, Chandel S, Singh N, Singhal A (2014) Wisdom tooth: complications in extraction. J Contemp Dent Pract 15(1):34–36
Bouloux GF, Steed MB, Perciaccante VJ (2007) Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 19(1):117–128
Sigron GR, Pourmand PP, Mache B, Stadlinger B, Locher MC (2014) The most common complications after wisdom-tooth removal: part 1: a retrospective study of 1,199 cases in the mandible. Swiss Dent J 124(10):1042–1046 1052-1056
Huang GJ et al (2014) A prospective study of clinical outcomes related to third molar removal or retention. Am J Public Health 104(4):728–734
Contar CM et al (2010 January) Complications in third molar removal: a retrospective study of 588 patients. Med Oral Patol Oral Cir Bucal 15(1):E74–E78
Macfarlane TV, Blinkhorn AS, Stevenson LJ, Coulthard P (2010) Third molar removal and orofacial pain: a population-based survey. J Oral Maxillofac Res 1(3):E4
Deangelis AF, Chambers IG, Hall GM (2009) Temporomandibular joint disorders in patients referred for third molar extraction. Aust Dent J 54(4):323–325
Huang GJ et al (2002) Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD). J Dent Res 81(4):284–288
Carrara VS, Conti PCR, Barbosa JS (2010) Statement of the 1st consensus on temporomandibular disorders and orofacial pain. Dent Press J Orthod 15(3):114–120
Hayden JA, VAN DER Windt DA, Cartwright JL, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286
Hayden J, Moons K, VAN DER Windt D, Cartwright J, Côté P, Bombardier C (2015) Systematic reviews of prognostic studies 2: assessing risk of bias in studies of prognostic factors using the QUIPS tool. In: Filtering the information overload for better decisions. Abstracts of the 23rd Cochrane Colloquium; 2015 3-7 Oct. Vienna, Austria. John Wiley & Sons
Grooten WJA, Tseli E, Äng BO, Boersma K, Stålnacke BM, Gerdle B, Enthoven P (2019) Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS:Aspects of interrater agreement. Diagn Progn Res 3–5
Munawar NK, Abd Sattar SS, Hariri F (2016) The incidence of signs and symptoms of temporomandibular disorders following third molar surgery. Ann Dent 23:29–37
Barbosa C, Gavinha S, Soares T, Manso MC (2016) Coincidence and awareness of the relationship between temporomandibular disorders and jaw injury, orthodontic treatment, and third molar removal in university students. J Oral Facial Pain Headache 30(3):221–227
Duval F et al (2015) Relations between extraction of wisdom teeth and temporomandibular disorders: A case/control study. Orthod Fr 86(3):209–219
Huang GJ et al (2008) Age and third molar extraction as risk factors for temporomandibular disorder. J Dent Res 87(3):283–287
Akhter R et al (2008) The relationship between jaw injury, third molar removal, and orthodontic treatment and TMD symptoms in university students in Japan. J Orofac Pain 22(1):50–56
Huang GJ, Rue TC (2006) Third-molar extraction as a risk factor for temporomandibular disorders. J Am Dent Assoc 137(11):1547–1554
Fernández JMD, Blez RV, Reyes HA (1996) Effect of surgical treatment of the lower third molars on temporomandibular dysfunction syndrome. Rev Cuba Estomatol 33(2):76–80
Roda RP et al (2007) Review of temporomandibular joint pathology. Part I: classification, epidemiology and risk factors. Med Oral Patol Oral Cir Bucal 12(4):E292–E298
Oral K, Bal Küçük B, Ebeoğlu B, Dinçer S (2009) Etiology of temporomandibular disorder pain. Ağri 21(3):89–94
Han D et al (2011) Global self-rating of oral health, concerns about oral health, and history of jaw injury related to temporomandibular joint symptoms in Korean adults. J Orofac Pain 25(4):308–316
De Boever JA, Keersmaekers K (1996) Trauma in patients with temporomandibular disorders: frequency and treatment outcome. J Oral Rehabil 23(2):91–96
Leuin SC, Frydendall E, Gao D, Chan KH (2011) Temporomandibular joint dysfunction after mandibular fracture in children: a 10-year review. Arch Otolaryngol Head Neck Surg 137(1):10–14
Oliveira AS et al (2003) Pain impact on life of patients with temporomandibular disorder. J Appl Oral Sci 11(2):138–143
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First Author: Yohana Sandy Souza Damasceno
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Damasceno, Y.S.S., Espinosa, D.G. & Normando, D. Is the extraction of third molars a risk factor for the temporomandibular disorders? A systematic review. Clin Oral Invest 24, 3325–3334 (2020). https://doi.org/10.1007/s00784-020-03277-6
- Temporomandibular joint disorders
- Temporomandibular joint dysfunction syndrome
- Temporomandibular joint
- Third molar
- Oral surgery